Wednesday, February 02, 2005

India's Health Care System (or lack of it)

The Hindu interviews Amartya Sen, who has just finished a survey of India's public health care system. He isn't pleased (not surprising). The Indian government spends far less on health care as a proportion of its budget than most other developing countries, says Sen. At the same time, the health care system is riddled with corruption. Doctors don't show up, and when they are there they basically engage in extortion of their patients, forcing them to their private practice.
when patients go to many of the primary health centres, they find no one there. Sometimes, when they find someone, they will be referred to private doctors. Also, the medical system in the public sector offers no diagnostics, even of basic illnesses like malaria or TB. Patients are usually told to go to private practitioners for testing. Sometimes the testing isn't very good and, in any case, the economic cost could be ruinous.

On top of that, the care that is often provided by the private sector comes from quacks. We found an incredible proportion of quacks in Jharkhand, particularly, but a significant proportion even in West Bengal, who provide almost no serious medical attention and instead give saline injections for malaria, which is not really known anywhere in the world as a cure.

How do you fix the problem? More spending, says Sen, but that is only part of the solution.
there are a number of things that have to be done, and if you look at the health sector, yes, I would strongly recommend that we spend a lot more on public healthcare. But along with that, we have to introduce a better monitoring system for the delivery of public health services, and we also have to introduce a system of weeding out quackery.

I think the combination of quackery and crookery which takes place in the form of private medicine in some of the poorest areas of India and which mainly has the effect of making poor people part with whatever little money they have, rather than providing a cure, is something which has to stop. So if one just puts in more money, without making any other change, we would be caught in a very sticky ground, but we have to do these things together, and yes, along with the other changes, there is a case for a very dramatic increase in public health expenditure.

Sen also takes a shot at the extravagantly high tech medical centers that are competing (unfortunately successfully) for public funds. The divide between rich and poor in India is phenomenal, and yet the rich get subsidized. Alongside the health care tragedy that Sen describes in his interview, there are world-class hospitals like this one. That said, perhaps there is a role for world class private (emphasis on private) medical institutions, as they could help to bring foreign exchange revenue. Indeed India is trying to promote itself as a health care destination, and is being successful at this.


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