10 ms·

India Aims for the World's Biggest Health Care Overhaul

117 points by happy-go-lucky 8y ago

PeterisP 8y ago
The math doesn't check out. "Each family would get more than $7,200 in annual coverage"; "better health care for 1.3 billion people" and "Modicare is expected to cost the Indian government less than $2 billion annually" seem to be mutually exclusive. There's no reasonable way for health insurance/coverage to be so underutilized that on average only $1-$2 of $7200 would get used.
- onion2k 8y ago
  When they say it'll cost $2b I think that's in addition to what's already being spent.
  - Apes 8y ago
    $2 billion across 1+ billion people is the $1-2 he refers to. The implication is that the additional $7,200 is purely coming from efficiency gains, which he suggests seems improbable.
    - onion2k 8y ago
      A lot of the maths in insurance seems improbable.
- balladeer 8y ago
  You should hear our respected PM's (PM Modi) speeches (pick pretty much any) and ruling party's (BJP) statements and you would get used to math and facts not checking out. I used to think those were just slips and mistakes. It took a couple of years for me to finally understand that those were indeed mistakes but "calculated" ones. It works like this - you declare "every household will get X by the end of 3rd year" and you know that 80% will be just euphoric to hear that and after 6 months they will forget it was 3 years - they are your fans. Once you say something they take it onto them to defend you and what you said forever, no matter how absurd it was. You will also know that out of remaining 20% like 1-2% will dig into it and out of that 1-2% a minuscule will have the guts and acumen to speak out and if they do that previous 80% will take care of this fractional percentage who speaks out either by drowning their voice with their collective noise or bully or silence them somehow. "Somehow" also includes "non-peaceful" means (very effective in silencing people).
  - shripadk 8y ago
    Can you explain what is wrong with the math here? Are you expecting 1.3 billion people to fall ill every year? This is coverage we are talking about. I can't understand how some people don't know what coverage means.
- sn41 8y ago
  Great observation. You are absolutely right. Unfortunately, the public does not care about, or understand, numbers, probability, expectation or black swans, and the politicians know that at a gut level. I wish there was a consistent way to call out such bullshit in a way that matters. But the history of humanity vis-a-vis rhetoric from the time of Demosthenes is not entirely inspiring.
- thatfrenchguy 8y ago
  Coverage up to X does not mean people will use X. 7200$ is a shit ton of money in India.
  - PeterisP 8y ago
    Sure, people will not use X but they'll also use more than 0.02% of X; Even a ridiculously unrealistic low utilization of 0.2% is 14$/year and would cost ten times more than the "estimated" cost.
    - deleted 8y ago
      [deleted]
    - shripadk 8y ago
      No they won't. You aren't discounting those who already hold health insurance because it's a deduction for their tax returns. So for such people it's an investment. You are also not discounting those who are covered by their employers group health insurance. Not to forget those people who already have enough to spend for private healthcare. Not all 1.3 billion people in India are poor who depend on government health insurance.
      - PeterisP 8y ago
        These factors don't need to be explicitly discounted because they are far too small to matter. The number of people covered by various private group health insurance in India is something like 100 million, so it's just a 10% difference when we're talking about order-of-magnitude differences. Yes, not all 1.3 billion are poor and depend on government health insurance, but the numbers are so outrageously off that it doesn't work for 1.3 billion people; doesn't work for 1.0 billion people, doesn't work for 0.8 billion people (who are currently uncovered by other gov't subsidies including RSBY). Unless you're arguing that it applies to a tiny, tiny fraction of Indias population, the math doesn't work out, either the cost estimate or the benefits will be entirely different.
        deleted 8y ago
- shripadk 8y ago
