A friend working in public health once told me that while mortality rates were highest in Africa, morbidity rates (the rate of non-fatal illness) were highest in India. If I remember correctly, she told me that this had to do with relatively high rates of innoculation – which cut all the nasty childhood diseases that lead to low life expectancy at birth – but a poor health system over all.
While I’m not sure if this is still true, what I do know is that getting sick is expensive, anywhere. Consider the impact of illness on financial health in the USA:
50 percent of all bankruptcy filings were partly the result of medical expenses… Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem. [Link]
p>And this is even though “68 percent of those who filed for bankruptcy had health insurance” [Link].
p>If illness wipes out the savings of relatively high (by world standards) earning Americans, you can imagine what it does to the poor in India. While the cost of medical care is cheaper in absolute terms in India, it is still a large share of already meager resources. Couple that with lost earnings, and the impact can be dire.
About one-fourth of hospitalized Indians fall below the poverty line as a direct result of their hospital expenses, according to a 2002 World Bank report. Many people take out steep loans or sell their homes in order to pay. And for the poor, losing even a day’s wages while waiting in the hospital can be devastating.
“A health event is a bigger risk to farmers than an unsuccessful crop. Once they sell their land or livestock, they become indentured laborers. That takes a generation to fix,”… [Link]
p>Free public health clinics are limited as a solution to this problem. The quality of care is poor, absenteeism is very high, and medicines go missing. In practice, even free services become privatized, as access is restricted to those who will pay.
p>A new approach involves the market, in particular, micro-insurance:
India is a world leader in this emerging field, with 5 to 10 million people enrolled in micro health insurance nationwide. Fewer than 10 percent of India’s 1.1 billion people have any sort of health insurance, much of which covers only government employees. Poor people usually work in informal jobs or are self-employed, so they are extremely unlikely to be included in employment-related plans.
… the poor are willing to pay an average of 600 rupees ($13.40) per year, or a little over 1 percent of their income, for their family’s premium. This amount exceeds the premiums currently being charged by plans, which often rely on additional subsidies, such as grants, to make ends meet. [Link]
p>Interestingly, this approach doesn’t replace public health systems, it complements them:
The programs employ a variety of means to keep costs low. Some require patients to seek care at government hospitals, which are already highly subsidized. Others curb their administrative costs by asking volunteers from the community to handle duties such as processing claims. They buy generic drugs, or grow a garden full of herbal medicines. Even small measures, such as creating identity cards that cost half a rupee (1 cent) to produce, are taken seriously. [Link]
p>And they’re hardly a panacea:
The insurance plans are also designed, with varying strictness, to reduce costs. Most exclude preexisting and chronic illnesses, such as AIDS and diabetes. The more limited plans cover only hospitalization expenses, while broader plans offer outpatient and drug benefits. [Link]
While I’m not automatically enthusiastic about all things “micro” or “grassroots”, despite all their limitations of scope and scalability, this sounds like a welcome step indeed.