Medical emergencies have put families across the world into poverty. But it becomes more pertinent in the case of developing nations. Those currently hit by the coronavirus are being pushed further into poverty in India.
Let’s understand the dynamics of medical emergencies and poverty in India. Despite growing medical tourism, due to relatively low-cost treatment than many of the developed countries, India is not able to support its own population when it comes to medical emergencies.
The rate of people going below the poverty line due to medical emergencies has gone up from 4.19% in 1991-92 to 4.48% in 2011-12. A recent survey conducted by the Public Health Foundation of India reveals that around 5.5 crore people were dragged into poverty in a single year due to medical expenses.
One needs to understand the reasons behind this. India has a very large population who are poor and vulnerable. They survive on what they earn daily. In such situations they don’t have any savings for emergencies.
During emergency hours, as most people don’t have any savings, they rely on borrowing money from somewhere. Their primary reliance is on informal sectors like moneylenders, relatives, vendors or wholesalers (in case the borrower is also a vendor).
In most cases the interest rate of 3% to 10% is charged leading to devastating situations post-recovery. Some even end up using the savings of their child’s marriage or money saved for a new home.Only the rich have access to formal banking sector loans which they have to apply to beforehand. In the case of SHGs and micro financing institutions it is the same.
If in case access to these institutions is available they have to inform them a few days early for any loan. Most of the loans taken up have to be paid back very shortly and it leads them into debt-traps most of the time. In many cases poor households end up selling their non-movable assets like land, cattle, gold, etc. The selling of land and cattle force them into poverty and it becomes very difficult for them to come out.
Support in the form of affordable health insurance is also absent. According to a Business-Standard report 90% of poor people don’t have health insurance. There are several factors to this:
When it comes to seeking medical help people from poor families only go to doctors when the disease becomes severe. This in the end leads to more expenses. Poor facilities in public hospitals and the apathy of public sector professionals have distressed the situation even more. People prefer going to private hospitals even though they can’t afford the expenses.
India’s public health system is dwindling with a very low hospital-bed density — 0.7 per 1000 population (World Bank, 2011). It’s the same case with the ratio of physicians to the population — 0.8 per 100 population (World Bank, 2011).
The number of medical students graduating every year is very low when compared to the actual demands. Against the promised 2.5% expenditure of the total GDP only around 1% is spent on the health sector.
High costs of medicines is another major issue which severely impacts the poor. With failed public sector mechanisms to provide medicines at affordable prices the business of pharmaceutical companies has grown a lot. The medicine which barely has a few rupees manufacturing costs comes with an MRP of hundreds of rupees. The retail market exploits the MRP to its fullest.
This is my personal experience that I’m sharing here. In Kota, while preparing for IIT there were a few instances when I had to go to medical stores. I was shocked to know that they charged me half the MRP of the medicine.
Later I came to know that being a student hub the regulations there were strict, leading to affordable prices. I was wondering whether such strict regulations could also hold on the prices all over the country where the poor are being exploited.
The situation will only worsen with the current coronavirus outbreak. The only way out would be the government’s conviction to spend more on public health. More medical institutes need to be opened. Preventive measures need to be taken in order to avoid severe cases which lead to emergencies. Mobile units can be deployed for regular check-ups in remote areas.
Impact India’s lifeline express is another model that can be adopted at a large scale which would provide relief to people from other urban areas (towns with less than a million population) who spend the largest share of their personal income, 5.4%, on medical expenses.
Apart from these steps, community engagement in the provisions for health services will be crucial to their active participation which will result in preventive health care. Only through a holistic approach, with all stakeholders’ claim to it, can it lead to a holistic healthcare service which will ensure fewer people falling into poverty circles.