A ‘Gandhicare’ For India
By Arindam Majumder
10 November, 2013
Countercurrents.org
A controversial act which aims to make quality healthcare affordable to all Americans had polarised the country and forced a federal shutdown. Such an act if implemented in India could be a game changer for the ailing Indian healthcare system and make the dream of universal healthcare system a reality.
The Indian healthcare system lies in a sorry state even after 66 years of independence. Basic healthcare facility is absent in many parts of rural India. It is unsurprising that India leads the world in neo-natal and infant mortality rate. This dismal state is the result of lack of public health infrastructure in most parts of India. According to the latest National Family Health Survey, private medical sector remains the primary source of healthcare in both rural and urban areas.
But the cost of treatment at private healthcare facilities is mostly out of reach for people of rural areas. According to a study conducted by IMS Institute of Healthcare Informatics ‘Understanding healthcare in India-what is the current state?’ cost of healthcare at a private healthcare facility is 2 to 9 times more than that in a public healthcare facility. The study also says that the costs of the treatment sometimes is more than the average monthly household expenditure.
Both in USA and India, medical expenditure is mainly through ‘out-of-pocket (OOP) expense’, i.e the patient has to bear the cost on his own. But unlike USA, insurance penetration in India is very low. According to IRDA, an agency of Government of India that supervises insurance sector, less than 15 % of Indians have some form of health insurance coverage. Thus, for a majority of Indians, every component of the expensive private sector health facility remains out of reach.
While there are lucrative insurance coverage in place for the central and state government employees, it has little effect on majority of Indians as India's workforce comprises nearly 92 per cent in the unorganised sector.
While the Indian government runs insurance schemes like Rashtriya Swasthya Bima Yajona (RSBY) and National Rural Health Mission (NRHM) but those schemes are targeted towards the BPL(Below Poverty Line) sections of the society. With no foreseeable end to the conundrum of defining a fixed poverty line, majority of Indians fail to reap any benefits from these schemes.
While providing healthcare to the poorest is an essential duty of the government, it shouldn’t overlook the rural middle class who does not come under the scheme but are unable to afford the costly private healthcare system.
The ACA act also makes it compulsory for insurers to pay for prescribed drugs, routine check-ups and diagnostics which used to be optional. The condition is similar in India.
According to the IMS health report, the existing health insurance facilities cover just one-third of an individual’s OOP expense. A major portion of the expenses , like doctors’ fees, diagnostics and cost of medicines, do not come under these schemes and hence the need of a national insurance funded by government becomes an essential.
Ensuring healthcare to every single citizen of the country is a cornerstone of being called a ‘developed’ nation. Providing a universal health insurance coverage will be an important step towards that direction.
An incentive-cum-compulsory health insurance coverage for which every citizen is taxed can make India’s dream of ‘universal health care’ a reality. India can learn a lot from ‘Obamacare’ despite its loopholes.
After ensuring ‘food -for- all’ through the Food Security Bill, India can look forward to a ‘health-for-all’ scheme. This can be our own ‘Gandhicare’.
Arindam Majumder is a student of Asian College of Journalism,Chennai. He writes for the TN labour blog.
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