There has been a slow but steady
investment in healthcare by several multinational companies and even investment
by proxy by the IMF through the International Finance Corporation(IFC).The
aim of the investment by the multinationals and venture capitalists
is maximizing profits in the chosen ventures. This investment can only have maximum returns
if a greater proportion of the population utilize the services of the
for-profit healthcare providers and a nudge towards this can only come from the
inaction to solving an industrial dispute pitting doctors and government run
facilities. The resulting vacuum generated by such inaction will result in an
acceptability of greater privatization of even essential services that are
currently available in public hospitals. Several private equity firms have in
the recent past made in-roads in acquiring local stakes in local medical facilities such as Metropolitan Hospital, Goodlife pharmacy chains and health insurance companies. These investments
and also in for-profit social franchising models targeted towards the low
income communities of the slums and rural areas will be the greatest
beneficiaries of a collapsed. non-welfare health system. The returns from
greater private insurance coverage, greater uptake of private services and
increased importation of pharmaceutical and medical equipments shall tilt the
curve to benefit repatriation of profits.
The government will almost
robotically be willing to go along with the experiment as it will be rid of the
high payroll expense of doctors and specialists who would be expected to join
the consortiums that will be formed to protect their interests. This will
reduce the government expenditure on health as a percentage of GDP well below
3% and ensure absorption of the difference by more politically expedient
causes. The government will even go to the extent of marketing a pro-poor
medical insurance scheme under NHIF in the guise that it would reduce financial
burden through pooling of resources and would allow the bottom of the pyramid (slum
dwellers) to access care at the social health franchises after an enrolment fee
and a few other jargon that will be added to confuse them. The new system will
almost certainly be touted as a success based on a successful US or Indian
model. What won’t be divulged is that, the US healthcare system has the worst per
capita efficiency and quality of care among OECD countries. With this
information all will proceed so fast that we will find ourselves with a predominantly
private health system modeled on the US system. The system will however be a
success to the shareholders and venture capitalists that will get maximum
returns on investment. Already there are counties that have had initial contact
and alliances with private healthcare entities to set up base in their areas, allocated
huge chunks of land to the private healthcare providers and thus it’s only a
matter of time before the process is full completed and the vision realized.
The desperation of the doctors and need to
succeed in their chosen field will also force them to either join the growing
private care provision or force them to seek greener pastures in foreign lands.
Either ways its win-win for the private system and a great loss for the
country.
My plea is that we reform our
health system to have a more robust, resilient public health system with
sustainable healthcare financing model that does not take us the United States
way. Several studies including some from The Commonwealth Fund have found that
public, tax-funded health systems have ensured greater access to care for the
populace and better outcomes than other systems. Studies have also showed that
a dollar spent on healthcare by the government has an impact in raising the GDP
of that country. Therefore we need a re-think of leadership and governance of
health system in the country and entrust it to individuals and structures that
cater for the greater good and ensure equitable, sustainable, affordable and
quality care to all. The British created the National Health Trust (NHS) from
the ashes of World War II and it’s a model we could borrow a leaf from taking
into consideration local variation and shortcomings of the NHS.
But what do I know? Am just a
dreamer, a wishful thinker dreaming of a better health system and quality
healthcare for all.
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