Sudhanva Shetty Shetty
Writer, coffee-addict, likes folk music & long walks in the rain. Firmly believes that there's nothing more important in a democracy than a well-informed electorate.
One of the major news stories of the first week of 2017 was regarding France adopting the opt-out system when it comes to organ donations. This is essentially a “presumed consent” system where it is assumed that a deceased person has agreed to donate their organs unless they have added their name to a national “refusal register”.
The move was met with applause from many quarters. The opt-out system has worked wonders in many other countries like Spain and Chile. Commentators expect France’s transition to an opt-out system to increase organ donation rates massively.
But what ensures the success of an opt-out system, and can the same be implemented in India?
The importance of healthcare and Government health spending
One must not forget that such a transition is radical and its success is heavily reliant on the concerned country’s health scene. France, for example, boasts of a universal healthcare system hailed by the World Health Organisation (WHO) as “close to the best overall” in the world. Government funded agencies bear nearly 77% of health expenditure of French citizens. Spain, similarly, invests heavily in healthcare. Despite decreasing rates of health spending in recent years, the Spanish healthcare system is considered among the best in the world by the WHO.
It is important to note that the success of the opt-out system can only be ensured when it is accompanied by high numbers of medical facilities, personnel and awareness. The reason why the opt-out system worked for Spain and Chile – and will most likely succeed in France too – is because these countries already invested heavily in healthcare. They ensured a system of progressive healthcare for all citizens and had high levels of health spending as a percentage of their national GDP.
Organ donation in India
A huge gap persists between demand and supply of organs in India. India has a donation rate of 0.5 per million – one of the lowest in the world. In contrast, Spain has a donation rate of 36 per million inhabitants while numbers for Germany and the United States are 11 and 26.
According to studies, around 1.6 lakh patients are waiting for organs in India while a mere 12,000 donors are available. The Ministry of Health has estimated that the annual requirement for kidneys could range between 1-2 lakh with a mere 5,000 transplants occurring in reality.
The state and central governments have taken many steps to increase the rates of organ donation in India. For example, in 2012 the Delhi Government launched an online portal for registration of organ donors. The Indian Medical Association recently announced several campaigns to increase awareness about organ donations.
India can solve its problems regarding organ donation only by increasing health spending. If the government were to increase government spending on healthcare – like in the West – it would improve health conditions of millions of Indians. Without improving its healthcare scenario, India cannot hope to make meaningful strides towards ensuring that its organ donation needs are met.
Healthcare in India
India’s healthcare system remains backwards and insufficient, with private providers being the dominant force and no solid program for a universal healthcare system in sight. Spending on health care increased from about 3.5% to 5% in the period between 1988 and 2002. In countries like the United States and the United Kingdom, healthcare accounts for more than 18% of the GDP. Meanwhile, government spending on healthcare has hovered around 20–25% during the past two decades. Health spending as a proportion of total government recurrent spending fell from 4.5% in 1985–86 to 3.3% in 2004–05. It is currently hovering around 5% and is still as insufficient as ever. Moreover, healthcare in India is severely divided along the lines of income and urbanisation.
The Modi Government’s strides in healthcare
The Modi Government has repeatedly professed that it is serious about providing universal healthcare – healthcare for all Indians. On 22 December 2016, the Prime Minister said the country was moving towards the “best healthcare system” in the world and stressed the importance of providing quality and affordable healthcare to all Indians, especially the poor.
There were high hopes of the Government finally focusing on improving the health sector. However, the government has continuously slashed the health budget. Because India only spends 1% of its current GDP on healthcare, further budget cuts in this sector can lead to some grave repercussions. It is noteworthy that India’s spending on healthcare is already among the lowest in the world – China spends 3% and the US 8.5% of their respective GDPs.
Why is health care not a major part of political rhetoric?
Partly because the other issues that India faces like government corruption, border disputes, religious tensions, etc. make universal healthcare seem less important. Also, interest payments and entitlement liabilities have greatly constrained the government’s fiscal capacity to fund social programs such as healthcare. The economic crises India faced in the early 1990s also led Indian policymakers to place a high priority on economic growth.
At the same time, though, India is at the centre of a booming medical tourism industry. Here, by global standards, the best diagnostic tests and procedures can be had for a fraction of Western prices, the fact that fuels medical tourism to the tune of an estimated $78.6 billion in India. India’s corporate hospitals are among the best in the world, but a distant dream for the country’s millions of poor.
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