 Welcome to NewsClick, we have with us Dr. Mitse Ngupta, who is going to talk to us about the health sector in the country and how it is a sorry affair. So recently in Delhi, we had seen the two big hospitals, the Fortes and the Max Hospital, involving in malpractices. One hospital declaring 20 feet is dead and also the other hospital keeping a boy, a girl in the hospital and charging about 18 lakhs. And they were not even showing some humanity, they even charged for the bed sheet that they covered the dead body. I mean, what do you think is the health sector and why do you think it is in this sorry state of affairs? So the two incidents in Delhi in the last few days have actually focused on the absolute breakdown of regulation in private health care. And points to the fact that private hospitals today appear to be in a position to get away with anything, charge whatever they want to and also provide services that are of poor quality on one hand. And the widespread existence of malpractice in these private hospitals is also something that these two incidents bring out. Now this is not something that is new. It happens across the country in almost all or most big hospitals, corporate hospitals. In the last two decades, there has been a shift where commercial enterprises, corporate enterprises have entered the health care sector. As against what you had say about 20 years back, when most big private hospitals were also run by charitable trusts or they were doctor run hospitals. So a few doctors would come together, start a polyclinic that would grow into a hospital. Now all that has changed. What we are seeing now are the Apollo's, the Max's and the Fortis' who look at the health sector as an enterprise and as a way of making money. So the quality of care, the kind of expenses that are involved are dependent on what they see the market as being able to deliver for them. And this is something that will not change unless there is a real attempt to regulate practices, both the quality of care, the pricing of care and the outcomes. And this happens all across the world, but it doesn't happen in India. No, but sir, India is one of the highest and the most privatized health systems in the world. Why do you think that is? Because we are a poor nation and we expect the government to invest in health care. And India is also one of the worst performing in terms of how much we spend as percent GDP on health care. We are among the bottom 10 if you go by the World Bank and WHO databases. And public expenditure has stagnated around between 1 and 1.2 or 1.3 percent of GDP. Since the last 40 years, almost ever since independence. And health care is an area where if you do not have public services, people by force will migrate to private facilities in the private sector. And that's what we are seeing today. And additional impetus to this is the role of technology. The fact today that you have technologies that can actually meaningfully treat a number of conditions that earlier you could not, is something that the private sector is making use of by introducing high-cost technology and by charging amounts which are really off the roof. Also the neoliberal reforms have led to a section of the people having a lot of surplus money. And that is what is the primary target of the big corporate hospital. But unfortunately, they are also now attracting a lot of people who otherwise cannot afford to get treated in these hospitals. But because of the lack of public services are forced into these facilities. So I mean, you talked about negligence in the first part. How do you think? Because the market economy operates on no government interference and no rules. And the market will take care of its own. Do you think that logic is applicable in the health sector? Market does not regulate in the health sector. And that is true not only for countries such as India, but across the world. And that is why if you look at most developed economies, health sector is one area where there is independent government regulation, where the public sector is actually the largest provider of health services. And there is a particular reason why market does not regulate. They are not answerable to anybody else. And the main impetus in their functioning is how can you maximize profits? And they maximize profits in two different ways. One is by doing unnecessary procedures in keeping on like the Fortis case in Delhi. It appears that the child who was brought in with very severe hemorrhaging dengue fever was put on the ventilator on the second day. And according to the testimony of the child's father, it seems that the child was probably brain dead by the second or third day. Yet they kept the child on a ventilator for two weeks. They were also making a profit out of the medicines that they were giving to the child. Without regulation, you will expect these trends to continue in the corporate hospital. Not only this hospital, there was a similar case in Medanta, where a seven-year-old boy was put in on ventilator. And the parents had to sell their own house. They came from Gwalior. And they were, I mean, it is reported that the ambulance drive, the ambulance service providers, they were insistent on going to the corporate hospital instead of going to a government hospital. How do you think this nexus works? You have a huge nexus between individual doctors, between hospitals, between different levels of care workers