Health and Wealth: The Double-Edged Sword of India's Healthcare System

A mere five days ago a Mohali based hospital was charged Rs 1.2 lakhs fine, for an inflated medical bill provided to a 76 year old patient for COVID-19 treatment in 2021. The patient was a recipient of intensive care during his stay at the hospital, and was discharged with a 7.62 lakh rupee bill. Even with over 6 lakhs of the bill getting covered by health insurance, 1.2 lakh rupees had to be paid out of pocket. It was revealed in the court that there were charges levied for dietician consultation, a CT scan and physiotherapy sessions, twice a day every day in the ICU, even though the patient never received those services, (source: Hindustan Times). As a reader you may just right now think, another day, another story of fraudulent private healthcare delivery in India. But if you really think about it, a 76 year old person is probably retired, living on a pension or on their children’s earnings. In such old age having to pay such a hefty sum of money and to go through years of financial damage and mental agony, is not something anyone should have to experience because they needed medical assistance.?

What’s concerning is even if there was no fraud and all the money was legitimately charged for the services provided, having to pay lakhs of rupees out of pocket is not easy for an average person of our country. People end up borrowing money to pay off healthcare expenses, according to the NSSO (National Sample Survey Office), 63% of Indian households have to resort to loans, the average amount borrowed being Rs 15,000. Healthcare is a basic human right and the taxpayers pay for their healthcare to be received by the public health sector. But? barely 1.6 to 1.8 per cent of the GDP is spent on the public health sector, said Ashutosh Raghuvanshi, managing director (MD) and chief executive officer (CEO) of Fortis Healthcare, and president of Nathealth. “These allocations are insufficient to tackle the magnitude of healthcare challenges,” he said.

All of us are surely aware of the condition of government hospitals, from questions on the sanitation practices to unavailability of staff. People who end up in CHCs (Community Health Centre), PHCs (Primary Health Centre) and GHs (Government Hospital) are people who cannot afford the private clinics because if provided a choice there is definitely more trust and credibility in the hospitals charging thousands of bucks for physician consultations. If we try to define the problem, it's on both the ends, the patients and the providers. What the private hospitals are charging, if we only consider the legitimate billing and keep aside the frauds that go on because that’s a whole story on its own, are appropriate for the world class services they provide, for the top surgeons and physicians that they employ and for the ease of workflow they have achieved. They are in business, and they will obviously work for profit. But the patients are in a situation where you cannot blame them for not wanting to walk in a community health center that will not even provide for a c-section and will have to refer people to the district’s GH which already is bearing the burden of a larger number of people than their catering capacity. So what are people paying income taxes even paying for if both education and healthcare are better provided by businesses rather than the government?

What the public health sector demands from people is time and what the private sector demands is money, and in most cases, a sick or injured person has neither. According to The World Bank more than 70 million Indians are pushed into poverty due to healthcare costs. Even a laparoscopic cholecystectomy, gall bladder removal due to stones, costs 30-40k. Is it done for free in a civil hospital? yes. Do people have to wait for unfair amounts of time to get appointments for surgeries? yes. It’s like a double edged sword where people choose to live with debt rather than not making it at all and it's heartbreaking to think about how people have to spend their lifetime’s earnings to save their family members’ lives.?

Does the government provide any assistance? Yes. AB-PMJAY is definitely a great example where the government prevents people from catastrophic expenditure due to healthcare expenses. The scheme provides upto 5 lakhs of financial protection for secondary and tertiary care to poor and vulnerable families, and an upgrade to 15 lakhs is also in the talks. Employers provide health insurances as well but the patient entitlement is complicated and borderline impossible to unfold. The current policy debate is about “health for all with financial protection” from the concept of “health for all” which was more common in the last decade. Affordability and financial risk protection are key principles under the National Health Policy 2017 of India. But while the state is serving the poorest of the nation with financial protection, what about the middle class? Health insurance programmes must be expanded to cover outpatient and preventive health services, include people above the poverty line, cover the whole household irrespective of the number of members living in the household and the coverage threshold limits must be increased. Urban poor must be enrolled in health insurance programmes without any delay.?

If there is one service that unarguably should never lead to any sort of financial damage it’s healthcare and even though the government is already taking steps towards universal health coverage, the citizens should also try and make a switch to actually availing the services that the state is providing for either very low costs or no money at all. Development of better health infrastructure, restoration of trust in the public health sector and an unbiased providence of health insurance will certainly reduce the financial burden that healthcare is bringing to Indian families.

Credits: Sneha Kumar