In a world where each country battles and thrives on its diversity, population, climate, diet, culture and politics, there are few essentials that stay the same. Our need for a sustainable source of food, accommodation and basic health-care. While most government charters in the world pronounce this as a right of every citizen (their tax-paying ability not withstanding), ground realities are a little sketchy.
Countries that topped the WHO health-care ranking systems in 2000 have a lot to boast about. France, relying both on private and government insurance offers an astounding universal coverage where it shares 70:30 ratio between public and private insurance agencies. This means the sicker get more coverage and treatment for chronic diseases such as diabetes and cancer are entirely government funded.1
Switzerland, another frontrunner in quality healthcare, also provides universal coverage, wholly privately funded. Citizens choose from a variety of private plans and those who can’t afford it receive government subsidies.2Several other countries like Italy, Singapore, Hong Kong and Japan also have excellent schemes for their health-care services.
Of course, the inherent byproduct here becomes prohibitive taxation where about 21% of an average income is swallowed up by the national health system. As the employers pay more, higher taxes restricts their ability to hire more.
Governments of developing countries have often blamed their population for most of their inefficiencies, loopholes and corruption. Health-care just another likely victim of their inept governance. While it may not be a good enough excuse for all their inadequacies, let us not limit our understanding of the magnitude of the problem. India for example, has a population of 1.2 billion people, three-quarters live in rural areas. Nearly 400 million people live on less than 1.25 USD per day, 44% of all children are malnourished. The burden of infectious and non-communicable chronic diseases is on the rise, while India’s public spending on health is extremely low, in 2009 being only 1.1% of GDP. Combining the public, private and external funds it comes to about 4.1% of GDP.3
There is a private and a public sector but the shortage of even the most basic healthcare facilities has made the private sector, perhaps the largest in the world – 78% outpatient and 60% in patients, a thriving one.4 None however, cover chronic diseases. Poor regulation of insurance facilities has led to painfully high out-of-pocket expenditure and almost zero accessibility to the poor.
The two government-run healthcare programs, National Rural Health Mission (NRHM) run by the Central government and second is Rashtriya Swasthya Bima Yojna (RSBY), a health insurance program, have seen marginal success.5 With legislative gaps, lack of uniform standards leading to fragmented and uncontrolled nature of private sector and ineffective implementation in the public sector have ensured that on the whole it is a failing system with a dire need for overhauling.
Perhaps not exclusive to India, there exists a concept of commission in laboratories and even between doctors for referral. It is common to see pharmaceutical companies bribe practitioners with gifts for writing more prescriptions of their expensive drugs over generic ones.
In my understanding, the government lacks accountability, which is a key factor in making sure that the system is efficient. Health systems in developing countries needs to undergo a proactive restructuring, one that combines horizontal, vertical and diagonal approaches. A plausible alternative could be a centralized health system that lays down ground rules for nations and then add laws based on individual country needs. A basic model can be as depicted in this pyramid –
The knowledge of various health systems enables us all to learn from each other. To recognize the effectiveness, advances and policies of one country where it is successful, customize it to country-specific needs and apply it to nations where it may be lacking would definitely enable humanity as a whole to progress in unison for a better world for each one of us.
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