- Narender & Vaishali
David Harvey, a Marxist, has rightly argued that
in neo-liberal capitalism, the private sector including multinational companies
are not interested to deal with global public health crisis like the Covid-19
pandemic but the private hospitals and pharmaceutical companies to have more
capital accumulation by undertaking more business from public health and
maximize their profits by any means. As he stated:
“Corporatist Big Pharma (Multinational Company) has little or no interest in
non-remunerative research on infectious diseases (such as the whole class of
coronaviruses that have been well-known since the 1960s). Big Pharma rarely
invests in prevention. It has little interest in investing in preparedness for
a public health crisis. It loves to design cures. The sicker we are, the more
they earn. Prevention does not contribute to shareholder value. The business
model applied to public health provision eliminated the surplus coping
capacities that would be required in an emergency. Prevention was not even an
enticing enough field of work to warrant public-private partnerships. President
Trump had cut the budget of the Center for Disease Control and disbanded the
working group on pandemics in the National Security Council in the same spirit
as he cut all research funding, including on climate change. If I wanted to be
anthropomorphic and metaphorical about this, I would conclude that Covid-19 is
nature’s revenge for over forty years of nature’s gross and abusive
mistreatment at the hands of a violent and unregulated neoliberal extractivism”
In the past three decades, Indian
government has been consistently making rhetoric statements on increasing
public health care spending up to 3% of GDP to achieve SDG 3 on universal health
care to all by 2030. At present, the percentage share of GDP in Indian health
care system is lowest at global level, which is only one percent of GDP. Due to lower public funding in healthcare by
the governments, Indian household is compelled to spend on private healthcare,
as the percentage of total health expenditure in India out of the individual’s
pocket is highest at global level, i.e. 62%. It is the public nature and the
longer gestation period of final outcome or realization of health or education
services after the consumption or use that delays or derails the public
response. This happens due to asymmetric information between the buyer and user
or seller and producer. Despite knowing about their wellbeing, people’s voices
remain feeble on uniting against such policies and ask government to raise
public expenditure or to universalize essential services like education and
health. Today India is progressing from second rank to first rank in terms of
highest number of Covid-19 virus cases and the resulting deaths, but there is
no talk on increasing the spending in health care. The US is on first rank as on 14th of
September 2020 and Brazil has third rank in terms of the number ofCovid-19
cases at global level. Another common feature among three nations- India, the
US and Brazil, is that they allhave the most populous leaders as their heads of
the governments, which have exposed
their poor Covenant in handling Covid-19 virus as these three countries stand
on first 3 ranks in having maximum number of Covid-19 cases at global level.
Indian state under Neo-liberalism
has weakened the public healthcare by allowing privatization of health services
in India and also inviting private interference in public healthcare, also
called de facto privatization in
terms of public private partnership (PPP). The PPP model in the health care
sector is using insurance schemes in the healthcare services by the government
and private hospitals. In 2018,
September, the present Modi government launched Ayushman Bharat Pradhan Mantri Jan ArogyaY ojana(AB-PMJAY), to cover health
insurance of 10 crores people through public private partnership. But, would it
be viable to ensure universal public health care? The answer lies in the basic
public economics principle of provision and production of public services, like
health services as the privatization of public services led more economic inequities,
social injustice and corrupt practices. After the completion of 2 years of
implementation of the AB-PMJAY, there are reported cases of corruption, showing
the failure privatization in healthcare sector and wastage of public funding
via adopting PPP model. In Delhi and Mumbai, governments have asked private
healthcare sector to contribute in controlling Covid-19 pandemic. It was noticed that private health care
providers are shirking from their responsibilities as most of the private
hospitals in India are not offering more than 50% of their capacities of beds
and patients intakes in the private hospitals during the Covid-19 pandemic
.They are also withdrawing from delivering 10% quota of hospital beds for the
Indoor Patient Department (IPD) and 25% reserved Outdoor Patient Department
(OPD) quota of beds to the Economic Weaker Sections of the society as the
government gives the expenses of the health expenses of the EWS category[1]. Thus, the
private health care service providers and hospitals are absent from the
provisioning of health services in this health emergency rather there are
instances of private hospitals making profit out of misery of the masses during
Covid-19pandemic, by charging exorbitant medical fee. For instance, according
to the media reports, the private Max Hospital in Delhi is charging Rupees 25,
00,000 for a Covid-19 package and plasma therapy is being charged at Rupees 2.5
lakh by the private hospitals in urban India. Such episodes adds on to enough reasons for
arguing against private intrusion in social sector mainly health and education.
