With over 85% out-of-pocket, healthcare expenditures and less than 30% government health care spending, India has one of the most privatized health care systems in the world. Largely unregulated, health care is a free market commodity. It is consumed, bartered for and negotiated in rhythm with market supply and demand. One’s body and its individual health needs is a side note, a secondary consideration.
I want to take a moment to explain what that means in a different way. Typically, when you go to the doctor, the doctor examines you and uses his or her (expensive, time-consuming and specialized) knowledge to come up with a diagnosis and prescribe treatment. In a privatized, market-driven health care economy, this doctor benefits monetarily from prescribing you pharmaceuticals, tests and medical procedures that you might or might not need. While to some extent, this is true in many health systems — in India, this plays out in a blatantly open process through which healthcare is negotiated in terms of how much you (as the patient) is able to afford and/or pay for. Less importance is given to whether or not your body needs it or not.
This does several things.
1. It creates a medical model that values (and benefits from) pathologising our bodies’ reactions to stress and/or trauma. Not surprisingly, it’s a model that also devalues our own abilities to fight disease and stress. (You will almost never hear a doctor tell you to go home, drink plenty of water and rest in India. Antibiotics are routinely prescribed for viral flu infections and (cheap) flu vaccinations are unheard of).
2. Access to health care is a luxury with its own tiers designated for those willing to pay more for better care. It is consumer-driven and thereby, subject to the same forces that dictate purchasing a nice car or an ipod.
When the obvious inequalities and human rights violations are questioned, inevitably public-private partnerships emerge as some sort of solution. Which brings us to Apollo Hospitals, one of India’s largest private chain hospitals with centers all over the country, inaugurated and blessed by Prime Minister Manmohan Singh himself.
In 1988, the government leased prime property to Apollo Hospitals on a token payment of one rupee/ per acre.
Via the Indian Journal of Medical Ethics
By the terms of this agreement, the government provided 15 acres of land and Rs 16 crore. In return, the AHG [Apollo Hospitals] agreed to provide free services to patients occupying at least one third of its 600 beds and to 40 per cent of those seeking outpatient care (1). A landmark public-private partnership (PPP) was thus embarked upon.
In 2009, the Delhi High Court imposed a fine of Rs 200,000 on Apollo Hospitals for not abiding by an earlier court order of providing healthcare to poor patients. This fine is then a particular sweet bargain price for land subsidies that would have otherwise cost millions.
NDTV recently did some excellent reporting on Delhi’s Apollo Hospital’s shaming of poor patients who try to access care at the hospital.
It’s worth watching.
Again from the Indian Journal of Medical Ethics
A review of the terms of agreement clearly indicates that the expectation and agreement were not for the AHG to render “charity” or even to engage in corporate social responsibility. Rather, the Delhi Administration had established a legal obligation for the AHG to provide certain clearly specified services for its citizens in return for a substantial financial subsidy to the company.
Apollo Hospital is not the only one, of course.
Private hospital enterprises like the AHG (followed by others like Max, Fortis and Wockhardt) […] have [all] employed the strategy of lobbying the government for concessions, promising free or subsidised treatment for a percentage of patients – a promise unkept.