India is a unique country, no doubt. It produces the largest number of doctors in the world (30,000 medical seats), as well as the largest number of nurses (Bangalore alone has over 900 nursing schools and colleges) and medical technicians. Outside the US, India has the largest number of US FDA-approved pharma companies. With their current capacity, Indian companies can make medicines for the whole world, if they are allowed to. Of course, they are not allowed, but that is a different matter.
When it comes to providing healthcare services, India is not the world leader. Today, the largest number of procedures on the human body is done in the US. Of the 6.5 lakh heart surgeries done annually in the world, 4.5 lakh are done in the US. The rest of the world accounts for just 2 lakh heart operations.
India requires 2.5 million heart surgeries each year but only about 80,000 are done in the country annually. The numbers for other procedures are not greatly different.
So how is India going to bridge this gap in less than five years?
The biggest hurdle in the path of universal quality healthcare delivery in India is the inability of most people to pay for it. Of course, if the US did not have its health insurance programme, most Americans would not be able to afford even a toenail removal, forget about heart surgery. But because most developed countries have organised themselves well and have a functioning healthcare system financed by health insurance, most people can afford to pay.
Four years ago, Karnataka State Cooperative Society in association with Narayana Hrudayalaya started a Micro Health Insurance Programme called Yeshaswin. The insurance programme has proved that by just paying Rs 5 a month, millions of poor farmers can afford to undergo any surgery, including heart surgery, totally free. Today, four years after the scheme was launched, nearly 2.4 million farmers have already benefited and various versions of the Yeshaswini scheme have been launched in other states. One such scheme is Arogya Shree, launched by the Andhra Pradesh government, which sponsors all types of surgeries to BPL (below poverty line) cardholders in three districts of Andhra Pradesh.
West Bengal, too, has a novel health insurance scheme for approximately 4 lakh teachers working in village schools. Each teacher gets Rs 100 each month for health expenses, which is not enough to buy them even a course of antibiotics. Now, the West Bengal Education Department and the National Insurance Company have come together to offer a health insurance cover of up to Rs 1.6 lakh a month for a teacher’s entire family. All the teacher pays is Rs 100 a month. In just one move and without any additional expense, nearly 20 lakh working-class people have been covered for major medical treatment and surgeries.
A few days ago, my wife was walking by a mall where she saw a beggar begging with his face covered. Curious about why he had covered his face, she took a closer look and found him chatting on a mobile phone wile begging with the other hand.
India defies logic and beggars owning mobile phones is not uncommon. The country has effortlessly moved from having no phones to the most modern mobile phones, from no radio to colour televisions with over a hundred channels to choose from. Using technological and economic tools, the essentials of life such as quality healthcare should now be dissociated from affluence. Even a person who lives in slum should have access to high-tech healthcare, which should be within their grasp using a smart card.
Poor people are very weak by themselves, but emerge very strong together. Governments are the only organisations in the world that can do wonders by putting things in order without having to spend money. Micro Health Insurance is an excellent example of this. I strongly believe that the government will gradually become a health insurance provider rather than a healthcare provider. When this happens — and it will require a policy change — this country will become a wonderful place to live in.
( Dr Devi Shetty is Chairman, Narayana Hrudayalaya, Bangalore, and one of India’s most celebrated cardiac surgeons)