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HEALTH COSTS

Those who once said that health is wealth could not have gauged the depths of their own prescience. With a subtle but devastating shift in meaning, the phrase has come to mean health is wealth untouched, and sickness is poverty. In spite of recent efforts by governments, such as the United Progressive Alliance’s National Rural Health Mission or the Bharatiya Janata Party’s vision of health insurance for all, India’s health delivery system is riddled with anomalies. The older government hospital system has been driven to the ground by deprivation, neglect and exploitation, while private hospitals — many of which invite health tourism — thrive largely on the illnesses of the various strata of the middle-class and the segments bordering it just above and below. There are exceptions to both, of course, but this is the general picture. Today, except for the rich in India, a serious illness is financially fearsome, and often tragic even before treatment can begin, ironically because there are choices — and these are harsh and inescapable.

Those who can afford some sort of insurance have a kind of consolation, but now the general insurer, National Insurance, has asked for a national regulator for health to regulate prices of private hospitals. Given the size and number of claims, insurance is apparently becoming a loss-making business. The insurer argues that, for an integrated health delivery system, a regulator must scrutinize financing and delivery of health goods. It is part of India’s anomalous health system that here a public sector body, National Insurance, is being pitted against private hospitals, which, however exorbitant their prices, are ultimately regulated by market forces. The consequences of this situation for an already suffering people are dire, but the way out cannot be sought through a government regulator sitting on private institutions. Policy-makers must decide on priorities. Making the best possible treatment available to the widest swathe of people would mean reforming the health system from the bottom up — including the modernization of government institutions from primary health centres to hospitals, the standardization of teaching and distribution of medical and para-medical staff as well as the broadening of the health insurance net. Private hospitals would find their own level, especially if what is monitored is not their pricing but their medical services.