Saturday December 7, 2019

How govt can provide better healthcare system to more than 125 crore people in India

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With a population of more than 125 crore, contemporary India yearns for another opportunity to become a global leader. Looking at our credentials of democracy, diversity and tolerance, many look upon us as the future of the world. But the rural-urban divide and non-inclusive, lopsided development remain a matter of concern. While Silicon Valley in USA thrives upon the innovative minds of Indians, back home, the country has no credible research and development (R&D) and innovations to boast about. Similarly, Indians constitute 5% of the doctor workforce in USA (and 20% of its International Medical Graduates). Indian health workers are also the pillars of medical services in the Middle East. In contrast, in India we continue to struggle with health challenges. With a massive population load and gross national income per capita of $3,900, India spends just 4.1% of its national budget on health. It has one doctor for 1700 citizens (WHO says the optimal number should be 1:1000). Cuba has 6.7 and America has 1.5 doctors for their 1000 population. With its gross national income per capita of $54,000, USA spends about 18% of its budget on health. However, this is not to say that everything is in perfect shape in USA. In fact, many experts feel that the American health system is ‘broken’ due to its inability to provide health care to millions of uninsured people.

With this background, let us study the basic health care delivery models that are prevalent in the world.

The most prevalent service model is ‘Out of Pocket’. In India, we may not have any problem in understanding this concept: You are responsible for footing the fee and bills to the doctor and/or hospital. Well, many will say, the government does provide free universal health care to all its citizens. That is true. India claims (unlike USA, as we shall see below) that anyone can visit a government healthcare facility and avail treatment literally free of cost. However, in actuality, the government health facilities are dilapidated, over-crowded and dysfunctional thanks to poor work ethics, chronic absenteeism and corruption, thereby limiting the access for a large chunk of population.

Contrast this with Britain’s National Health System (called the Beveridge Model). Here, the government provides health care through its government doctors, clinics and hospitals. The private medical sector is negligible. Everyone is eligible to choose a General Practitioner (GP) who is your primary doctor and avail medical care free of cost (the care is free at the point of use).The government will pay your bills. In communist Cuba, hailed by many as the successful model for a developing world, the same system is seen in extreme form: the whole health care system – be it clinic or a pharmacy- is owned by the government. No doctor is allowed to have a private practice.

Canada also provides a universal health care to its citizens, but in a different way. The government provides every citizen a health insurance (National Health Insurance model). The patient can choose to go to a private clinic or a government doctor or facility.

Germany has a slightly different system. The government mandates a health insurance for everyone, and that is provided by the employer. The employee also contributes a part of that. But the whole system is created not to make profit and must cover everyone, even if unemployed.

The above models are typical examples of what we call Socialised Medicine, where the government pitches in to provide subsidies through taxation. In other words, these are public-funded health care programs.

When it comes to USA, the concept of universal health care becomes fuzzy. According to the Institute of Medicine, USA is an exception among the developed countries that does not provide a universal health care. Here the government hardly runs any health care centres (except a few county hospitals administered by county governments. One famous example is Cook County hospital in Chicago). For a majority of people, health care benefits come through their jobs. In other words, your employer will buy you a private health insurance. You also pay a portion of that premium per month, though. The companies that issue health insurance are called Health Maintenance Organisations (H.M.Os) and they are for profit. But if you become unemployed or operate your own business, you have to buy your own private health insurance. However, for army men, the government provides health care through government–owned and operated facilities (Department of Veteran Affairs). For senior citizens (more than 65 years of age), the government runs a Medicare insurance scheme and thus bears the costs of their medical bills (Canadian system).

Thus it is obvious that India has a mixed system where the government pledges to provide health care, but is unable to meet the demand. The private health sector is robust, but the poor and needy may not be able to use the services for want of money. How do we strengthen the health care system in India, then? We need to increase access to affordable and quality health care for everyone. India needs to increase its budget share on health, particularly preventive and primary health care. In addition, we must produce more doctors and para-medical forces. Instead of running the health facilities itself, the government will do well to broaden health insurance to its citizens and put good regulations in place so that through the private sector, it can provide much needed health care to its citizens.

A MK

The author is a a practicing Neonatologist in Chicago. This op-ed is an exclusive article in his series Musings from Chicago. You can reach out to him at e-mail ID: pedia333@gmail.com and on Twitter @drMunishRaizada.

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Reduction in Air Pollution May Increase Life-Expectancy: Study

Findings of a Research indicate almost immediate and substantial effects on health outcomes followed reduced exposure to air pollution

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Pollution
Fortunately, reducing air Pollution can result in prompt and substantial health gains. Pixabay

Reductions in Air Pollution yielded fast and dramatic impacts on health-outcomes, as well as decreases in all-cause morbidity, a new study suggests.

The study, published in the journal Annals of the American Thoracic Society, reviewed interventions that have reduced air pollution at its source. It looked for outcomes and time to achieve those outcomes in several settings, finding that the improvements in health were striking.

Starting at week one of a ban on smoking in Ireland, for example, there was a 13 per cent drop in all-cause mortality, a 26 per cent reduction in ischemic heart disease, a 32 per cent reduction in stroke, and a 38 per cent reduction in chronic obstructive pulmonary disease (COPD). Interestingly, the greatest benefits in that case occurred among non-smokers.

“We knew there were benefits from pollution control, but the magnitude and relatively short time duration to accomplish them were impressive,” said lead author Dean Schraufnagel from the American Thoracic Society in the US.

“Our findings indicate almost immediate and substantial effects on health outcomes followed reduced exposure to air pollution. It’s critical that governments adopt and enforce WHO guidelines for air pollution immediately,” Schraufnagel added.

Pollution
Reductions in Air Pollution yielded fast and dramatic impacts on health-outcomes, as well as decreases in all-cause morbidity, a new study suggests. Pixabay

According to the researchers, In the US a 13-month closure of a steel mill in Utah resulted in reducing hospitalisations for pneumonia, pleurisy, bronchitis and asthma by half.

School absenteeism decreased by 40 per cent, and daily mortality fell by 16 per cent for every 100 µg/m3 PM10 (a pollutant) decrease.

Women who were pregnant during the mill closing were less likely to have premature births.

A 17-day ‘transportation strategy,’ in Atlanta, Georgia during the 1996 Olympic Games involved closing parts of the city to help athletes make it to their events on time, but also greatly decreased air pollution.

In the following four weeks, children’s visits for asthma to clinics dropped by more than 40 per cent and trips to emergency departments by 11 per cent. Hospitalizations for asthma decreased by 19 per cent.

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Findings of the Study indicate almost immediate and substantial effects on health outcomes followed reduced exposure to air pollution. It’s critical that governments adopt and enforce WHO guidelines for air pollution immediately. Wikimedia Commons

Similarly, when China imposed factory and travel restrictions for the Beijing Olympics, lung function improved within two months, with fewer asthma-related physician visits and less cardiovascular mortality.

“Fortunately, reducing air pollution can result in prompt and substantial health gains. Sweeping policies affecting a whole country can reduce all-cause mortality within weeks,” Schraufnagel said.

ALSO READ: YouTube India to Focus on Regional Languages For Driving Creator Growth

Local programmes, such as reducing traffic, have also promptly improved many health measures, said the study. (IANS)