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The Tree of Life
(Terrence Malick)
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India’s ‘Foreign Policy’: A Long way from Bandung |
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Under External Affairs minister SM Krishna, India’s foreign affairs activity seems to have become restricted to registering protests of various sorts – at the indignities suffered by Indians in Australia, at a Russian court’s ban on the Bhagwad Gita in remote Siberia and at SRK being detained for two hours in a US airport. Are India’s foreign policy initiatives directed outward as they should be or are they directed towards influential private interests?
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Editorial |
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Healthcare and the Medical Profession
Although India’s growth story has been heartening, the country has been lagging behind in the human development index. 47% of India’s children below the age of three are malnourished, nearly twice the level for sub-Saharan Africa which stands at 28%. World Bank estimates this figure to be 60 million children out of a global estimated total of 146 million. Although India’s economy grew 50% from 2001–2006, its child-malnutrition rate only dropped 1%, lagging far behind countries with a comparable growth rate. Approximately 1.72 million children die each year before turning one. The under five mortality rate and infant mortality rate indicators declined between the years 1970 and 2002 (202 to 90 & 192 to 68 per thousand live births respectively). However, this rate of decline is slowing. Reduced funding for immunization leaves only 43.5% of the young fully immunized. Infrastructures like hospitals, roads, water and sanitation are lacking in rural areas. Shortages of healthcare providers and newborn care contribute to the high infant mortality rate. In the middle of all this, the Indian healthcare industry is growing at a rapid pace. A US $36 billion industry today, it is growing at 15% and is expected to become a US$280 billion industry by 2020. The healthcare industry, in effect, is growing at twice the pace of the country’s GDP. There is apparently something seriously wrong when the country’s healthcare system is abysmal but the healthcare industry is doing so well. The purpose of this editorial is to speculate about healthcare in India today based on information which is commonly available and which is unlikely to be disputed by the reader.
- The cost of medical education has become enormous and higher education in areas like surgery can only be afforded by the rich. This means that there will be a pressure upon most doctors to recover the cost of their education as early as possible. Even ‘merit quota’ seats in medical education are hardly inexpensive although they are affordable to the middle class. Since a majority of the doctors have spent huge amounts on medical education, it is apparent that medical consultation is becoming more expensive.
- New developments in medicine mean introducing new products. New products are expensive since their patents have not yet run out. They yield higher profit margins for healthcare companies. Where two or three different drugs compete for the patient’s attention, it may be expected that there will be pressure upon doctors to prescribe the more expensive drugs – at least wherever patients can afford expensive treatment. Since most doctors have incurred huge expenses in pursuing their education, one may expect them to be susceptible to persuasion and material incentives.
- Diagnostic equipment is expensive. Doctors are now routinely asking for tests also specifying the laboratory in which the tests should be conducted. It is apparent that most doctors have now entered into lucrative arrangements with pathological laboratories.
- As clinics and hospitals become more sophisticated, there is a need to install expensive equipment. Competition also makes it necessary for hospitals to install them. This puts pressure on doctors, clinics and hospitals to put the equipment to use. There is no check to make sure that hospitalization for longer periods and expensive treatment is actually necessary whenever it is recommended. One feature widely noticed is the advising of different treatments depending on whether the patient has medical insurance. Very often, the best-equipped hospitals tend to recommend surgery in doubtful cases although the doctor/ surgeon begins with a standard warning that there is no guarantee that surgery will be effective.
- While the new advances in medicine have increased life expectancy, most of the extended period passes under sedation and/or on oxygen, in feeble, unconscious or comatose conditions. One could say that a fair proportion of the additional time promised by increased life expectancy leads to higher revenue for the healthcare industry.
- While, by and large, the middle-class has access to second opinions before opting for expensive treatment, such recourse may not be available to the poor who need to implicitly trust their doctors. With government-run public health centers being badly mismanaged, the rural poor may be resorting to private doctors. In fact, there is the likelihood that government-run primary health centers are deliberately mismanaged to turn the rural public towards private practitioners. One finds a burgeoning of pharmacies in the smallest of small towns indicating that the medical profession has become very lucrative to be practiced among the poor, especially because the poor have no voice and do not get media attention. Since improved facilities have not led to a corresponding increase in life expectancy, one may broadly surmise that the medical treatment that the poor get from private enterprise is not efficacious. There are few effective checks to ensure that the poor are not cheated in the name of healthcare and one may suppose that they are being made to spend more on it than is necessary - based on doubtful advice from the medical fraternity without malpractice efficiently checked by the prospect of punishment.
- With the State inclined to retreat from intervention – i.e. make over its own responsibilities to the private sector – one may expect that the exploitation of the poor by the healthcare industry will increase several fold. This will be exacerbated by the State disinclined to strengthen the existing system of checks and balances.
- With free market exponents like Prime Minister Dr. Manmohan Singh and the Dy. Chairman of the Planning Commission Dr. Montek Singh Aluwalia advocating cash transfers as incentives, one may expect the healthcare industry to gain enormously through the poor without increasing their life expectancy in the smallest way. Cash transfers are evidently a way by which the poor can be relieved of their money by unscrupulous elements and the helpless reliance of the uneducated upon rendered medical opinion makes the healthcare industry the most necessary to monitor.
Whatever has been said will be difficult to refute. But if it points to anything, it is the need for stronger and more effective intervention by the state – at least in key areas like healthcare and education where the poor require the basics rather than cash compensation and the freedom to spend. Unethical practices by the medical fraternity – like forcing patients to undergo tests at specified laboratories should be termed a corrupt/ criminal practice and made punishable. The failure of the State in these crucial areas has led to both increasing costs and a lowering of standards - in terms of competence as well as ethics. With the state as effective competitor, private enterprise may become more inclined to offer better quality treatment at lower prices.
Editor
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