  Why is this so hard to understand? Why would 1.3 billion people want $7,200 in coverage at once? If that happens then it's a mega catastrophe of proportions that the entire World would not be prepared to bear. That would also mean the end of the World as we know it. So let's be realistic shall we? Of those 1.3 billion people hardly 0.1% of them might fall ill in any given year. That's 13 million people. That's still a huge number. Of them how many do you think would be critically ill? 100%? 75%? 50%? 25%? Let's take 25%. That would still be a huge number of critically ill patients (3.25 million). The total number of cancer patients in India per year is around 7 lakhs, which is 0.7 million (http://cancerindia.org.in/statistics/ http://cancerindia.org.in/statistics/) so my guesstimate of 3.25 million makes sense (even though I feel it's higher then what the actual stats are). Only such kind of people would need the $7,200 insurance because critical illness care is cheaper in India compared to any other country. You don't need $7,200 to treat malaria or flu or to get your wisdom tooth removed (https://timesofindia.indiatimes.com/city/ahmedabad/Wisdom-lies-in-getting-tooth-extracted-in-India/articleshow/26613578.cms https://timesofindia.indiatimes.com/city/ahmedabad/Wisdom-li...). You need that kind of amount if you get cancer/stroke etc. Of those 3.25 million patients what percentage do you think are people who can afford private healthcare and those can't? Of those who can afford how many of them are covered by their employers group health insurance or have their own insurance purchased as part of tax saving initiatives? Now you do the math and you'll get your answer.
  - PeterisP 8y ago
    "hardly 0.1% of them might fall ill in any given year" is a very unrealistic assumption - is service is available (which is not universal in India at the moment, but is promised to be with this reform) the expected number of annual per capita doctors visits is at least 1 (OECD country average is 7, poorer countries get 1-2), not 0.001, a thousandfold difference. Not all people won't get ill in a given year, but a large portion does; it depends on how severe illnesses you count but it's 30-60%, not 0.1% or 1%; and some people (much more than 0.1%) get multiple illnesses in a single year. I'm arguing that on average people (all 1.3 billion of them) need much, much more than $1 of coverage each year. You don't need $7200 to treat common diseases, but many of them will need more than $1. For every person that needs $0 of coverage there will be one that needs more than $2. If the estimate was comparable to $10 per person (so, excluding private insurance, roughly $10 billion total not $1-2 billion), then it might be worth starting a discussion about the details and how much what costs. But $1/person/year is so ridiculous that it's off the charts.
briandear 8y ago
What happens when 500 million people start to go to the few private hospitals? It looks like there could be some nice election-year “progress,” but that isn’t going to magically make more private beds appear. Perhaps funding and fixing the public hospitals might be a higher priority otherwise, private hospital prices will increase. This plan has the potential to create some serious health cost inflation. If everyone now has $7200 to spend, that’s just going to raise the prices because long waiting lists will lead to people who are private pay being able to access care more easily if they are willing to pay higher prices. But, “health insurance for all” sounds better as an election slogan than “we are going to fix the structural issues with our public hospital systems.” Employees not showing up to work in the public hospitals? Pay them more and fire them when they don’t show up. Medicine shortages? Then buy more as well as audit the current usages of medicines to reduce waste. Not enough beds? Buy more. Fixing the public system is going to be far more sustainable than suddenly giving everyone $7200 when there isn’t enough capacity. The math doesn’t work with 500 million people unless they expect utilization rates to stay the same — which they won’t there are probably 10s of millions that don’t use the system at all, but they sure will when they can afford it. I think this politician is making promises he knows will be impossible to keep, but will help him win an election before the people realize that it was an plan with no possibility of actually increasing availability of care.
- microcolonel 8y ago
