A land of extremes

Even though I see it in my daily life every day, the incredible disparity between rich and poor here in India never ceases to shock me. Nowhere is this more true than in healthcare. Earlier this summer, LifeSpring was invited to attend The Economist's Healthcare Forum, put on by its intelligence unit. It was a fascinating conference, focusing primarily on what the future of healthcare in India is likely to look like.

For me, one striking aspect was how the dichotomy of healthcare challenges seems to be growing. For instance, you had experts talking about the growing prevalence of obesity, diabetes, and cardiovascular diseases, particularly among Indian women. Speakers talked of middle and upper-class women who sit at home all day, get no exercise, and have their servants do their errands.

Then in the next breath, we would hear of the abysmal conditions in urban slums... and how one couldn't talk about exercise there, when the real challenge is getting clean water and proper sanitation.

At this week's recent India Health Summit, an underlying implicit theme was similarities and differences between India and other countries' healthcare systems. Perhaps the most striking opposition was when the Programme Director from Singapore's Ministry of Health spoke. As he spoke of his country's healthcare system, I couldn't think of a more stark contrast!

One of India's biggest healthcare challenges is accessibility for its vast rural population; Singapore is only urban -- and one city at that! He, too, cited the statistic that almost 50% of India's population must travel over 100km to access care; while adding that the entire country of Singapore is 40km across! I found their solution to healthcare interesting -- a compulsory medical savings program for its citizens, coupled with voluntary medical insurance. (In India, fewer than 10% of citizens have health insurance, so the vast majority of healthcare spend is out-of-pocket.)

Of course, references to the US healthcare system abounded. It was interesting to hear so many questions asked around "What lessons can America learn from India in healthcare?" -- particularly around affordability and efficiency. Speaker after speaker talked about America's failed healthcare system, and while I don't necessarily disagree, I do think it's a matter of degrees and reference points. When someone from the Economist Intelligence Unit cited a recent survey showing the vast majority of people in most countries were unhappy with their healthcare options (including the biggest spenders, like the US, UK, and Germany), another speaker chimed in and stated quite forcibly: "With all due respect, there's a big difference between being unhappy and a system being totally lacking."

I thought of this comment later in the day, when a physician addressed the middle and upper-class audience (all primarily senior management and government officials) and said:

"I'm sure all of us, at one point or another, have faced a situation where a medicine necessary for a loved one's surgery was not available at the hospital itself -- so you've had to run out and find the critical medicine elsewhere, while the surgery is going on." I looked around the room, stunned to see such a large number of nodding heads. It certainly makes you aware of the incredible challenges in healthcare, not only among low-income Indians, but across the entire income spectrum.