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Defining affordable healthcare in an increasingly unaffordable world

In a recent meeting of mine with a very senior & learned official in India’s Ministry of Health, I stumbled upon one question which was posed to me during our varied points of discussion. What does affordable health care really mean, in the true sense of the term?

There are many ways to look at how one would like to answer this question. Firstly, has affordable healthcare ever been visualized through the lens of a Health in All Policies approach? In a diverse nation with complex parameters, addressing healthcare needs an iron fist to boost the way it has been over the years. Health has never been an agenda on which political battles were ever one. This naturally reduces the priority level when it comes to the politics of opportunism. As a nation state, India has seen out of pocket spending as a norm as public hospitals make healthcare challenging for those whose voice cannot be heard.

Nevertheless, the healthcare industry is growing both in terms of revenue turnovers and in terms of job opportunities, thanks to the private sector and business-driven markets. So when businesses are driven by investors and turnover tycoons, where can the question of affordable health care really remain? Affordability in the private sector will be unrelated when you have your appointment planned, your lunch and dinner menu customized, your room peaceful with air-conditioning and a 24 by 7 call nurse available whenever you need any assistance.

It falls back on the state to ensure that India’s most vulnerable get the healthcare they deserve and with optimum quality. Affordability need not merely be met with finance capital or the ability to pay, it needs to be also viewed through the lens of the ability to seek services which make sense and appeal to the masses and the classes. Since the Bhore committee report in 1946, India’s Health Ministry has invested heavily on taking healthcare to the villages. It is here that we need to engage in strengthening existing health systems rather than disrupting the same under the garb of innovation.

Affordability does not require innovation at all times, it simply needs lateral thinking. A lot of times affordability and accessibility are pitched on the same note, however, let us logically think. If coca-cola like soft drink brands can reach the most difficult places, what prevents vaccination from reaching there, what prevents essential medicines from reaching there?

I would like to float the concept of “Door-step Doctor” as a solution for India’s myriad triple burden of diseases. If we could have postal service at our doorstep, if we can have dominos pizza at our door-step and if we can also have ASHA workers at our door-step, the dream of affordable healthcare will be a reality to our billion beat nation, when we push forth the door-step doctor to reach villages in parts on a regular basis as a policy norm. This door-step doctor will be the Chief Medical Officer, the most competent person to take a decision on the spot, to undertake monitoring and evaluation, to conduct environmental centric research which will also determine social outcomes of health and who in the true sense of the term builds community resilience through inter-sectoral coordination and behaviour change strategies.

Tamanna (name changed) had 7 children and conceived yet again at the age of 41 came seeking health care during a camp we organized in one of the rural heartlands of India’s village. Her problem was she was pregnant and did not want the pregnancy. Travelling was difficult for her, and she feared wage loss, therefore, preferred to continue working. Her only solace was a medical officer offering advice and timely treatment as appropriate. Again going to a private care provider was unaffordable and the government doctors who technically were supposed to treat her free, charged her exorbitantly was her claim. Can we aspire for affordable healthcare with universal health coverage when many such Tamanna’s still are deprived of something as basic as health? Perhaps, it is that time of the day when Ayushman Bharat is one of those many steps in the right direction. There is much done and much more left to do.



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