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Health Industry
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<!--emo&:ind--><img src='style_emoticons/<#EMO_DIR#>/india.gif' border='0' style='vertical-align:middle' alt='india.gif' /><!--endemo--> http://economictimes.indiatimes.com/Opinio...934,curpg-3.cms
<!--emo&:thumbsup--><img src='style_emoticons/<#EMO_DIR#>/thumbup.gif' border='0' style='vertical-align:middle' alt='thumbup.gif' /><!--endemo--> How can healthcare be made affordable?
13 Nov, 2007, 0421 hrs IST, TNN
Shubnum Singh
Chief Physician,Max Healthcare Institute

The key to sustainability of India’s rapid economic growth lies in the health of its people. As our service-oriented economy booms, we as a nation will have to evolve mechanisms unique to our social and economic needs in providing healthcare for all.

Containing rising healthcare costs challenges all nations irrespective of their GDP or quantum of healthcare spends. However, it is not necessary that a higher spend results in better healthcare outcomes.

In India, unlike many other low and lower middle income countries, an individual incurs the largest out-of-pocket expenses on health. This, despite a national commitment which embraces the notion that access to basic, essential health services should be guaranteed to everyone, irrespective to income or ability to pay. The meagre government spend of 1% of GDP is unable to address the needs be it in capacity or spread of healthcare services.

As healthcare costs have increased it is, therefore, not surprising that medical expenditure, which on a yearly basis can amount up to 60% of an individual’s annual income, is one of the leading causes of indebtedness.

If we were to analyse the drivers for rising healthcare costs they would fall into three main categories — consumer, provider and supplier driven.

From a consumers’ perspective the list is huge. India’s population is increasing and ageing: 32.8% of the entire population will be over 50 years of age by 2050. This would mean an exponential increase in the percentile of people suffering from chronic diseases like hypertension, diabetes, etc. In 2005, it was estimated that chronic disease in India accounted for almost 53% of all deaths and in 2020 will account for 66.7%. This comes close when we have yet to contain the menace of infectious diseases like TB, malaria, AIDS, SAARS, etc.

Decisions in choices of care are largely defined by an acute need for the service and not value based. At best, the consumer transfers it to the provider, that is, the physician.

From a provider’s perspective the constantly evolving nature and technological complexity of health services causes information available to consumers to be inadequate for economic decision-making thereby making physicians the final authority in the process. Physicians, in turn, are influenced by myriad circumstances, from emergence of new epidemics, for example, SAARS, evidence based quality practice of medicine to legal and institutional challenges in providing the best possible care. All these help fuel a perception of what is perceived as “unnecessary hospitalisation and over investigation. “

From a supplier’s perspective, a shortage of capacity exists in terms of beds and manpower coupled with a skew in their urban and rural presence. India, according to Ficci, would require an investment of $78 billion in the next decade to fund the addition of approximately 1,000,000 beds which are needed. It is anticipated that government, given its lacklustre performance in its healthcare spend of 1% of the GDP, will contribute $8.2 billion and the private sector $69.7 billion.

Public health is fundamental. Despite the minimal spend, it has brought down infant and maternal mortality rates (IMR and MMR ) along with increasing life expectancy. So is the private sector, which provides 70% of care.

What we need today is a sound public-private partnership to put into place regulatory, fiscal and reform policies that will promote creation of capacity for labour, infrastructure and innovation on the one hand and institute sustainable financing mechanisms to collect and distribute funds on the other, thereby ensuring affordable quality health care to all.

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