Monday, December 07, 2009

Community Solutions For Healthcare

While the healthcare debate in America rages on, universal healthcare is not optional for the developing countries; it is a must have if these countries are going to run as functional societies. I have India in mind in particular. Indian government is increasingly deferring to the private sector for providing healthcare services, while making some efforts to get a nationwide health insurance scheme going for the poor and the needy. But that effort is more of a political spectacle, as most of the state-run hospitals are suffering from lack of investment and infrastructure. Most of the state hospitals, the sheer sight of it, are so scary that one would think it is designed to drive whoever can afford to private hospitals. In effect, there is a two tier system being created - one that costs money but provides services, and the other which does not cost money for no services. That surely not the way to look at this problem.

It is a problem because Indian government can't obviously do a carte blanche solution for universal healthcare. One hears arguments like a set of brand new hospital in every Indian village costs as much as a few Sukhoi fighters, but unfortunately those Sukhoi fighters will be needed, at least for some time. It is not an either/or, and this is where most of the liberal advocacy has gone awary. One has to see how India can maintain a credible defence establishment, continue to invest in its physical infrastructure, not cripple the middle class and businesses with an overwhelming tax burden and yet move towards an universal healthcare provision.


I don't think the solution to this will come from the market-based economics, because it is not a market issue. Poor people dying because they can't afford treatment isn't sustainable in a democratic society, and if we allow that to happen, this issue itself will push us to mutate into a more elitist/ oligarchic society [which, I shall fear, will happen to America]. There is no textbook solution for provision of healthcare for 1.2 billion people, roughly half of which will be below poverty line. So, one has to look for solutions elsewhere.


Thinking about this issue, one sees that some form of community-based solution needs to be found here. For example, government probably needs to find the money to set up the basic healthcare infrastructure across the country but let the community run it whereever possible. And, even pay for it by way of a local tax. There is some bureaucracy involved, but if the management of the system is accountable to the community - let's say a hospital board drawn from a cluster of village administrations - it will be rid of many of problems a bureaucracy entails. There will be politics involved, yes, but this can be battled with a patient's charter of rights and a system of direct accountability. Besides, with such a system, the focus should shift to prevention rather than cure in the healthcare system. The community should be aware that their taxes would go down with healthier lifestyles, and they should be responsible to create awareness and programmes to promote healthier living.

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