Sick Care In India Is Making Us Sicker

India’s sick care also weakens the country’s economic growth and reduces earning capacity and creates dependency for millions of people

The pandemic has taught us many things, and one is the importance of preventive measures in stopping a disease. Nonetheless, India’s healthcare system continues to focus more on sick care than preventive care. This system is not only making us sicker, but it has also contributed to making India the diabetes capital of the world.

In India, an estimated 77 million people have diabetes with a whopping 1,00,000 lower limb amputations taking place every year. Less than one-third of diabetics are detected and diagnosed early in the onset of the disease. As a result, almost one-third of those diagnosed suffer lifelong complications: nearly 30 per cent of diabetics end up with kidney failure, and tens of thousands develop diabetic foot, leading to amputation.

As a doctor, I see daily examples of how this disease affects a person’s health, financial state, emotional well-being, and the future of their kids. A diabetic foot surgery costs Rs 20,000 (US$261), but the patient also bears the cost of losing his foot, and possibly his job and income. Adding to that is the cycle of long-term chronic disorders, repeated hospitalisations, loss of well-being, and depression.

Amid all this trauma, a middle-class patient falls into poverty while a poor person’s life becomes a living hell. The cost of the treatment is passed on to the next generation where a now unemployed patient has to pull their children out of school and send them to work, scarring the children’s future.

India’s sick care also weakens the country’s economic growth and reduces earning capacity and creates dependency for millions of people. On the other hand, it prioritises choosing the more expensive medical option. For example, treatment costs for diabetes complications are exponentially higher than that of a simple test for early detection of high blood sugar levels, which could prevent the occurrence of severe, costly disease complications later.

A lion’s share of the country’s healthcare funds (91 per cent) is spent on sick care and less than 9 per cent on preventive care. And government funding continues to reinforce this status quo. The latest example comes from the government plan to increase payments to hospitals by 20 per cent for low-income patients. 

Although it intends to entice more private hospitals to join the publicly funded Ayushman Bharat PMJAY insurance scheme and to expand the pool of eligible patients, the plan would continue to siphon money away from essential primary and health services and people will keep getting sicker.

To be sure, the plan will bring more people into these hospitals. The hospitals may benefit, but the patient will not.

A plan to rebalance priorities

Rather than paying more for sick care, funding is needed to build the government’s promised network of 1,00,000 primary and preventive healthcare centers.

Despite being proposed three years ago, about 20 per cent of primary health centers do not even have access to electricity or water to date. More than 50 per cent of primary health centers are documented to have doctors, yet there is no data on how many of these doctors show up and offer services. The healthcare system lacks the resources in the form of staff or otherwise to prevent the incidence of diseases in the first place.

With strong preventive care, people could avoid devastating health complications and live healthier, fuller lives. Then why haven’t we shifted our focus?

India favors sick care because our entire health system pivots around fee-for-service insurance models initiated in the United States and being copied across the world. These models do not incentivise doctors to prevent a person from having a heart attack. Instead, they are driven by fees for service, and hospitals and doctors are compensated based on the number and expense of the treatments delivered.

In more ways than one, India cannot afford a fee-for-service system. The US spends more than three trillion dollars every year, 17.5 per cent of its GDP, on healthcare, but still has health outcomes that are worse than that in Cuba in many respects.

Some people hold that focusing on preventive care is anti-progressive. Gleaming hospitals, robots, and other fancy gizmos appear to be cutting edge, and too many doctors may prefer to do a kidney transplant than educate diabetics in a village about how to control their sugar levels and prevent kidney failure.

Real progress for India would slash the number of people developing diabetes or dying from heart disease, through strong preventive and primary health care systems. Our fee-for-service healthcare system has become one-sided to yield any good results. Also, India cannot manage to spend a fortune on healthcare as the US does.

To build a healthy future, the government of India needs to pivot and invest in primary health centres and preventive centres, and ensure they are well-equipped, staffed, budgeted, and managed. It is to be noted that though Covid may be loosening its grip, diabetes and hypertension certainly are not.

(Dr Shuchin Bajaj is a medical doctor and social entrepreneur. He operates a network of more than 18 hospitals, outreach clinics, and digital health services in North India)


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