So, despite the pandemic being class and caste neutral, its medical expenses
are exorbitantly high for people who can’t afford.
Status and Strategy in Combating Covid-19
Pandemic
The number of Covid-19 cases in India is rising at greater
pace along with the number of resulting deaths. It is observed that the
neighboring countries, Pakistan and Sri Lanka have performed better to contain
the Covid-19 pandemic than India. The clustered based lockdown in Pakistan has
contributed better in containing Covid-19 showing better governance in the
country rather than India’s strategy in handling Covid-19 by imposing complete lockdown.
In comparison to India, Sri Lanka has also shown better status of containing Covid-19
because of having better health infrastructure to flatten the Covid-19 curves
as noticed in the cases of data explained below.
A comparative analysis of status of health infrastructure, in different countries and its impact on containing Covid-19, was done. It included countries like the USA and Brazil (non-flattening curve of Covid-19 in these countries), Germany, Norway, and New Zealand (highest human developed countries and have managed to flattenCovid-19 curve), Sri Lanka, Pakistan (neighbouring countries of India and developing economies and flatten their curves), China (the neighboring country of India and flatten its curve) and the communist country-Cuba. For the comparison, three indicators of health infrastructure are considered- physical, financial and human. The physical health infrastructure is analyzed by using number of hospital beds per 1000 people, the financial health infrastructure is analyzed by using private and public health expenditure in the country as well as out of pocket health expenditure. Human health infrastructure is examined here by using number of doctors and nurses per thousand person ratios. The number of Covid-19 cases and resulting deaths are also examined in these countries till the time period of 14th September 2020.
Physical, Financial and Human
Infrastructure in Healthcare Sector
The public funding in India is mere 1 per cent in this
critical times, pushing people to spend out of their pockets in the absence of
government health Finance. Data suggest
that out of pocket private health expenditure in India is highest at 62%. After
India, China has second rank, in terms of out of pocket health expenditure
which is only 36% out of total expenditure in health. Public funding by the
Chinese government in Healthcare is 3% of GDP, which is 2 percent-point higher
than Indian public spending in health. This implies that the Chinese government
spends higher public funding than Indian government. This could be a major reason or factor in
containing the Covid-19 virus.
The
communist country, Cuba is most successful in containing the Covid-19 pathogen.
The main reason behind containing the virus is public funding which is highest
at global level, that is 10.5% of GDP. It is because of the higher public
funding in health by Cuban government,
the people are not forced to spend higher amount of Private Health
expenditure out of their pockets therefore percentage of out of pocket expenditure in health is only
10.5% of total health expenditure in Cuba. Germany is another country, which has
shown improvement in flattening the curve of Covid-19 virus, due to higher
funding, which is 8.7 percent of GDP. As
a result, out of pocket health expenditure in Germany is also in lowest category
that is 12.7% of total health expenditure.
After Germany, New Zealand is also successful in containing the virus,
with higher public spending of 6.9 percent of GDP and declining out of pocket
health expenditure at 13.6% health expenditure from the total health
expenditure in the country.
In addition to that, physicians per
1000 people; and nurses and midwives per 1000 people in India are lowest at
global level, which are 0.8 physicians per 1000 people and 2.1 nurses and
midwives per 1000 people. Comparatively, these two respective rations for China
are 2.0 and 2.7 respectively, showing higher ratios. In the communist country,
Cuba has relatively higher ratios in comparison to India and China, which are
7.7 and 8.3 respectively, reflecting highest physician ratio at the global
level. These ratios in Germany are 4.2
and 13.2 and in New Zealand, these respective ratios are 3.5 and 12.3,
reflecting highest nurse ratios in Germany and New Zealand at the global level.
The higher ratios of doctors and nurses in the communist country and the highest
human developed countries, like Germany and New Zealand, which are successful in
flattening the curves of Covid-19. But the conditions in India are not
conducive due to poor ratios of health professionals and lowest public funding,
which in turn reflect at crumbling situation of Indian health infrastructure.
