Healthcare for Those who can not Afford it.

Turning away a fellow human being from the doors of a hospital when he is ill and unable to pay the bills appears to be wrong. However, if one was to dispassionately examine the situation, setting up and running large hospitals require huge amounts of capital, which has to be recovered from those who use the services of the hospital. If the hospitals were not to charge for their services from those who cannot afford to pay, they will soon go belly up and that surely does not help anyone.

So what does one do?  

In our country the burden of treating the millions of poor squarely rests on the government. Thus, the government has established large hospitals in across all major cities, which provide care to those who can not afford to go to private hospitals. Unfortunately the government has a minuscule budget and the needs of the poor can hardly be met by the infrastructure that exists. The government hospitals are overflowing with patients. The doctors work long hours in cramped, unhygienic and poorly equipped and poorly supplied hospitals to provide the best care that they can. These behemoths are also dens of corruption and the staff is innured to the suffering of ordinary citizens. (The other day, The Hindustan Times reported of a woman giving birth outside the doors of one such hospital in Delhi, the child died) No one is accountable or really cares, unless you can pull some strings. And the poor surely can not. However, these hospitals, while terrible in the eyes of the affluent are often the lifeline for the poor, who can not afford anything else. At least they get a chance. The government can establish more such hospitals, but they do not appear to be an acceptable solution.

Health Insurance premiums while low are still beyond the reach of the really poor. The gradual penetration of health insurance is helping the affluent and the middle class to access better quality healthcare, which in itself is good. However, the problems of the really poor remain. Where do they go?

Private Public Partnership arrangements have been touted as a solution. This in simple terms mean that the government and private healthcare companies come together to establish facilities for the poor. The private companies believe thay can run government or jointly owned hospitals much more efficiently, provide better care and also make a small profit for themselves. On the face of this, the model looks good. However, if one were to look at Indraprastha Apollo Hospital in Delhi, which is 26% owned by the government of Delhi one soon realises that this model can deteriorate to become a sham. While Apollo Hospital, is meant to treat a certain percentage of people free, it hardly ever does. Ironically, its full paying wards are teeming with the poor from other countries who can not afford treatment in their own country. The social entrepreneurship required  for a model like this to succeed does not exist in India as yet.

Dr. Devi Shetty in Bangalore has pioneered another more inclusive model of micro insurance, which holds great promise. Dr. Shetty figured out that even if he was to offer healthcare at rock bottom costs, it will still remain unaffordable to most poor people in India. He also understood that he can persuade the government owned insurance companies to device a cheap insurance policy, which covers a very large number of people. Thus if a million people were to contribute Rs. 10 per month towards their insurance premiums, the insurance companies can make this work. The real challenge here is to have a million people regularly contributing towards their monthly premiums.

The need of the hour is to have more such innovative solutions. I am sure there would be others like Dr. Shetty, who would be willing to try something different. Unless, we confront the appalling state of our healthcare institutions meant for the poor and herald change big time, all the talk about India being a global healthcare destination will continue to ring hollow.

Pic courtesy http://www.flickr.com/mariyamboo