NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Monday, September 28, 2015

In the last two decades, there has been a steady erosion of the provision of free health care by a quickly spreading private health system. Middle class families are paying out-of-pocket or becoming dependent on health insurance schemes, while poorer families are being forced to access private health care in life and death matters.

Chronic non communicable diseases (NCDs) like diabetes, hypertension, heart disease, asthma, cancer, and, now, chronic kidney disease, are on the rise and give cause for concern. The success story of free health is overshadowed by the inability of the public sector to provide adequate care for NCDs.

Current approach to NCDs
The Ministry of Health’s approach to NCDs focuses on promoting “health lifestyles” and improving access to screening and treatment. A range of health educational initiatives are underway to foster public awareness on the dangers of excessive salt, sugar or fat intake, and nation-wide campaigns seek to curb the use of alcohol and tobacco, also “risk factors” for NCDs.

The Ministry has strengthened screening and treatment for cardiovascular disease through “Healthy Life Style Centres” at the community-level. The government has also invested billions of rupees in technologies for the detection and treatment of NCDs. These efforts have materialized in new cardiac catheterization labs, cancer centers and dialysis units in government facilities.

Growing out-of-pocket payments
Even so, a large proportion of the population accesses care for NCDs from the private sector. More and more patients, including those attending government clinics, pay out-of-pocket for the monitoring and treatment of these conditions.
Public sector patients are now directed to the private sector to purchase expensive medical devices unavailable in government hospitals. For instance, angioplasty and stenting, accessible through cardiac centers in government facilities, involves substantial payments as medical accessories (amounting to about Rs. 2.5 lakhs per stent) are purchased directly by patients from pharmaceutical representatives stationed within hospital premises.

The President’s Fund does cover a part of this cost (Rs. 1.5 lakhs per stent), and provides significant relief to those struggling to make ends meet. But that cannot be the answer as access to the Fund involves a procedure that is not immediate; many cannot afford the balance; and a patient may apply only once to the Fund in her/his lifetime.