who are given incentives in order for patients to be pushed into these hospitals. So in a way, these hospitals have a system in place where they are foraging for patients. Two or three decades back, every localities, middle class or low middle class localities would have several practitioners who are known as the GPs or the family doctors. Now, even they have disappeared because they have become franchises. They now find it almost impossible to practice on their own, given the rise of the corporate sector. See, most patients would not require to go to a hospital. Less than one percent of patients who get sick actually need to go to a hospital. But the trend is towards trying to push patients towards corporate hospitals. And once you are in the system, it's out of your hands because of the information asymmetry. You go by what the hospital tells you. Sir, it has been reported that every year about 38 million people are pushed into poverty in India. And with no government regulation, you see more of this. It has been reported that even childbearing in India is such an expensive exercise. So where is our health sector going? Is there no outcry from public or is there not enough pressure on the government to actually put in place some systems? In the run-up to elections, you never see health as an issue that is foregrounded. You may get a sporadic human cry like recently in Delhi. But there is no systematic focus in our political process that puts pressure on the government of the day to actually provide for better healthcare services. Now, in that sense, India is quite unique because that's not what you have in almost any other part of the world. Even in the United States in the last elections, if you remember, or in several elections, health insurance has been a big election political issue. In the UK, the attempt to privatize the NHS is a huge, huge political issue. So you have that in developed countries as well as developing countries. Public health is finally a solidarity-based process where you raise taxes in order to cover for illnesses of whoever might suffer from some disease. And because you raise taxes, so the rich obviously are supposed to pay more. That's the solidarity-based model of public health. Whereas in India, we follow the individual model of public health. Probably it's somehow related to our understanding of karma that if you fall ill, you suffer and you die. And it's seen as an individual responsibility. So there is this fatalism that is related to disease and illness in India that seems not to lend itself to a solidarity-based public system. That sees health care as a right and not a charity. Coming back to the issue of medical negligence and the fraud being committed by major hospitals, what do you think should be the checks and balances? In the UK, people don't go to private hospitals unless you feel the rich. And the reason you don't is because public hospitals provide care which is of a higher order. So functioning public systems are the best check as far as both quality of care is concerned and pricing of medical procedures are concerned in the private sector. So that's the first thing. The second, in the interim, because even if you were to initiate such an exercise in improving public services, it will not happen overnight. You have to put in place stringent regulatory mechanisms. And this is what we see happening now in almost all parts of the world. For example, if you look at Japan, Japan is interesting because most of the services are provided by the private sector, which are part of a mandatory insurance system where the government pays for most of the expenses. But the services are by the private sector. But Japan has one of the most stringent regulatory mechanisms in place. It's not necessarily the best system. As I was saying earlier, the most effective system. In fact, all the success stories of public health are of countries where the dominant mode of provision of care is through the public sector. So if you look at Asia, South Asia, Sri Lanka, 90 to 95% of hospitals are in the public sector. You look at Thailand, you look at Malaysia, some of the better performing countries, you see the same thing. If you look at Latin America, it's Costa Rica, it's Cuba, countries such as that who have always had a big emphasis on public sector provisioning. And as I said earlier, most of Europe, you see that. In fact, you contrast that with what you see in the United States. The United States is the one country among the developed economies, which has a large functioning private sector. And the United States is acknowledged as the most inefficient health system in the developed world. So public sector provisioning, public investment is key and regulation of the private sector, both of quality of care as well as of the pricing of various procedures is concerned. Like Dr. Amit said that in India, we don't have enough discussion and political pressure on the health systems that I mean that govern our country. It should become a discussing point where we talk about the cost involving childbirth to the health of the each individual family. And when there is a discussion among the community, among the people, I think it becomes a discussion point for the politicians and the political parties. I think only that pressure can set right our a-link health systems. Thank you for watching NewsClick. Do subscribe and like our channel as well. Thank you.