  > What happens when 500 million people start to go to the few private hospitals? It looks like there could be some nice election-year “progress,” but that isn’t going to magically make more private beds appear. That seems to be the least serious issue with this. Firstly, the coverage is minimal enough (especially considering their estimates of the rate of payout) that I doubt it would have that great an effect on usage. I don't really see why the market would fail to meet new demand in this case, and certainly I don't see why you think that it would be easier or cheaper for the Indian government to fix their public hospitals (especially if you've seen their other programmes, especially public primary schools).
- intended 8y ago
  Hahaha, we wish. Poor people will be kept in different wards, or some understanding will be reached to ensure that the status quo is maintained. Nothing in India is done just based on the rules, everything is done with the meta rules firmly in mind. As for your other ideas- these are things you do when you have the ability and personnel to do it. Huge audits and legal systems capable of prosecuting the vast back log of cases. Edit; That said, I do hope this takes off, healthcare investment in India needs to expand significantly and affordable healthcare is needed. We will definitely need state healthcare to help a lot of people.
sremani 8y ago
The beauty of (Indian) democracy is that every 5 years the year before election an innovative world saving scheme that is expensive would be implemented or started.
- thevardanian 8y ago
  Across almost all metrics, infrastructure, corruption, ease of business, electricity, even cleanliness India has improved on. This isn't just another election year innovation, this is just another list of innovations that have been added, which also include things like investments in clean energy, and providing rural impoverished citizen with gas to cook (people in rural areas would cook in wood fired stoves that would produce a lot of smoke and be terrible for their health). You can be a pessimist, but I don't see that, and most investors are very optimistic about the Indian market.
  - deleted 8y ago
    [deleted]
  - l8again 8y ago
    >> Across almost all metrics, infrastructure, corruption, ease of business, electricity, even cleanliness India has improved on. Source?
  - dominotw 8y ago
    Isn't this true almost everywhere in the world most of time?
  - mandeepj 8y ago
    > Across almost all metrics, infrastructure, corruption, ease of business, electricity, even cleanliness India has improved on You are drinking ruling party’s a lot of cool aid
    - thevardanian 8y ago
      What are you talking about? There are very few metrics that you can list that show a decline. So how about you show me the data for decline.
mataug 8y ago
> The plan is to roll it out by the end of the year – ahead of elections expected early in 2019. Wow that seems to be a highly ambitious timeline. I hope India manages to setup the program enroll people onto it, but I'm also doubtful whether it can be achieved before the elections.
- abhiyerra 8y ago
  Having just gone to India everything is tied to the Aadhaar Identification: banks, schools, welfare, etc. It has overall completely replaces a bunch of different identifications into a single centrally located entity. However weird I feel about it being Orwellian I can't say it hasn't been good in terms of simplifying access and providing services since you just need a single identification. So it wouldn't be that hard to just add additional information like how much healthcare was used where and can easily be implemented by end of the year. But the problem is will all the private sector be able to handle the added load of nearly a billion people accessing the resources...
  - sbmthakur 8y ago
    And it's probably saving government some money: https://www.livemint.com/Politics/6NgxeSDqmL6BgrL0FS6RRI/Aadhaar-helped-Indian-government-save-9-billion-says-Nanda.html https://www.livemint.com/Politics/6NgxeSDqmL6BgrL0FS6RRI/Aad...
helpme420 8y ago
I hope it SAP or Oracle gets this contract.
pm90 8y ago
This is absolutely fantastic. Even if it doesn't succeed, it would lay the framework for something to build on next, as often happens in India.
neil_s 8y ago
The best thing about this article is the moniker Modicare
- namanyayg 8y ago
  Hope it doesn't catch on
deleted 8y ago
[deleted]
petilon 8y ago
