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Tuesday, December 01, 2020

Cash and care

Demonetisation has affected people’s ability to access health facilities.

Written by Shah Alam Khan | December 16, 2016 1:09:15 am
demonetisation, 500 rs, 1000 rs, black money, currency ban, demonetisation effcet, private hospitals, govt private hospitals, india news, indian express There have been requests to postpone surgeries, patients have dropped out from follow-up clinics and significant number of appointments have been canceled.

More than a month after the government announced its demonetisation drive, the country has begun to realise its social, economic and political implications. As we know, the move has affected processes and practices that require cash transactions throughout the country. It will take some time for the full impact of the demonetisation process to manifest but its short-term implications are already visible. These need careful evaluation. One doesn’t need rocket science to understand that one area where cash crunch has affected the common people, directly, is access to healthcare.

Working in the country’s largest public health hospital, I have realised that demonetisation has hit healthcare access in a significant way. There have been requests to postpone surgeries, patients have dropped out from follow-up clinics and a significant number of appointments have been canceled. The AIIMS’s orthopedic out patient department (OPD) saw a 22 per cent dip in patients in November (between November 11 and December 2) as compared to October 2016 (between October 4 and October 30). National festivals, inclement weather and school holidays usually cause a dip in patient attendance at the AIIMS but none of these reasons were at work during this period.

In India’s three-tier healthcare delivery system, people have to travel to access healthcare. A significant number of patients who consult doctors at the AIIMs are from outside Delhi. Demonetisation has badly hit people’s capacity to move out of their hometowns to seek health advice even though public funding systems are, to a significant extent, taking care of the costs of medicines, surgery, and implants.

The Indian Council on Competitiveness’ roundtable on healthcare has identified a financial barrier as the toughest obstacle in the way of common people accessing healthcare. Demonetisation and lack of funds have, unfortunately, aggravated matters. The corridors of hospitals like the AIIMS are full of stories on credit spending, particularly by people facing dire situations, including those suffering from diseases such as cancer. A large number of patients say the fund crunch has forced them to take credits. This aggravates poverty caused by healthcare expenditure.

At the AIIMS, there is little or no demand on the patient’s pocket. Even then, there has been a significant reduction in patient numbers. We can imagine what the cash crunch has done to patients seeking private healthcare. In a country where the private sector delivers around 70 per cent of healthcare, the situation arising out of demonetisation can be anybody’s guess.

My friends who work in private medical institutions relate similar experiences: Patient attendance has gone down, surgeries are being postponed and people are resorting to credit. So even when the full impact of demonetisation is yet to unfurl, common people appear to be cutting down on healthcare costs. This is a serious challenge and needs active government intervention. It is difficult for the medical fraternity to give a clear solution because the problem lies in bringing the patient to the hospital and not initiating actual treatment. And this problem stems from the absence of cash in hand.

A robust government health insurance policy (with a home to hospital coverage) would have gone a long way in mitigating this situation. Measures like provision of cash at hospital kiosks and registration counters, free transport services for patients and educating the masses to avoid cost-cutting on healthcare could have prevented people from (forcefully) opting out of medical treatment.

We are told to be patient (and rightly so) during this process of massive transformation of the Indian economy. Unfortunately, however, preaching patience to the ill, disabled and the dying can be tricky. Yes, we need to cleanse the system but that should not be at the cost of the poor who are dependent on cash for essential needs like healthcare. Doing so is unethical and dangerous.

The writer is professor of orthopaedics, AIIMS, New Delhi. Views are personal.

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