Sunday, June 8, 2008

India's Health Care System

India’s healthcare system is undergoing dramatic changes that parallel its' odd emergence as a capital market. Where Singapore, Japan, Hong Kong and more recently China have emerged from rural societies into modern economies through industrialization, urbanization then modernization, India has skipped a step. There has been a quick and dramatic split in society with the minority changing from rural to modern and the majority remaining in poverty.

The divide is mirrored in the healthcare sector with a two-tier system characterized by untamed variation in the quality of care. The divide between public and private enterprise is wonderfully illustrated by the fact that cell phone service is more reliable than electricity. Similarly, foreigners come from abroad for surgery in major private centres while rural society languishes.

The state of affairs is exacerbated by rural societies’ reliance on local healers and poor infrastructure in smaller communities. With such a badly split healthcare system, how will India’s government respond when care is being rationed by profit in the private sector and wait times in the public sector?

Unfortunately, oppressive bureaucracy and stifling labour laws thwart industrialization of the countryside so the same is likely to hold for public healthcare. One can only conclude that without major political change, private-public partnerships will be the only salvation for India short of global public health projects.

It would be easy for those of us in Canada, the United States and the United Kingdom to scoff at the situation as being the result of a country undergoing the pains of modernization. Certainly, the effects are more dramatic than we see in Canada.

Yet, despite the enshrinement of physician autonomy in the Canada Health Act (1984) increasing centralization, flat fee payments and regulatory hurdles stifle individual initiative in health care providers. Comparisons to India are easy, if not in the US then certainly Canada and the UK. Are we taking an already imperfect system and drawing it back into the 20th century by suppressing the desire for personal enterprise from our own health care providers? In another 20 years will there no longer be an incentive for young health care providers to venture outside of the cities in the hopes of finding a better life?

India has seen increases in life expectancy which are in relative terms far beyond those of the G7 countries. They have also devoted significant sums of public and private money to health projects. Public health projects improve the overall health of the populace but will not develop India’s healthcare sector into a first-world market. In the short term, it is hard to imagine that the public sector will be able to pull the proverbial “rabbit out of the hat” to bring modern health care to the underprivileged masses of India. It would seem that private for-profit enterprise is going to be required which will in the short term limit access but in the long run better balance access between the rich and poor. As for the health care economies of the G7, whether care is privately or publicly funded, the governments need to continue to foster a sense of adventure in the clinical and commercial lives of young health care providers if progress is to continue.


Doc Gurley said...

The idea of parallel healthcare systems is really interesting - especially if one considers the implications for diseases that don't respect that divide (infections, for example). As someone who works in a homeless clinic in the U.S., it truly is an issue that applies to all of us. Looking forward to hearing more about the topic.

Thomas said...

Should drug trials be conducted in India?
The recent death of 46 children who were part of various drug trials in India's AIIMS hospital is shocking.
It is well known that pharma companies use the path of least resistance to get their drugs approved and are willing to spend huge amounts of money to do it.
For the relatively poorly paid faculty of AIIMS, conducting drug trials is a source of quick money. Drug trials need to be closely monitored and regulated, and this is obviously nonexistant in India.
I have taken part in clinical trials in India and abroad and am aware of the financial gains involved.
The doctors who were responsible for these trials at AIIMS should be put behing bars for murder.