>> which would offer the poorest half of India health insurance to apply toward private hospitals This is a terrible idea. Did they learn nothing from the failure of Health Care in the United States? When insurance pays for everything patients stop worrying about costs, which in turn causes hospitals and drug companies to raise prices. This is what has caused Health Care to fail from a costs point of view. The solution is to make the consumer participate in driving costs down. In the US, one employer I know of has an excellent solution to the problem: Make employees pay 100% of the bill up to a certain amount, such as $6000. That's a large amount, but the employer then contributes a large amount to your Health Savings Account (HSA), such as $4000. This amount is for you to keep regardless of whether you have any health bills or not. (This money can be used for medical expenses only, but can be used any time, including after retirement). So the maximum you will spend out of pocket per year is $2000. How does this encourage the consumer to scrutinize and control medical expenditure? Because the first $6000 of medical spending in a year is "your money". This is money you'd be able to keep in your HSA if you didn't have any medical expenses. This gives the consumer a strong incentive to reduce costs, question charges, avoid unnecessary services, and so on.
- h4b4n3r0 8y ago
  $4k is not a “large amount”. I buy my own insurance and cheapest plan that covers anything at all is $13k/yr for a family of 3. If that’s all this employer is contributing, the employees are getting shafted.
  - nv-vn 8y ago
    The GP was probably just making up numbers or basing it on costs for a single person.
- rishav_sharan 8y ago
  This is not a problem in India as a lot of treatment s in govt run hospitals is free for low income people. But then, the problem is that such hospitals are hugely overused and the quality of care suffers. By enabling the poor to use private options the demand can be better distributed between private and public.
raincom 8y ago
The number of seats in Indian medical colleges is 91040. Why not increase these seats by 10 fold. In a couple of decades, that can help.
- intended 8y ago
  Because scaling this IS hard.
  - vidarh 8y ago
    Notably, it's unusually hard in that actual practice on humans is still a necessity since there aren't good enough training analogues to substitute for real cases, so even if you managed to scale the basic training it's still an unsolved problem to scale up the number of doctors rapidly in safe way. E.g. you can't just educate 10x as many heart surgeons without actually having 10x as many cases for them to scrub in on that you have experienced heart surgeons to lead on unless you're prepared to kill a lot of people in the process.
dmix 8y ago
Modi announcing big plans and Modi implementating big plans are two very different things. He still hasnt done hardly any of his original and badly needed economic reforms.
modi15 8y ago
Interesting comments here but imo India already has a pretty fantastic healthcare system. People who argue against spend some time understanding the US healthcare system and the disaster it is. India already has health insurance by private companies but its probably not used extensively. Something like this is basically a government run insurance scheme - it will most likely be a no-frills service, offer standardized plans with fixed reimbursements and provide some tax benefits for enrollment. There is very little that can go wrong here and probably pretty good upside. This is the kind of things that make for very good politics and there is no harm in the govt. capitalising on it. That being said most of India has access to govt. run hospitals which offer near free services. The article paints a grim picture of these facilities and that might be largely true but I frequent govt. hospitals all the time even if I can afford private. They are quick, almost free and doctors are pretty good.
- rahulthewall 8y ago
  >That being said most of India has access to govt. run hospitals which offer near free services. Nothing could be farther from the truth. I would recommend the following study, published in The Lancet >In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. See: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61894-6/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
  - modi15 8y ago
    I dont really need the study. I stay here and experience this on a daily basis. There is nothing in the study which contradicts what I said. People do visit private hospitals if public hospitals dont meet their needs and such visits can definitely bankrupt people. That doesnt have to mean that the govt. hospitals are doing a bad job or that private hospitals are inaccessible.
ForFreedom 8y ago
That is a scam in the making...

