Unable to pay medical bills, some just choose to die

Source from New Straits Times

INDIA is being projected as young, vibrant, incredible and resurgent, everything that is music to the ears. But it is not a healthy India.With 45 per cent of the population below 20 years and 54 per cent below 25, India takes pride in being a young nation. However, health indicators are poor.

Recent research shows coronary artery disease (CAD), affecting nearly 90 per cent of heart patients, is hitting people as young as 30.

Vivek Gupta, the hospital's intervention cardiologist, says: "There is an alarming shift in the pattern. Out of 100 patients visiting New Delhi's Indrapratha Apollo Hospital, 70 per cent are 50-plus, 15 per cent are between 40 and 50 years and 10 per cent are below 30 years. Of the 10 per cent, between two and four per cent are 20-somethings."

In a paper titled "Coronary Artery Disease in Young Indians: The Missing Link" H.S. Rissam, S. Kishore and Naresh Trehan wrote: "The risk of CAD among Indians is three to four times higher than among white Americans, six times higher than Chinese and 20 times higher than Japanese.

Compared with the Western population, where the incidence of CAD in the young is up to five per cent, it is 12 to 16 per cent in Indians.""Working towards Wellness: An Indian Perspective" shows that the mortality rate among CAD patients in India is estimated at 30 per cent in the 35 to 64 age group. By comparison, the death rate due to cardiovascular diseases in the US is 12 per cent, 22 per cent in China and 25 per cent in Russia.

The main culprit, of course, is smoking. A study published by The Lancet in 2006 revealed that sixth-grade students in Delhi and Chennai used significantly more tobacco than eighth-grade students.

Causes among the young are sedentary lifestyles, stress, excessive competition, desk jobs, bad food habits and lack of sleep. Lack of social security drives them to push themselves harder, so they face a lot more stress than Western youth.

Lack of knowledge adds to the problem. Since none readily believes a young person may be having a heart condition, chances of delayed treatment are high.

The latest report of Global Hunger 2007 from the International Food Policy Research Institute says that 40 per cent of the world's underweight children below 5 live in India. More than half of all children with low birth weight are born in South Asia.

Eating after the male family members, "Mother India" is left to eat the leftovers. "The result is children of undernourished and anaemic mothers who have a higher risk of being born underweight," says the report.

India's public expenditure on health is only 20.7 per cent of the total, compared with Bangladesh's 25.2 per cent, Pakistan's 34.9 per cent and China's 33.7 per cent, says another study jointly conducted by Associated Chambers of Commerce and Industry of India and PriceWaterhouseCoopers.

With Rs165.3 billion (RM120 billion), a 15 per cent increase in the budget for 2008-2009 has been proposed for healthcare and to fight HIV/AIDS. But that would be just 1.1 per cent of gross domestic product.

Public expenditure on healthcare in Pakistan and Bangladesh is higher than in India because of two reasons. The economies of Pakistan and Bangladesh are emerging for development, and that is why their governments have been making higher healthcare allocations for their people to partake in global competition, the study says.

India is no longer fighting shy of its baby boom. Indeed, the growing population is taken as an asset. It is a far cry from the earlier attempts to enforce an incentive-driven two-child norm.
The result is numbers, with poor health quality. India's population may exceed China's sooner than the estimated year of 2030.

India today bears the burden of both communicable and non-communicable diseases. Besides tuberculosis, malaria, pneumonia and HIV/AIDS, hitherto neglected diseases like diabetes are likely to take endemic proportions.

It is expected that the country would have around 57.2 million diabetics by 2025. Add to them some diseases and ailments that have refused to go and have indeed, increased. Among them is blindness; India has the world's largest population of the blind.

P. Sainath in his book Everyone Loves a Good Drought notes that infrastructure of public health in India is rickety. Thousands of primary health centres in the rural pockets have not seen doctors for years.

Kalpana Jain, one of India's best-informed writers on health issues, has run a health e-letter for the past one year.

She says: "Only 17 per cent of the total healthcare in India is borne by the state; the remaining 83 per cent comes as out-of-pocket expenses by the people. The poor are at a severe disadvantage. In the absence of any savings, they slip deeper into debt. Healthcare costs remain the main reason for 35 per cent of the poor sliding down the poverty line."

India is blessed with different schools of medicine: Ayurveda, Homoeopathy, Unani and Siddha. While paying lip-service to them, the government promotes mostly allopathy.

Medical tourism is the new injection that is fuelling the Indian economic boom, having earned US$333 million (RM1 billion) and growing at 30 per cent.

More and more hospitals are tying up with multinational chains and developing super-specialities, mostly in the urban areas. Good medical help is there for those who can pay.

These swanky hospitals are essentially health shops that provide no health education. There is no medical college attached to any of them, as is the case with the shabby, neglected, crowded, government-run hospitals. The medical-college-and-hospital concept is being passed over.

Admission to the government-run colleges and at universities is expensive. A seat is bought for upwards of Rs2 million. Little wonder, the medico wants to recover it fast. The villager is left to the mercy of quacks.

The Indian's lifespan is going up, but so are the diseases. Health insurance snaps at 58 or 60, just when it is needed the most.

Says Jain: "Some of the vulnerable groups such as the elderly find they have little choice in their growing years when faced with high healthcare costs. Doctors admit they find many elderly patients, especially women, stopping treatment once they learn that the cost of treatment would be way beyond them. Doctors suspect many of them just choose to die."