Jugaad cannot fix India’s failing healthcare system. People need medical insurance

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Medical workers collect samples for Covid-19 in New Delhi | Representative image | Suraj Singh Bisht | The imprint

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VSDeaths linked to ovid-19 in India are expected to double in the coming weeks. People of all socio-economic classes are cremated en masse in large holes in the ground. The ordeal does not even end with death. Medical bills are piling up, a burden heavy enough to push working-class families into multigenerational poverty. Young adults desperate for vaccines are effectively forced pay for them, while those most at risk are not sufficiently insured. The state’s threadbare safety net has all but collapsed.

In normal times, most Indians use their savings, borrow, and call on friends and family to pay for health care, assuming it is accessible. Personal expenses are among the highest in the world. Over 60% of the population is not covered by insurance. Government employees can get some coverage under a few different plans, but most others, including the self-employed, pay for their own salaries. Costs increase due to growth dependence on private hospitals and clinics.

Two years ago, after several unsuccessful attempts at universal coverage, Prime Minister Narendra Modi’s administration unveiled what it called the biggest health insurance plan, targeting more than 107 million people – the poorest 40% of the population. It was supposed to be a better version of a ten-year-old policy that was insufficient in terms of the amount reimbursed and the cap on the number of people enrolled in a household. Under the new plan, families are covered up to 500,000 rupees ($ 6,670) for medical procedures. Eligibility has been broadened and is based on several criteria of “deprivation” in rural and urban areas.

Yet the new policy did not “Effectively improved” access to health care, according to a working paper written by researchers at Duke University. For starters, the eligibility criteria are based on a 10-year-old census and exclude many potential participants due to inconsistent data. In addition, outpatient services, which represent 60% of personal expenses, are not included. Another area of ​​concern is the program dependence on private hospitals. Finally, if the insurance fully covered its intended beneficiaries, the cost would be far exceed budgetary allocations.

For a country struggling with the worst wave of the pandemic the world has seen, it’s hard to start thinking about long-term changes. India is now considering creating a fund of at least 1 trillion rupees to support the uninsured, The Hindustan Times reported last week. Helping the population through a third wave is the obvious priority. But now is the time for policymakers to take seriously a minimum – and rising – standard of care for everyone.

As an alternative model, Taiwan stands out, and not just because of its globally recognized success in the fight against the Covid-19 pandemic. While its population of 23 million does not compare to India’s 1.4 billion people, Taiwan’s fundamentally strong health care holds valuable lessons.

All long-term residents are covered by comprehensive national insurance. User fees on prescriptions as well as visits to the doctor are reasonable and capped at around $ 7 and $ 14, respectively. Hospital stays also have cost limits.

It wasn’t always like that. Before 1995, four out of 10 people in Taiwan did not have medical insurance. Despite all of its export-fueled boom in previous decades, capitalist society’s score in treat preventable deaths was worse than the countries behind the Iron Curtain. Now Taiwan is doing almost as well as the United States on this measure and is not too far behind Japan.

Taiwan’s transformation was sparked by his decision – on the recommendation of the Princeton University economist Uwe Reinhardt – move to a single payer system. Effective insurance did not come with an outrageous price tag. Taipei has used technologies, such as electronic health cards that store patient and treatment data, to increase efficiency and keep costs down. 6% of gross domestic product. It is much lower than other rich countries. The Taiwanese system is not immune to cost pressures, but this is the price of its popularity: some patients only seek too many consultations.

In India, public health expenditure represents only 1.2% of GDP. Still, targeting a higher number won’t automatically improve things. Good care, as Reinhardt pointed out, is about not esteeming anyone. But in India’s highly informal economy, only 90 million people earn regular wages. Of these, 80% earn less than $ 270 per month. Can this narrow base of taxpayers support a good standard of care at prices that do not exclude the poor?

The best way to do this is to make the government a single buyer of everything – from generic drugs (of which India is a world leader) to medical equipment – to reduce spending. The country’s natural wage advantage can be harnessed by providing labor-intensive services at low prices – not by impoverishing healthcare professionals, but by increasing hiring in the public sector and expanding state funded training.

Suppose that better cost management increases the 2.4% of GDP that Indians spend out of pocket to 2%. Plan for an equal amount for infrastructure investments for at least 10 years and inject 1.2% of GDP into current government spending. The 5.2% of GDP in financing required can come, as in Taiwan, from taxes on wages and sin, as well as levies on interest, dividends and rents.

Funding will be centralized, not service delivery. Private hospitals will not waste away, but they will have to accept government-imposed prices. The primary responsibility for clinical care will rest with the 28 Indian states. They will be free to offer add-ons. Perhaps the national program will not be able to immediately cover chronic mental illnesses, for example. But richer states in the west and south should be able to include it. In Tamil Nadu, for example, the recent Chief Minister-elect announced his government would reimburse Covid-19 treatment bills from private hospitals. In addition, private insurance plans will exist as a supplement for those who want specialized procedures or long-term rehabilitation.

The pandemic will eventually recede, but scarred citizens will no longer want to face such desperation. People are search for resources on social networks and elsewhere. Individuals have turned to importing oxygen concentrators, making agreements with suppliers around the world. Anecdotally, some are combining smaller capacity respirators more widely available to create larger ones that are rare. Indian style jugaad, or quick, self-administered workarounds, cannot repair a broken system, however. It is time to rebuild health care. – Bloomberg


Read also : Selling buffalo for brain scan – Covid exposed India’s healthcare system


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