The math doesn't check out. "Each family would get more than $7,200 in annual coverage"; "better health care for 1.3 billion people" and "Modicare is expected to cost the Indian government less than $2 billion annually" seem to be mutually exclusive. There's no reasonable way for health insurance/coverage to be so underutilized that on average only $1-$2 of $7200 would get used.

onion2k 8y ago
When they say it'll cost $2b I think that's in addition to what's already being spent.
- Apes 8y ago
  $2 billion across 1+ billion people is the $1-2 he refers to. The implication is that the additional $7,200 is purely coming from efficiency gains, which he suggests seems improbable.
  - onion2k 8y ago
    A lot of the maths in insurance seems improbable.
balladeer 8y ago
You should hear our respected PM's (PM Modi) speeches (pick pretty much any) and ruling party's (BJP) statements and you would get used to math and facts not checking out. I used to think those were just slips and mistakes. It took a couple of years for me to finally understand that those were indeed mistakes but "calculated" ones. It works like this - you declare "every household will get X by the end of 3rd year" and you know that 80% will be just euphoric to hear that and after 6 months they will forget it was 3 years - they are your fans. Once you say something they take it onto them to defend you and what you said forever, no matter how absurd it was. You will also know that out of remaining 20% like 1-2% will dig into it and out of that 1-2% a minuscule will have the guts and acumen to speak out and if they do that previous 80% will take care of this fractional percentage who speaks out either by drowning their voice with their collective noise or bully or silence them somehow. "Somehow" also includes "non-peaceful" means (very effective in silencing people).
- shripadk 8y ago
  Can you explain what is wrong with the math here? Are you expecting 1.3 billion people to fall ill every year? This is coverage we are talking about. I can't understand how some people don't know what coverage means.
sn41 8y ago
Great observation. You are absolutely right. Unfortunately, the public does not care about, or understand, numbers, probability, expectation or black swans, and the politicians know that at a gut level. I wish there was a consistent way to call out such bullshit in a way that matters. But the history of humanity vis-a-vis rhetoric from the time of Demosthenes is not entirely inspiring.
thatfrenchguy 8y ago
Coverage up to X does not mean people will use X. 7200$ is a shit ton of money in India.
- PeterisP 8y ago
  Sure, people will not use X but they'll also use more than 0.02% of X; Even a ridiculously unrealistic low utilization of 0.2% is 14$/year and would cost ten times more than the "estimated" cost.
  - deleted 8y ago
    [deleted]
  - shripadk 8y ago
    No they won't. You aren't discounting those who already hold health insurance because it's a deduction for their tax returns. So for such people it's an investment. You are also not discounting those who are covered by their employers group health insurance. Not to forget those people who already have enough to spend for private healthcare. Not all 1.3 billion people in India are poor who depend on government health insurance.
    - PeterisP 8y ago
      These factors don't need to be explicitly discounted because they are far too small to matter. The number of people covered by various private group health insurance in India is something like 100 million, so it's just a 10% difference when we're talking about order-of-magnitude differences. Yes, not all 1.3 billion are poor and depend on government health insurance, but the numbers are so outrageously off that it doesn't work for 1.3 billion people; doesn't work for 1.0 billion people, doesn't work for 0.8 billion people (who are currently uncovered by other gov't subsidies including RSBY). Unless you're arguing that it applies to a tiny, tiny fraction of Indias population, the math doesn't work out, either the cost estimate or the benefits will be entirely different.
      - deleted 8y ago
shripadk 8y ago
Why is this so hard to understand? Why would 1.3 billion people want $7,200 in coverage at once? If that happens then it's a mega catastrophe of proportions that the entire World would not be prepared to bear. That would also mean the end of the World as we know it. So let's be realistic shall we? Of those 1.3 billion people hardly 0.1% of them might fall ill in any given year. That's 13 million people. That's still a huge number. Of them how many do you think would be critically ill? 100%? 75%? 50%? 25%? Let's take 25%. That would still be a huge number of critically ill patients (3.25 million). The total number of cancer patients in India per year is around 7 lakhs, which is 0.7 million (http://cancerindia.org.in/statistics/ http://cancerindia.org.in/statistics/) so my guesstimate of 3.25 million makes sense (even though I feel it's higher then what the actual stats are). Only such kind of people would need the $7,200 insurance because critical illness care is cheaper in India compared to any other country. You don't need $7,200 to treat malaria or flu or to get your wisdom tooth removed (https://timesofindia.indiatimes.com/city/ahmedabad/Wisdom-lies-in-getting-tooth-extracted-in-India/articleshow/26613578.cms https://timesofindia.indiatimes.com/city/ahmedabad/Wisdom-li...). You need that kind of amount if you get cancer/stroke etc. Of those 3.25 million patients what percentage do you think are people who can afford private healthcare and those can't? Of those who can afford how many of them are covered by their employers group health insurance or have their own insurance purchased as part of tax saving initiatives? Now you do the math and you'll get your answer.
- PeterisP 8y ago
  "hardly 0.1% of them might fall ill in any given year" is a very unrealistic assumption - is service is available (which is not universal in India at the moment, but is promised to be with this reform) the expected number of annual per capita doctors visits is at least 1 (OECD country average is 7, poorer countries get 1-2), not 0.001, a thousandfold difference. Not all people won't get ill in a given year, but a large portion does; it depends on how severe illnesses you count but it's 30-60%, not 0.1% or 1%; and some people (much more than 0.1%) get multiple illnesses in a single year. I'm arguing that on average people (all 1.3 billion of them) need much, much more than $1 of coverage each year. You don't need $7200 to treat common diseases, but many of them will need more than $1. For every person that needs $0 of coverage there will be one that needs more than $2. If the estimate was comparable to $10 per person (so, excluding private insurance, roughly $10 billion total not $1-2 billion), then it might be worth starting a discussion about the details and how much what costs. But $1/person/year is so ridiculous that it's off the charts.

