Why healthcare does not win votes
Dr Rana Mehta April 4, 2014
It has been an interesting past few weeks, with the build-up to the elections in full fervour. Varied parties, myriad issues, a plethora of 'healthy' demands - the conversations, scrutiny and analysis have been like never before.
Even as we cry hoarse over corruption, investments and development, one element quintessentially missing from public discourse, in print and television discussions, and in social media too, has been a discussion around healthcare. It is a strange situation where many Indians perhaps know more about 'Obamacare' than about their own country's healthcare challenges and prerogatives. But the truth is, there is a lot of activism around healthcare that needs to be brought to public attention, in much the same way activism around corruption has.
According to World Bank, India spends 3.9 per cent of its GDP on provision of healthcare facilities, which is equal to the GDP expenditure of Kazakhstan and Algeria. Comparatively, developed countries like the US and the UK have an expenditure of 17.9 per cent and 9.3 per cent of GDP, respectively. The public expenditure on healthcare in India stands at 31 per cent, indicating that majority of expenditure is borne by households out of their pockets.
On the other hand, most of the developed nations witnessed post-welfare healthcare reforms, driven by their governments and political parties. While in the US, cost of care was the leading driver for its healthcare agenda and became a primary presidential election issue in 2012; in the UK it was equitable access that led the way. The unrest in the country over inequity led to the government-sponsored National Health Service (NHS), the largest publicly funded health service in the world. The NHS is based on the principle of availability of affordable healthcare to all.
While the US and the UK being welfare states gave healthcare that kind of status, it is understandable that Indians still do not comprehend healthcare as a national issue as a majority of its population is still grappling with basic needs of housing, food and drinking water. The same can be supported by Maslow's hierarchy of needs model, which places the physiological needs of food and water at the bottom of the pyramid, while safety needs like healthcare are secondary and are desired by individuals only after the primary needs are met.
A glance through Center for Health Market Innovations (CHMI), an online platform that promotes and lists inclusive and innovative healthcare models globally, is encouraging.
It shows that developing countries are leading the way as far as healthcare innovations go, with India ahead of the pack with 250 such solutions that are helping people in the remotest corner of the country access quality healthcare, against the eight in China and 54 in South Africa. CHMI is supported by the Bill & Melinda Gates Foundation, the Rockefeller Foundation, UKaid and other global partners, and is working towards bringing governments, non-governmental organisations, social entrepreneurs and private companies together for development of the healthcare markets across the globe.
One such project is Healthline 24x7, which provides a comprehensive database to patients for selection of the most suitable healthcare provider, diagnostic centre and medicines, based on parameters selected by patients. Another program, School Health Annual Report Programme (SHARP) has been working in the field of health education and medical and clinical and immunisation services for school children since 1998.
Why the young should care
Most of these innovations are being led by young, enterprising individuals. This is heartening to see. Culturally, youngsters in our country may be driven to join a gym, but are not quite aware of other aspects of healthcare, including healthcare insurance. But what the young in India need to realise is that while India is poised to become the world's youngest country by 2020, with an average age of 29 years, the benefits India enjoys in terms of its population distribution will taper off by 2050 when a huge chunk of the population will fall in the 60+ age bracket, and health facilities will be needed to cater to the disease pattern of an ageing population.
Healthcare - In no man's land