Your Daughter is dead! This is what parents of the 7-year-old girl were told who died because of dengue at Fortis Memorial Research Institute (FMRI) in Gurugram. "Saving & Enriching Lives”, is the vision statement of this private hospital that has kept profit margin of 1700 %, slapping a bill to the tune of 16 lac rupees. This deplorable and sordid state of healthcare in India is no hinterland and this script of pain and agony has been narrated ofttimes. The detailed report of National Pharmaceutical Pricing Authority (NPPA) of Fortis fiasco reveals how these institutes of social cause have the sole objective of profiteering. Global Health Systems Transparency Index 2017 of KPMG in its global “Through the looking glass” report ranks India at 31 of the 32 countries. This report measured the healthcare systems across 6 major dimensions vis a vis Quality of healthcare, Patient experience, Finance, Governance, Personal healthcare data and Communication of healthcare data. “Health systems globally and more so in India, have suffered from Asymmetry of information, with caregiver making decisions on behalf of patients, primarily due to patients lacking adequate information” reads this report.
Why do people need to visit private hospitals? Of many reasons, one major reason is the poor quality care and hygiene with more than 57% of households considering this as a major reason for a preference for private health care. Government hospitals irrefutably are struggling to match the demand and supply and this overburden often ends up on quality compromise. Economic survey 2016 of state of J&K explicitly mentions that the workload of hospitals has increased manifold due to law and order situation in the valley. The ailing public health system is further aggravated because of low budgetary allocation. The Economic Survey 2016-2017 shows the combined expenditure (Central and state governments) by the government on health as a percentage of GDP was 1.4 per cent, well below the global average. The Draft National Policy 2015 estimated public health expenditure to be at 2.5% of the GDP. As per the economic survey of the state of J&K, there is a decline in terms of financial resources available to the health department. The total annual financial resources available with the department were Rs. 2060.93 crore during the year (2015-16) as compared to Rs 2154.50 crore in 2014-15, reads the economic survey 2016 of J&K.
With the lowest government spend and public spend, as a proportion of gross domestic product (GDP), and the lowest per capita health spending. Countries like China spends 5.6 times more, the developed nation like the US spends whopping 125 times more than India. 62 percent of health expenses are met from their personal savings by Indians, referred as "out-of-pocket expenses", The Out of Pocket Expenses (OPE) in India on healthcare by its citizens is amongst the highest in the world, compared with 13.4 percent in the US, 10 percent in the UK and 54 percent in China. Rural households primarily depended on their ‘household income/savings’ (68%) and on ‘borrowings’ (25%), the urban households relied much more on their ‘income/saving’ (75%) for financing expenditure on hospitalisation, than on ‘borrowings’ (only 18%) (MOSPI/ NSS 2014).
Source : NSS 2014, Ministry of Statistics and Programme Implementation
These worrying numbers had its repercussions as well. India has the largest share of global under-five deaths at 1.3 million annually. According to the United Nations, in India, about 48 out of every 1,000 newborns die before reaching the age of five. The cost of private healthcare is about four times greater than the country's public healthcare. About 72 percent of residents of rural areas and 79 percent of residents of urban areas use private healthcare services. The doctor-patient ratio in India is a dismal 1:1,700 against the WHO recommendation of 1:1000. The situation in the state of J&K is similar with a doctor-patient ratio of 1:1880.
Source: NSS 2014, Ministry of Statistics and Programme Implementation
It is pertinent to highlight here the vast difference in pay that exists between private and public sector thus causing a huge brain drain from the public to private sector. Medical Council of India back 2011 had established a committee under the chairmanship of Narayan Murthy to look into the remuneration of the health sector. This committee had strongly opined that the pay of doctors is not competitive enough to attract talent.
For the country that has doubled in size in just 40 years, it is imperative, nevertheless, to ensure that the healthcare sector in India needs a rescue and liberal financial boost. The potential of healthcare sector in terms of employment and revenue is promising unless the the government chances its mindset of healthcare being an investment and not a cost. The public-private partnership models as recommended by experts need impetus with focus on justice and equity rather than merely financial expedience. The convergence of resources alongside the alternative channels of healthcare service delivery systems need to be restructured and augmented with latest technological interventions. Benchmarking against the best healthcare models of countries like Canada, Qatar, and Singapore that are patient-centric and offers world-class care can help in resolving this healthcare imbroglio. It calls for an unequivocal turnaround so that access to healthcare is not a privilege of rich but right of all.
In the words of Dr. Leana Wen, what does a health care Dystopia look like? “You wake up to a world where people die waiting for healthcare, where corporate interests reign, and where doctors get paid to do more rather than to the right thing”. We all are living this dystopia, lest we bring the incremental changes for better utopian healthcare.