Subir Roy’s “Cashless or clueless on health care?” (August 4) made an interesting read. As somebody who has practised medicine in the US for 40 years and is currently managing a 250-bed multi-speciality hospital in Bhubaneswar, I have a few comments to make.
Much like India now, in the 1970s, the US had a cost-plus system of payment by health insurance companies like not-for-profit Blue Cross and Blue Shield. That led to an increase of 8-10 per cent a year in health insurance premium when general inflation was about 2 per cent. To rein in the rising cost, in the late 1980s, third-party administrators (TPAs) and for-profit companies like United Healthcare came into being. They demanded steep discount from the doctors and hospitals. Initially, the rate of increase in health care premium moderated but, ultimately, it did not work. By 2000, patients, doctors and hospitals were all unhappy with TPAs. Obama’s health-care plan was passed because of the failure of TPAs to rein in the ever-increasing health-care cost in the US, which accounts for 16 per cent of GDP now. Among the Western countries, the Canadian system of health-care delivery works the best. Canada provides universal care with about 10 per cent of GDP spent on health care.
India claims to provide free care to all but, as pointed out by Roy, “does not deliver free care now”. The country spends a minuscule amount of GDP on health care. It cannot even provide safe drinking water to all. Its malnutrition rate is one of the highest in the world. The health-care budget cannot tackle that. As suggested by Roy, the top 10 per cent of Indian elite can afford to go to a five-star-hotel-like hospital. But the remaining 90 per cent should be able to meet their health-care needs with a model of “public funding of private delivery”, like the Rajiv Arogyasri health insurance scheme in Andhra Pradesh or Kalaignar health insurance scheme in Tamil Nadu. It is time the central government came forward to help all the states adopt one of these models.
Saheb Sahu, Bhubaneswar
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