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A high-risk, low-reward plank that touches all

In the four weeks since her 12-year-old son was diagnosed with blood cancer, Shah Jahan Begum has only fleetingly wondered why the government isn’t paying for the medicines he will need.

Shah Jahan Begum and her husband Nur Alam, who live in Bankra town in Bengal’s Howrah district but have brought their son to the All India Institute of Medical Sciences here for treatment, say they have nearly exhausted their savings.

Their medical bills have hurled them into a set of households facing catastrophic health care costs at about the same time the Congress, the BJP and the Aam Aadmi Party released manifestos pledging health care for all ahead of the 2014 general election.

Health surveys suggest about seven million households across India — more than double the number of households in Calcutta during the 2011 census count — are challenged by medical bills that exceed 40 per cent of their capacity to pay, a standard definition of catastrophic health expenses.

“We heard the government gives assistance to cancer patients, but we didn’t know how to get it, and my son needed treatment fast,” Shah Jahan Begum said on Monday, while she sat on a pavement outside the AIIMS Rotary Cancer Hospital waiting for her son’s turn to receive an injection.

“The doctors here are very kind, but not all the medicines they prescribe are available for free,” she said.

The couple have been told the treatment may take three to six months. Alam, who works in a factory near Howrah making metal bangles, said the longer he stays away from work, the harder it will be to pay for the medicines.

Their plight, sections of health experts and social scientists say, reflects India’s paradox that health remains a weak political issue — among both political parties and the public — despite rising health care costs. “Both political parties and the public seem to understand that making universal health care a reality is not something easy to do,” said Rohini Somanathan, professor at the Delhi School of Economics, who teaches the economics of health and education, among other topics.

“The existing health system functions poorly, it’s a broken system that doesn’t inspire confidence,” Somanathan told The Telegraph.

“Political parties and the public recognise reforms needed to correct the system are enormous. But if a political party were to get its act together and start something the day it comes to power and deliver within five years, it could win votes — health, education and safety are a citizen’s biggest concerns.”

A nationwide health survey eight years ago showed that about 70 per cent of urban households and 62 per cent of rural households in India rely on the private medical sector as their primary source of health care.

Health experts say things have not changed since then. “Government health facilities in India are generally perceived to be of poor quality — so voters may not be convinced by the promise of improved government health care,” said Tannistha Samanta, assistant professor of social sciences at the Indian Institute of Technology, Gandhinagar, who specialises in public policy and health.

“Political parties may find highlighting health care to be a high-risk, low-reward move,” Samanta told The Telegraph.

But some believe the steep rise in health care costs in the private sector in recent years could push health care into the political limelight.

“The most vocal sections of the population, the middle-classes, mainly use the private sector,” said Abhay Shukla, a community medicine specialist with Cehat-Sathi, a non-government organisation in Pune. “If this section raises the issue of high costs, health care could become a bigger political issue.”

Samanta said health care initiatives launched over the past decade and specially targeted for the poor may be signals of reform in the health care sector. Andhra Pradesh, Tamil Nadu, Kerala and Rajasthan have already introduced components of universal health care in different ways.

Andhra, for instance, introduced a public health insurance plan in 2007 that covers a household for up to Rs 2 lakh a year for a small premium paid by the government. Health experts estimate that over 70 million people are covered by the plan.

“Public expectations will rise in such an environment,” said Krishna Rao, a health economist at the Public Health Foundation of India, an academic and research institution in New Delhi. “People want more — the government will need to expand its role in a big way.”

But until that happens, households like that of Begum and Alam, struck by nasty illnesses that are expensive to manage, will continue to face catastrophic health expenses that may force them to change the ways they live.