Healthcare in India is making us sicker

The pandemic has taught us many things, and one of them is the importance of preventive measures to stop an illness. However, India’s healthcare system continues to focus more on medical care than preventive care. Not only is this system making us sicker, it has also contributed to making India the diabetes capital of the world.

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

As a physician, I see daily examples of how this disease affects a person’s health, their financial state, their emotional well-being, and their children’s future. 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 this is the cycle of long-term chronic disorders, repeated hospitalizations, loss of well-being and depression.

Amidst all this trauma, a middle-class patient falls into poverty, while a poor person’s life becomes hell. The cost of 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, jeopardizing the children’s future.

India’s medical care also weakens the country’s economic growth, reduces earning capacity and creates dependency for millions of people. On the other hand, it prioritizes the choice of the most expensive medical option. For example, treatment costs for diabetes complications are exponentially greater than a simple test for early detection of high blood sugar levels, which could prevent serious and costly complications of the disease later on.

Most of the country’s health funds (91 percent) are spent on medical care and less than 9 percent on preventive care. And government funding continues to reinforce this status quo. The most recent example comes from the government’s plan to increase payments to hospitals by 20% for low-income patients.

While it aims to attract more private hospitals to join the publicly funded Ayushman Bharat PMJAY insurance scheme and expand the pool of eligible patients, the plan will continue to divert money from primary and essential health services and people will continue to get sicker.

For sure, the plan will bring more people to these hospitals. Hospitals can benefit, but the patient cannot.

A plan to rebalance priorities

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

Despite being proposed three years ago, around 20 percent of primary health centers still do not have access to electricity or water. More than 50 percent of primary health care centers have registered physicians, but there is no data on how many of these physicians appear and offer services. The health system lacks the resources in the form of personnel or otherwise to prevent the incidence of disease in the first place.

With strong preventive care, people can avoid devastating health complications and live healthier, more fulfilling lives. So why don’t we change our focus?

India favors medical care because our entire healthcare system revolves around fee-for-service insurance models started in the US and copied around the world. These models do not encourage 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 treatments performed.

In more ways than one, India cannot afford a fee-for-service system. The US spends over three trillion dollars every year, 17.5% of its GDP, on health, yet it still has worse health outcomes than Cuba in many respects.

Some people argue that the focus on preventive care is anti-progressive. Gleaming hospitals, robots and other fancy gadgets seem to be cutting-edge, and many doctors might rather perform a kidney transplant than educate diabetics in a village on how to control their sugar levels and prevent kidney failure.

Real progress for India would reduce the number of people who develop diabetes or die from heart disease through strong preventive and primary health care systems. Our fee-for-service healthcare system has become one-sided to produce good results. Also, India cannot spend a fortune on healthcare like the US.

To build a healthy future, the Government of India needs to streamline and invest in primary health centers and preventive centers and ensure they are well equipped, staffed, budgeted and managed. It should be noted that while Covid may be eroding its grip, diabetes and hypertension certainly are not.

(Dr Shuchin Bajaj is a physician and social entrepreneur. He operates a network of over 18 hospitals, outreach clinics and digital health services across North India)

Healthcare in India is making us sicker

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