briandear 8y ago

What happens when 500 million people start to go to the few private hospitals? It looks like there could be some nice election-year “progress,” but that isn’t going to magically make more private beds appear. Perhaps funding and fixing the public hospitals might be a higher priority otherwise, private hospital prices will increase. This plan has the potential to create some serious health cost inflation. If everyone now has $7200 to spend, that’s just going to raise the prices because long waiting lists will lead to people who are private pay being able to access care more easily if they are willing to pay higher prices. But, “health insurance for all” sounds better as an election slogan than “we are going to fix the structural issues with our public hospital systems.” Employees not showing up to work in the public hospitals? Pay them more and fire them when they don’t show up. Medicine shortages? Then buy more as well as audit the current usages of medicines to reduce waste. Not enough beds? Buy more. Fixing the public system is going to be far more sustainable than suddenly giving everyone $7200 when there isn’t enough capacity. The math doesn’t work with 500 million people unless they expect utilization rates to stay the same — which they won’t there are probably 10s of millions that don’t use the system at all, but they sure will when they can afford it. I think this politician is making promises he knows will be impossible to keep, but will help him win an election before the people realize that it was an plan with no possibility of actually increasing availability of care.

microcolonel 8y ago
> What happens when 500 million people start to go to the few private hospitals? It looks like there could be some nice election-year “progress,” but that isn’t going to magically make more private beds appear. That seems to be the least serious issue with this. Firstly, the coverage is minimal enough (especially considering their estimates of the rate of payout) that I doubt it would have that great an effect on usage. I don't really see why the market would fail to meet new demand in this case, and certainly I don't see why you think that it would be easier or cheaper for the Indian government to fix their public hospitals (especially if you've seen their other programmes, especially public primary schools).
intended 8y ago
Hahaha, we wish. Poor people will be kept in different wards, or some understanding will be reached to ensure that the status quo is maintained. Nothing in India is done just based on the rules, everything is done with the meta rules firmly in mind. As for your other ideas- these are things you do when you have the ability and personnel to do it. Huge audits and legal systems capable of prosecuting the vast back log of cases. Edit; That said, I do hope this takes off, healthcare investment in India needs to expand significantly and affordable healthcare is needed. We will definitely need state healthcare to help a lot of people.

sremani 8y ago

The beauty of (Indian) democracy is that every 5 years the year before election an innovative world saving scheme that is expensive would be implemented or started.

thevardanian 8y ago
Across almost all metrics, infrastructure, corruption, ease of business, electricity, even cleanliness India has improved on. This isn't just another election year innovation, this is just another list of innovations that have been added, which also include things like investments in clean energy, and providing rural impoverished citizen with gas to cook (people in rural areas would cook in wood fired stoves that would produce a lot of smoke and be terrible for their health). You can be a pessimist, but I don't see that, and most investors are very optimistic about the Indian market.
- deleted 8y ago
  [deleted]
- l8again 8y ago
  >> Across almost all metrics, infrastructure, corruption, ease of business, electricity, even cleanliness India has improved on. Source?
- dominotw 8y ago
  Isn't this true almost everywhere in the world most of time?
- mandeepj 8y ago
  > Across almost all metrics, infrastructure, corruption, ease of business, electricity, even cleanliness India has improved on You are drinking ruling party’s a lot of cool aid
  - thevardanian 8y ago
    What are you talking about? There are very few metrics that you can list that show a decline. So how about you show me the data for decline.

mataug 8y ago

> The plan is to roll it out by the end of the year – ahead of elections expected early in 2019. Wow that seems to be a highly ambitious timeline. I hope India manages to setup the program enroll people onto it, but I'm also doubtful whether it can be achieved before the elections.

abhiyerra 8y ago
Having just gone to India everything is tied to the Aadhaar Identification: banks, schools, welfare, etc. It has overall completely replaces a bunch of different identifications into a single centrally located entity. However weird I feel about it being Orwellian I can't say it hasn't been good in terms of simplifying access and providing services since you just need a single identification. So it wouldn't be that hard to just add additional information like how much healthcare was used where and can easily be implemented by end of the year. But the problem is will all the private sector be able to handle the added load of nearly a billion people accessing the resources...
- sbmthakur 8y ago
  And it's probably saving government some money: https://www.livemint.com/Politics/6NgxeSDqmL6BgrL0FS6RRI/Aadhaar-helped-Indian-government-save-9-billion-says-Nanda.html https://www.livemint.com/Politics/6NgxeSDqmL6BgrL0FS6RRI/Aad...