The condition becomes severe when private health care providers across the
country are either making profit or shirking from their social responsibilities
in the Covid-19 pandemic. The situation confirms the failure of private good in
the public health services and so by allowing private stakeholders dominance in
healthcare, the Indian government is violating the basic principles of the
public economics since early 19990s under neo-liberal economic policies. The
public health expenditure by the Norway government is also higher at 8.9 % of
GDP which reduces out-of-pocket health expenditure at 14.2% of total health
expenditure. In the US, government
expenditure in health is 8.6 % of GDP; total expenditure in health in the US is
17 .1%, reflecting higher proportion of private expenditure in the US, which
could be one of the reasons behind higher number of cases of Covid-19 and the
resulting deaths in the US.
In terms of physical health
infrastructure in terms of hospital beds per 1000 people on an average, India
and Pakistan have lowest ratios than the world average of 2.7 beds, i.e.0.7
beds in India and 0.6 in Pakistan. Brazil (2.3) has also lower beds than the
world average and the US is also not far behind the world average at 2.9 beds
showing poor physical infrastructure in the US. However, the communist country,
Cuba has 4.2 beds followed by the highest human developed countries -New
Zealand, Finland and Norway, which has higher hospital beds than the world
average, i.e.8.5, 5.3 and 4.0 respectively (UNDP, 2020).
Other countries with better hospital beds ratios are Russian Federation
(8.4), Germany (8.2) China (4.2), and Sri Lanka (3.6). The better equipped
countries with physical health infrastructure are most successful in flattering
the novel Covid-19 curve than countries like India, the US and Brazil. The
failure in ensuring health infrastructure as reflected in the above analysis on
the status of health infrastructure indicators provide lessons to contain the Covid-19
pandemic in India and other most affected countries. It is also advocated to
expand the public health care infrastructure via inserting more government
finance and improving their hospital beds ratios as well as the ratios of
doctors and nurses. The pandemic has taught world a great lesson to
universalize public health care to follow basic principles of public economic
of public good in case of social services like health and education to ensure
human right to lead a quality life for every citizen. However, in the
neo-liberal capitalism, it would be difficult to change the policy framework of
the health care sector, so the situation demands a political movement to
universalize public health care and also to achieve SDG-3. The ongoing emphasis
on adopting neo-liberal privatization in the health care via defacto and
dejure are fatal in ensuring public healthcare to all. The
universalization of health care, if adopted as an emergence action for short
run, would greatly result in containing the Covid-19 pandemic. But for the long run, there would be a need
to change the political economy of the health care policies through a change in
the political regime of the neo-liberal state and its privatization policies so
that global public good like health and education can be ensured to all.
Conclusion
In the neo-liberal capitalism, the
private sector is running its business in the health care sector via exploiting
people with (i) higher prices to reap profit/surplus by either working
individually (dejure) or coordinating
with the state under public -private partnership model (defacto) of privatization and (ii) shirking from their social
responsibilities for serving the people even under the global health crisis-the
COVID-19 pandemic. The analysis of Covid-19 cases and the deaths reported in
these countries especially India and the US, reflectsat the challenging times
in the Covid-19 pandemic. Even though, India is surging towards the top rank in
terms of having higher number of cases at global level, reflecting health
inequality due to lower public health and expanding privatization. This paper
has examined the factors behind increasing trend of Covid-19cases in
India. It is observed in the analysis of
health infrastructure in India in comparison to other countries including; the
communist country Cuba and the highest human development ranked countries like
Norway, New Zealand, Germany and Canada, Finland, India has poor health
infrastructure in terms of physical parameters, public funding and health professionals.
The poor health infrastructure and lower public funding reflect at the
challenges before India to contain the Covid-19 places and deaths in the
present time as well as in future. There is a need to change the policy
framework of healthcare in India, it should be welfare oriented rather than
market oriented, which is being followed by the present populist political regime.
At present there is no concrete
public policy in the healthcare sector to increase public spending from 1% of
GDP to 3% of GDP to universalize Indian health care as also stated in the United
Nations’ Sustainable Development Goal 3 (SDG 3), by 2030. The existing scenario
in Indian health care demands a strong political movement for universal public
health care for all in this global health emergency of Covid-19pandemic, as
observed in the highest human developed nations- Norway, New Zealand, Canada,
Finland and Germany. It would be for short run, but for the long run, the dire
need is to revamp the existing neo liberal dominance in every sphere, most
importantly in education and health. Indian health care in current situation of
health crisis require a change in the political economy of the health care
policies as in the case of Cuba so that global public good like health can be
ensured to all.
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