It would be perilous for society to leave health and two other sectors ~ education and food ~ to the total mercy of market forces. The startling symptoms of the health sector’s commercialisation and medical negligence are clearly discernible. As many as 63 children died in Gorakhpur (U.P.) on 13 August last year due to the interrupted oxygen supply ~ a commercial reason.

A similar ghastly incident occurred less than a month after that at Farukkabad where 14 children died because of the same reason. Similarly last month’s incident at Delhi’s Max hospital, where a live baby was declared dead, epitomises medical callousness.

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The list of other unethical practices is too long for a recital here. Consider the most distressing acts of misfeasance, malfeasance and nonfeasance committed with impunity by the people of the sector:

* The unscrupulous hospitals accept patients not on the basis of the seriousness of the ailment urgency for treatment, but on their paying capacity. The sick without the means are not admitted, while those with sufficient money but no disease get unnecessary treatment.

* Doctors prescribe tests lured more by the kickbacks the diagnostic centres offer than on the need for such tests. They prescribe the codenamed “sink tests” with one or two ‘marked tests’. Patients are charged for all the tests and samples collected for all of them. But the actual test is conducted for the ‘marked test’ and fake normal results are given for all the other tests; the extra samples, say blood, collected is thrown into the sink, so the name ‘sink’ tests.

* Patients are unnecessarily referred to other doctors just to get a cut from them. Those who give better commission get more referrals.

* The illegal sex determination tests are conducted and the information is secretly conveyed, codenaming, for instance, a male child as ‘Ganesh’ and a female as ‘Lakshmi’.

* Surgeries like hysterectomies, C-sections, cataract, knee replacements and lower back operations are unnecessarily performed to make a fast buck.

* Pharmaceutical companies supply expensive gifts and medical equipment to entice doctors to prescribe their drugs. Apart from gifts, foreign trips and five-star accommodation are offered to doctors and their families.

* The poor and illiterate people are used as guinea pigs for clinical trials.

* The ambulance services are paid bribes for bringing emergency patients to private hospitals.

* Hospitals force doctors to generate a monthly targeted revenue to justify their high salaries whereby doctors subject the innocent to unnecessary tests and procedures.

The Medical Council of India prohibits all these unethical practices. Yet its order has had little or impact on the errant doctors and hospitals. The latest health policy, National Health Policy 2017, commits itself, “to the highest professional standards, integrity and ethics”. But the objective cannot be achieved without applying the brakes on the ongoing commercialisation of the health sector.

For the past two-and-a-half decades, private interest has been accorded precedence over universal health care. This has forced people to increasingly depend on the private sector.

The National Sample Survey has shown that 72 per cent of rural and 79 per cent of urban healthcare are treated in the private sector. Thus, the private institutions dominated in-patient treatment both in rural (58 per cent) and urban areas (68 per cent). Despite the government’s boast of several health schemes, a staggering 86 per cent of rural population and 82 per cent of the urban population are not covered by any scheme whatsoever. Another disturbing feature is that 20 per cent of child births in rural areas and 11 per cent in urban areas are taking place in the home, not in any hospital or under medical supervision.

The nexus between corporate hospitals, pharmaceutical companies and doctors has increased the risks and costs of healthcare to such an extent that millions of middle class Indians are driven to penury when they fall sick; every year, more than 3.5 crore people fall below the poverty line due to illness.

The current health expenditure (CHE) ~ including prepayments for insurance premiums ~ by households as estimated by National Health Accounts 2013-14, was Rs 3,06,938 crore, equal to 2.7 per cent of GDP, and 72.9 per cent of CHE or 67.7 per cent of the total health expenditure. Of this, out-of-pocket spending was Rs 2,90,932 crore, 2.6 per cent of GDP or Rs 2,336 per capita.

The private medical industry has been flourishing particularly since 1990. There are 10.4 lakh healthcare enterprises, if the very small to the very big are counted. In money terms, the industry’s size in 2017 was equal to $160 billion; it was poised to grow to $280 billion by 2020. The Foreign Direct Investment it received between 2000 and 2017 was $4.34 billion. The number of medical tourists in 2016 was 2,00,000 against 1,30,000 a year before.

The government has the capacity to overtake the private sector… if it has the will. Even otherwise it should pool the resources for public health on a priority basis. The High-Level Expert Group on Universal Health Coverage for India, instituted by the Planning Commission under the chairmanship of Dr.K. Srinath Reddy (2011) had recommended that “the Government should increase public expenditure on health to at least 2.5 per cent by the end of the 12th plan, and to at least 3 per cent of GDP by 2022”. The current level is 1.15 per cent of GDP (0.40 per cent from the Centre plus 0.75 per cent from States) against the global average of 5.99 per cent.

It added: “We recommend general taxation as the most viable option for mobilising resources to achieve the target of increasing public spending on health and creating mechanisms for financial protection. The tax ratio in India, at a little over 15 per cent of GDP, is lower than the average for countries with less than USD 1000 (18 per cent) and substantially lower than the average for middle income countries (22 per cent) for countries with per capita income between USD 1000 and USD 15000).”

In other words, the health expenditure should be borne by the government and the government should raise it through taxing the rich, placing heavier burden on broader shoulders, which is possible in India .That means that radical changes are urgently imperative. No symptomatic tinkering will do.

The present pattern of development and the rapid growth of the private sector may yield higher profit to the investors, but not better health to individuals; no ‘trickle down’ benefits, so to speak. On the contrary, there is every possibility of more and more unethical medical practices. So, the right kind of treatment for the afflicted health sector would be to delink it from the influence of market forces and to ensure a hassle-free universal health coverage without the mediation any insurance business. The government should realise that nothing can be more important than public health and should act at once to correct the course. Will it?

The writer is a Hyderabad-based development economist and commentator on social and economic affairs.