Do we need 2 different healthcare programs to effectively cover India ?

Healthcare in India has been a mixed bag. There is a rich history with surgeons like Sushruta and

Public Healthcare

Public Healthcare

Healthcare in India has been a mixed bag. There is a rich history with surgeons like Sushruta and physicians like Charaka who healed many in the ancient history. Then there was the creation and growth of Ayurveda who many still claim has answers to most of the incurable diseases. As a matter of fact recent article in Asian age talked about how an college is claiming that they might have the cure for the disease.

 

But somewhere in the middle we lost our path. As the village system gave way to the cities, many Indians were actually left without care. A good case in point is my cook who lives in Bangalore, works 6 days a week and when he falls ill he has to depend on his clients to give him some medicines. He cant afford modern healthcare and has come too far from his village to turn to traditional remedies. Illness for him means loss of pay something he can ill afford. Incidentally he is not alone. The minimum wage in India is set at $689 per annum for a 48 hour work week. That’s 8 hours a day for 6 days. This would come around to $ 57 a month (Rs 3,500) , But that also means that leave of absence means loss of pay. In India there are approximately 400 Million daily wage workers. So falling ill is not an option.

On the other end of the spectrum are the city dwellers and middle and upper middle class Indians. They can afford to fall ill and miss work as they work in large organizations with health benefits or they have enough to pay for these out of the pocket. But they don’t suffer from the ailments of the daily wage workers. They suffer from chronic diseases – Diabetes, Hypertension,  Cardiac issues.

So in reality there are 2 India’s. The poorer India dealing with Malnutrition and infectious diseases and the richer India dealing with chronic ones.

In this context the recently announced Universal Healthcare System in India is going to be ideal for the daily wage workers. With focus on nutrition, preventive care, primary health and a government insurance system to cover certain procedures, the program is going to be launched in April of 2015 and would cover almost the whole of the country by 2019. The program would cost around $ 26 Billion (Rs 1.6 Trillion) to initiate and then would cost $ 11.4 Billion annually to sustain. The current spend on healthcare is around $5 Billion and that would represent 1 % of the GDP It a very ambitious but necessary program and I think the Government has taken a brave step to cover the country this way.

But I feel for urban India health insurance is the only way out. They can pay and are more financially literate. So an insurance plan with  incentives to keep their chronic disease parameters under check would be a great idea. A simple example would be that if someone is in a high risk category due to obesity. Then a simple tire up with a wearable like “Get Active” could help the insurance company customize a deal with the member that as long as he walks a certain number of steps then his insurance would remain low.

Healthcare resources are limited. Its best to give them to those who need it and make incentives to others who can avoid using them. I like some of the earlier programs like  E-Mamta in Gujrat. So we need a dual system, Universal Healthcare for the poor and Health Insurance for those who can afford them. Complicated but doable…as always I am open to comments and questions…

 

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