Reading Dr Vikram’s post on “is-health-insurance-the-answer-to-indias-healthcare-woes?” made me think. Well, in the United States, despite healthcare being the highest capita spend of the GDP as per Organization for economic Co-operation and development (OECD) survey. But yet still we are unable to meet the healthcare needs of the population. That made me think – Is having insurance (private and public) the answer to India’s healthcare issues?
I would like to give my perspective whether we should invest heavily in insurance and the role of the government, based on my knowledge of Unites States healthcare systems.
As per OECD survey for 20131, United States spend 16.9% of its GDP on healthcare, compared to India which is on bottom of this list and spends close to 4.0%. Higher GDP spending on healthcare does not mean healthier nation. The determinants which accounted for health of nation are mostly life expectancy and mortality rates. The United states has lower life expectancy and higher mortality rate, when compared to countries like Switzerland and Japan OECD countries3. As there are other determinants like life style, smoking and alcoholic drinking habits which impact the life expectancy and mortality rates.
As you may see from graph, United States may not be the best example to learn from, especially when it comes to healthcare expenditure. There are other countries which spend less percentage of their GDP income on healthcare and still have better health of their nation. Though I would agree with Dr. Vikram, we need to have some form of insurance and basic healthcare to all.
Let’s look at the articles published in OECD 20142, How does India compare in healthcare spending compared to other OECD nations?
India’s total healthcare expenditure per capita is roughly around USD 157 in 2012 (calculated based on purchasing power parity) compared to OECD countries average USD 3484 and United States USD 8785.
The most of health spending for OECD countries come from public/government sector up to 77%. In India total public sector spending in healthcare is 33% in 2012. Needless to say government needs to get its act together and increase its focus on health of its population.
Universal healthcare funded by government is not either the best solution as you may see from United Kingdom and Canada which perform far below some other countries. Unhealthy population ends up having longer wait times and inability to get healthcare for the more expensive procedures after you reach a certain age (“magic number” defined for the nation). Do we want that? I believe the answer is “No”. Anyone who can afford and able to pay, should get healthcare he/she needs irrespective of the age. If the country will not provide rich and aged population the care they need, they will seek healthcare outside the country. We do not want to lose that opportunity and revenues to our healthcare systems. The challenge is to find a right mix.
You may ask, what about the population who cannot afford to pay for increasing healthcare cost?
For weaker section and poor population having basic insurance funded by government or by government subsidized plans from private insurance is the answer. Though, I personally believe, nothing should be given for free because then people misuse and overburden the tax payers which becomes difficult to sustain in long run, as you see in Unites States with its Medicare and Medicaid programs.
If you are interested, do see Indian ministry of health and welfare website (http://mohfw.nic.in/), where you will get to know about new initiates like National Health Mission and various other program started by government. I am pleased to know that our government has taken initial first steps towards better health of a nation and recently, published standards for electronic health record in India 2016.
Government have responsibility to its people to give better care and provide basic utilities including water, electricity, infrastructure and medical care. When it comes to healthcare, right balance lies between providing preventive care, so we reduce the number of people who get sick but also let people opt for insurance for any catastrophic illness and take responsibility. May be government could also look into supporting health Savings Accounts ( HSA’s) similar to United States where the amount put in the health savings account are tax deductible and the amount could be spend towards drug prescriptions and health care cost for a longer term. India will emerge in global environment, with its young population, and if it takes along all of its population to make India a healthy nation.
About Author: Kiten Meena is Senior Business Analyst, working with a healthcare consulting firm in United States. She had thirteen years of experience in working in Healthcare Sector. She currently work as a consultant at Kaiser Permanente where she oversee new enrollments coming from state and federal exchanges. Kiten is actively engaged in the Indian Healthcare Space as well. She is also currently pursuing Executive Masters of Health Administration at University of Southern California Sol Price School of Public Policy.