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  • Raghav Sand

The Case for Not-for-Profit Healthcare

Healthcare for all must be a human right. Well-being is not a luxury, but it is essential. Some societies were already aware about the importance of access to healthcare, while others had this realization after the outbreak of Covid-19 pandemic. India’s healthcare infrastructure was not sufficient to cope with the multiple waves and new variants of the Covid-19 virus. Eventually, it turned out to be a lottery for those who had access to public healthcare system whereas private hospitals were content with serving the highest bidder or someone with a massive health insurance policy.

When we talk about common good and parity in allocation of essential resources, disciples of capitalism may try to subvert it as socialism. Whosoever is doing well in their life at the moment and have all the material comforts seem to have forgotten that, they or their ancestors were once beneficiaries of social welfare schemes. It is not easy to allocate which part of a person’s primary healthcare, food safety or education may have been funded by the community. Education, hard work and good fortune, in varied degrees, are the reason for upliftment and more often than not become the difference between the haves and the have-nots. Even if a person is lacking in all three departments, as stated above, should it become the reason for them to be deprived of basic healthcare?

Healthcare Needs Primetime Coverage

No society or country can flourish without caring for the health of its citizens. Every vulnerable person, left unattended, could have contributed in making the world a better place. Just because we have close to eight billion people living on the planet, it does not give anyone the right to choose and pick who gets to live and who is surplus to requirement. Occasionally, even those who have access to cutting edge healthcare facilities succumb to their ailments. People who have worked hard to earn money should get the best of everything. What someone spends is another person’s income. In hindsight, every activity could have been done better; healthcare is no different.

The debate about healthcare does not give rise to easy questions. They are especially difficult in our complex and increasingly global healthcare system. To address these questions both intelligently and effectively, therefore, will require the active participation of individuals with sufficient knowledge and skill, not only in the various healthcare professions themselves (e.g., medicine and nursing), but also in a range of ancillary disciplines and fields, including engineering, business, law, natural sciences and humanities.

Findings of a NITI Aayog Report on Healthcare

Despite economic growth and modernization, India continues to face significant challenges of unavailability and unaffordability in healthcare services. This is substantiated by the fact that India has a lower bed density than the rest of the world.

Bed density (number of Hospital beds per 1000 population) in India compared to other parts of the world. Source: World Bank and NITI Aayog Report Dated 21.06.2021

In addition, existing hospital beds and hospitalization services have a high level of concentration in urban areas, which in turn impact the accessibility and affordability of hospitalization services. Socio-economic commentators have argued that employment and education are the biggest reasons of migration for people living in rural areas. Surveys and reports have long overlooked access to healthcare as a reason for rise in urban population.

Breakup of Hospital beds in India. Source: World Bank, NSS 75th round, NHRR, IMS study. Source: NITI Aayog Report Dated 21.06.2021

The cumulative cost of care at not-for-profit hospitals is lesser than for-profit hospitals by about one-fourth in the in-patient department. This is reckoned by the package component of cost, which is approximately 20% lower, the doctor’s or surgeon’s charges, which are approximately 36% lower and the major aspect being the bed charges, which are approximately 44% lower than the for-profit hospitals.

*Cost considered for Government settings is only Out-of-pocket expenditure by patients, in addition to this, Doctor’s salaries, consumable costs etc., are borne directly by the Government.

The above charge structure is not specific to any ailment as studied in the NSS 75th round survey. Source: NITI Aayog Report Dated 21.06.2021

Who Made Healthcare a Business?

The very idea of health insurance is in some ways the original sin that catalyzed the evolution of today’s medical-industrial complex. As medical treatments and knowledge improved in the early 20th century, the concept of insurance evolved. Demand for health insurance presented a business opportunity and gave birth to an emerging market with other motivations.

Suddenly, at a time when medicine had more value to offer, tens of millions of people were interested in gaining access. They charge different rates, depending on factors like age, as they had long done with life insurance. And they produced different types of policies, for different amounts of money, which provided different levels of protection.

To some extent insurers do better if they negotiate better rates for your care. But that is true only under certain circumstances and in a limited way. “They are methodical money takers, who take in premiums and pay claims according to contracts — that’s their job,” said Barry Cohen, who owns an Ohio-based employee benefits company. “They don’t care whether the claims go up or down 20 percent as long as they get their piece. They’re too big to care about you.”

All for the Common Good

Every human has the right to live. Healthcare is a necessity. Indian healthcare system was making gradual improvements but the Covid-19 pandemic has made us realize that good enough is not enough. Both government and private sector have pledged some serious amount of money to strengthen the quality and reach of healthcare. Such promises have been made in the past as well. Will it be any different this time round? Can a more humane approach subside the anguish of people who have lost their dear ones to any health complication which could not be cured due to lack of access? To get things done, we should set realistic targets and achieve them, rather than formulating idealistic policies which garner applause in election rallies.

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