helpme420 8y ago

I hope it SAP or Oracle gets this contract.

pm90 8y ago

This is absolutely fantastic. Even if it doesn't succeed, it would lay the framework for something to build on next, as often happens in India.

neil_s 8y ago

The best thing about this article is the moniker Modicare

namanyayg 8y ago
Hope it doesn't catch on

deleted 8y ago

[deleted]

petilon 8y ago

>> which would offer the poorest half of India health insurance to apply toward private hospitals This is a terrible idea. Did they learn nothing from the failure of Health Care in the United States? When insurance pays for everything patients stop worrying about costs, which in turn causes hospitals and drug companies to raise prices. This is what has caused Health Care to fail from a costs point of view. The solution is to make the consumer participate in driving costs down. In the US, one employer I know of has an excellent solution to the problem: Make employees pay 100% of the bill up to a certain amount, such as $6000. That's a large amount, but the employer then contributes a large amount to your Health Savings Account (HSA), such as $4000. This amount is for you to keep regardless of whether you have any health bills or not. (This money can be used for medical expenses only, but can be used any time, including after retirement). So the maximum you will spend out of pocket per year is $2000. How does this encourage the consumer to scrutinize and control medical expenditure? Because the first $6000 of medical spending in a year is "your money". This is money you'd be able to keep in your HSA if you didn't have any medical expenses. This gives the consumer a strong incentive to reduce costs, question charges, avoid unnecessary services, and so on.

h4b4n3r0 8y ago
$4k is not a “large amount”. I buy my own insurance and cheapest plan that covers anything at all is $13k/yr for a family of 3. If that’s all this employer is contributing, the employees are getting shafted.
- nv-vn 8y ago
  The GP was probably just making up numbers or basing it on costs for a single person.
rishav_sharan 8y ago
This is not a problem in India as a lot of treatment s in govt run hospitals is free for low income people. But then, the problem is that such hospitals are hugely overused and the quality of care suffers. By enabling the poor to use private options the demand can be better distributed between private and public.

raincom 8y ago

The number of seats in Indian medical colleges is 91040. Why not increase these seats by 10 fold. In a couple of decades, that can help.

intended 8y ago
Because scaling this IS hard.
- vidarh 8y ago
  Notably, it's unusually hard in that actual practice on humans is still a necessity since there aren't good enough training analogues to substitute for real cases, so even if you managed to scale the basic training it's still an unsolved problem to scale up the number of doctors rapidly in safe way. E.g. you can't just educate 10x as many heart surgeons without actually having 10x as many cases for them to scrub in on that you have experienced heart surgeons to lead on unless you're prepared to kill a lot of people in the process.

dmix 8y ago

Modi announcing big plans and Modi implementating big plans are two very different things. He still hasnt done hardly any of his original and badly needed economic reforms.

modi15 8y ago

Interesting comments here but imo India already has a pretty fantastic healthcare system. People who argue against spend some time understanding the US healthcare system and the disaster it is. India already has health insurance by private companies but its probably not used extensively. Something like this is basically a government run insurance scheme - it will most likely be a no-frills service, offer standardized plans with fixed reimbursements and provide some tax benefits for enrollment. There is very little that can go wrong here and probably pretty good upside. This is the kind of things that make for very good politics and there is no harm in the govt. capitalising on it. That being said most of India has access to govt. run hospitals which offer near free services. The article paints a grim picture of these facilities and that might be largely true but I frequent govt. hospitals all the time even if I can afford private. They are quick, almost free and doctors are pretty good.

rahulthewall 8y ago
>That being said most of India has access to govt. run hospitals which offer near free services. Nothing could be farther from the truth. I would recommend the following study, published in The Lancet >In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. See: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61894-6/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
- modi15 8y ago
  I dont really need the study. I stay here and experience this on a daily basis. There is nothing in the study which contradicts what I said. People do visit private hospitals if public hospitals dont meet their needs and such visits can definitely bankrupt people. That doesnt have to mean that the govt. hospitals are doing a bad job or that private hospitals are inaccessible.

ForFreedom 8y ago

That is a scam in the making...