E.S. Krishnamoorthy

We must acknowledge that quality healthcare is a fundamental right, and not a privilege, and transform the current lack of equitable healthcare provision into a fiery debate.

  • In reality, quality healthcare services are often expensive
  • Focus must shift to achieving equity in healthcare
  • Announcements from the healthcare sector make headlines in India every day; about new facilities and equipment being unveiled; and about the potential of healthcare tourism as the new sunshine industry. There is little doubt that Indian healthcare is shining like never before. Well-trained doctors, many with considerable international exposure; a well-established system of nurse training that has made Indian nurses hot property in the west; well-equipped hospitals with contemporary equipment that can be accessed without significant waiting times; all inducing in us, a pride about Indian healthcare’s new place under the sun.

    The “3A” test

    Let us however pause for a moment and ask whether these advancements truly reflect improved healthcare for all Indians, whether we deserve to take pride in them, or indeed be comforted that they will serve us well when we need them most? Good healthcare systems world over must pass the “3A” test, being “Accessible,” “Affordable” and “Acceptable.”

    Not having access to quality healthcare is equivalent to not having healthcare at all. Both corporate hospitals and the government-run medical college hospitals, which frequently make the headlines, showcasing advances, are located in major cities, sometimes in towns, far beyond the reach of the average rural Indian. His awareness of these facilities, his ability to get to them in time, indeed the courage and wherewithal he needs to muster in order to approach them for help, remain, even today, barriers to accessing high quality healthcare. A further barrier is his ability to access, within these portals, the services that he really requires, without being misdirected or somehow exploited.

    Having accessed these hallowed portals, the common man has to then dig deep into his pockets to pay for their services. The blurb these tomes generate may indicate service and dedication; the reality often is that these services are only available at significant expense, either because it is necessary and possibly justifiable (as in the corporate model) or necessitates non-official expenditure (in the government-run equivalent). In either event, access to such state of the art healthcare is usually directly proportional to one’s ability to pay (or use influence). The situation is not unlike, therefore, the swanky new designer store in your neighbourhood. You are welcome to walk in and window shop, but can you afford to buy anything?

    The third A represents acceptability. Here we do not anticipate problems; after all, how can such state-of-the-art healthcare be unacceptable to anyone? Surprisingly, in talking to healthcare consumers, several examples of unacceptability emerge. Impersonal (albeit arguably efficient) hospital systems make the experience of hospitalisation both daunting and dehumanising. While in smaller clinics and hospitals, the chief doctor directs the consultation and treatment process, he is replaced in these ivory towers by a procession of specialists, all of whom seem to then proceed to order tests and treatments, not always after adequate discussion or explanation, with the junior doctor being the sole link to the patient. Another common acceptability issue is the perception among consumers, that healthcare provision is not always proportional to the patient’s human condition, being pitched too high (or indeed too low). These consumer-service provider conflicts do of course often have their genesis in poor communication, another factor that impacts on acceptability.

    On the flip side, legions of Indians belonging to middle and higher income groups’ benefit today from these advances in healthcare that come to their doorstep. The compulsion to travel abroad, even for complicated surgical procedures, has disappeared, as has the need for western expertise, the ill VIP being the singular exception. The healthcare industry is now generating valuable foreign exchange through its tourism efforts, as endorsed by the recent CII report that pegs additional revenues for tertiary hospitals at over Rs. 8,000 crores. There has to be, inevitably, a trickle down effect that will also benefit less privileged members of the communities we live in.

    Striking divide

    Nevertheless, the lack of equity in healthcare is among the most striking examples of the divide between the haves and have-nots in this country, with education and housing completing the triumvirate. The focus must therefore move immediately from the mere provision of modern hi-tech healthcare and promotion of healthcare tourism, to a core issue that matters to every Indian citizen: equity in healthcare, and how it will be achieved in India, this century. To do this we must first acknowledge that quality healthcare is a fundamental right, and not a privilege, and transform the current lack of equitable healthcare provision into a fiery debate that can win (or lose) elections. The failure to achieve such a mindset change, among the Indian public and its political masters, will result in the average Indian citizen remaining a tourist to healthcare provision in his own country, and to equitable healthcare remaining a distant dream.

    (The writer is Director and T.S. Srinivasan Chair at the Institute of Neurological Sciences — Voluntary Health Services Hospital, Chennai. E-mail: esk@nsig.org)