How the Health Care system failed and what is to be done to improve?

The government should be the sole conveyor of the health care service allowing private contracts in providing the medical treatment

Satya Rani

Executive Director of ADSCV Foundation

It was the final month of the summer and spring is kicking in. The trees blossom making soothing my eyesight. However, I was not in the zone of enjoying the wonders of nature. Pandemic induced suffering makes my heart cry for those searching for hospital beds, ventilators, and even medicine. The morning became worse when a phone call intimated to me about the death of my cousin due to the COVID complications. A day doesn’t go without hearing the sudden deaths due to the COVID infections. There came a situation when I started thinking about whether to answer calls or not. If I go out I see an ambulance with the siren every 5 minutes, hospitals are crowded with patients and their families. No doubt, the pandemic has hit the whole of India very Hard. Recovering from the untimely deaths of close ones, colleagues, friends, will be difficult. Undeclared, we are in a state of emergency. The questions -What made people suffer today? Did we ignore WHO warnings? Is it due to a lack of public healthcare infrastructure? Don’t we have enough doctors? Is it due to the negligence of the government? And did we fail in the Healthcare system as a whole?

As a resident of Hyderabad, I would only speak about the situation of Hyderabad. As we have very poor public health infrastructure people have no choice but to go to a private hospital, billing in private hospitals are within the reach of a common man but they have no option. I have lost 5 people whom I know closely. They have no previous medical history but still, they lost their life due to COVID-19.

Do we deserve to face these situations? Every family is suffering today. In December 2019, they are many media posts that trolled China saying that this coronavirus came from china. It might be true, but it did get us nowhere. When we were attacked by the coronavirus in 2019 we had a very less death rate compared to other countries like the USA, Brazil, UK and Spain. It might be because of a proper lockdown where every person strictly followed the protocol. This helped to overcome the pandemic. After the proud proclamation by Mr Modi, that India is successful in containing the virus, in Mumbai, 20,719 more deaths (around 23 per cent) were reported in the 2020 calendar year compared to 2019. It was 1, 11,942 in 2020 and 91,223 in 2019. May 2020 had the highest number of deaths registered (14,328) compared to 7,335 deaths in May 2019. Perhaps with the underrepresentation of cases, we have to multiply 10 times the current number provided. According to a census, 70% are men and 30% are women among infected This is according to the data collated by the National Institute for Demographic Studies from national statistical agencies across England and Wales, France, Germany, Italy, Netherlands, Portugal, Korea, and Spain, covering an estimated population of 194 349 591 men and 201 715 364 women from the beginning of the pandemic until June 21, 2020. Belgium and the USA were not included due to the presentation of data in different age categories.

77 652 men died and 59 591 women died. The overall male to female mortality sex ratio per 100 000 population was 1·4 (crude ratio 1·3). This ratio was not equal for all ages. For example, for people aged 0–9 years the ratio was 0·81. The ratio was 1·9 in the 40–49 years age group, 2·3 in the 50–59 year age group, 2·6 in the 60–69 years age group, and 1·65 in people older than 80 years, there are some variations across the countries but border pattern is the same. Even after such systematic research being done abroad, there was no such initiative in India. This shows the arrogance of the government or still worse, there is no expertise.

The incapacities of the Indian Health care system in data

I was working and researching on the healthcare system for three years, I visited many PHCs in Telangana, did some survey as to how the PHCs function. I felt good about the idea of Basti Dawakhana by the Telangana government but then it is only for minimal treatment like fever, cold, cough, sugar test and blood test. This pandemic taught us many lessons, we need a sophisticated healthcare infrastructure. Public healthcare hospitals should be completely equipped. Future healthcare systems should be war-prepared to battle pandemics whenever they break out. There should be an action plan that can be implemented in the shortest time frame. We have near-complete knowledge on tackling major killers like heart ailments, cancer, lifestyle diseases, AIDS etc., but not a virus. We also need to have early heads-up on the system. India will need 500,000 ICU beds, 200,000 nurses and 150,000 doctors, and 350,000 medical staff in the next few weeks. At present, India has 90,000 ICU beds and almost all are already occupied. If we see the doctor’s population in India there is one doctor for every 1,445 Indians as per the country’s current population estimate of 135 crore, which is lower than the WHO‘s prescribed norm of one doctor for 1,000 people. According to WHO norms, one nurse has to look into 300 patients but here we have 1:600, by this, we know at such situations doctors, nurses will be overburdened which is leading to a ruckus between doctors and patients. A total number of doctors at 1.2 million (of who 200,000 are unemployed); the number of doctors produced/year at 50,000; the number of trained nurses produced/year at 60,000, India supplies 40% of the world’s vaccines at the lowest cost.

More people might fall below the poverty line

104 million more people in India could fall below the World Bank-determined poverty line. At present, 60 per cent of India’s population, or an estimated 812 million people, live below that poverty line. 55million people were dragged into poverty in a single year due to patient care costs, this is because of the lack of affordable hospitals, doctors, ill-equipped health professionals, expensive drugs, antibiotic resistance, childhood malnutrition, negligence of women health and lack of funds. Due to lack of public infrastructure people are forced to visit private hospitals which the treatment cost is very high, this is making healthcare unaffordable for the people. There are many stories or scenario where we hear or see that until and unless u clear the medical bills patient is not allowed to discharge from the hospital. Only 15% of the population in India today has a healthcare cover, be it community insurance, employer’s expenditure and social insurance schemes. Every year four to six crore Indians pushed into the healthcare department into poverty.

How do insurance schemes work in India?

We have Aarogyasri at the state level and PMJAY at the centre level Aarogyasri health scheme was introduced in Telangana state which covers 233 lakh families in 23 districts in Telangana state. PMJAY scheme aims to provide healthcare to 10 crore families, mostly poor and have lower-middle-class income, providing a cover of Rs.5 lakh per family. These 10 crore families comprise 8 crore families in rural areas and 2.33 crore families in urban areas. How are these two insurance schemes going to help this country as it has limitations? If we have health insurance this could help us only to an extent all health insurance scheme comes with exclusions example few diseases are not covered, now due to overcharging for the medical treatment by the private hospitals and the limitations of the healthcare insurance creating disputes As per industry estimates, policyholders across the country have been receiving only around 50-55 per cent of their actual claimed amount for COVID-19 hospitalization. This virus Is spreading to everyone in the family, our schemes don’t help us as it covers only 5 lakh per family and private hospitals are charging one lakh per day Data shows we have 60 per cent of India population what about the rest 40% of the population this pandemic made every family went bankrupt. Few families lost their property, gold just to meet their medical expenses.

Only 1.3% of total GDP constitutes expenditure on public healthcare, the lowest amongst BRICS countries. How government is looking into this issue? We need solutions than slogans. Merging healthcare schemes is not the solution. We need to have one health policy, everyone should have access to the healthcare system, the government should act as the one single-payer government should remove all the competitors and act as a single donor this helps to keep the cost low and standardized benefits. Every individual who pays the tax is guaranteed the same access to healthcare and nobody would ever receive a medical bill. Our Netas only think about the vote bank and sadly, the rest is ignored.

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