The Novel coronavirus pandemic might have started in India among those holding passports but it is now reaching those clutching on to their ration cards.
The fight against the novel coronavirus pandemic is largely in the hands of government hospitals, which in India are not particularly known for robust infrastructure except for in the biggest cities. Government hospitals are plagued by a shortage of doctors, nurses and other support health professionals. And so, resources are spread thin in the fight against the coronavirus pandemic, which is the biggest human crisis since World War II.
On the other hand, private hospitals are better managed but less accountable to the people of the country. There have been reports that many Covid-19 patients being turned away from private hospitals leaving them clueless about where to go next. Some of them have died. Mumbai, in particular, has seen more such instances than other places, possibly because it has the highest coronavirus death toll among all cities.
There have been calls for a unified command for more effective coordination in the fight against the coronavirus outbreak in India.
For example, one 67-year-old person, who died at KEM Hospital on April 2, was denied admission at more than a couple private hospitals – the reason could have been anything including lack of beds. That patient might have been directed by a nodal official there to a hospital that could have admitted the patient.
Spain presents one such example.
Spain has been completely coronised. More than 14,500 have died due to coronavirus infections even though it is a country with comparatively better medicare infrastructure for the size of its population.
According to the World Health Organisation (WHO) data, Spain has three hospital beds and 4.1 physicians for every 1,000 persons. India, in contrast, has 0.7 hospital beds and 0.8 physicians for every 1,000 persons.
Still Spain’s healthcare system was pushed to the breaking point due to the novel coronavirus pandemic. It prompted the Spanish government to unveil sweeping reforms that led to nationalisation of all private hospitals. The country took over private healthcare providers and requisition materials such as Covid-19 test kits and protective gears including face masks.
Spain did it when the cases were rising, and community transmission had started. The death toll at the time was 309 from about 9,200 cases of novel coronavirus infections. In three weeks, Spain lost more than 14,000 people, and now health officials there are saying that “de-escalation” at hospitals is now being observed.
The Spanish government had declared a state of emergency to deal with the coronavirus crisis. In his video-con interaction with Opposition leaders on Wednesday, Prime Minister Narendra Modi too likened the coronavirus situation to an “emergency”.
The question is, should India take over private hospitals at least in districts where coronavirus cases are growing, until the Covid-19 outbreak is contained?
Andhra Pradesh has done it partially. It has taken over 58 private hospitals across 13 districts to deal with the coronavirus crisis in the state. This increased the bed-availability under the Andhra Pradesh government by 19,114 beds including 1,286 in ICU and 717 isolation beds.
This week, the Supreme Court directed the government to ensure that Covid-19 tests, which cost Rs 4,500 at private laboratories, are done free for all suspected cases. Private hospitals offer expensive treatment.
In one case in Mumbai, hospitalisation cost for a Covid-19 patient was reported to be Rs 12 lakh. The employer firm paid the amount. Not too many people can afford this cost of Covid-19 treatment in India.
Even the much publicised Ayushman Bharat scheme offers coverage of just Rs 5 lakh for each family. In the case of coronavirus infection, if one member of the family gets the disease, others are more likely to get it before the index patient starts showing symptoms.
The latest National Health Profile 2019 shows India’s public expenditure on health has been less than 1.3 per cent of the GDP for many years.
Low public investment in healthcare system incurs human costs. It increases out-of-pocket (OOP) spending of individuals and families on healthcare. A 2011-study published in The Lancet, said 39 million people fall into poverty every year due to high out-of-pocket spending on healthcare.
A 2018 study published in The British Medical Journal said 55 million Indians fell below the poverty line due to OOP in 2011-12. Of this, 38 million were pushed into poverty singularly by high medical costs, which have multiplied since then.
WHO data show India’s OOP in 2016 – for which comparable figures are available — stood at 65 per cent against the global average of a little over 30 per cent.-India Today