India Aims for the World's Biggest Health Care Overhaul | Hacker News Reader

India Aims for the World's Biggest Health Care Overhaul

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117 pointshappy-go-lucky76 comments

>> which would offer the poorest half of India health insurance to apply toward private hospitals

This is a terrible idea. Did they learn nothing from the failure of Health Care in the United States? When insurance pays for everything patients stop worrying about costs, which in turn causes hospitals and drug companies to raise prices. This is what has caused Health Care to fail from a costs point of view.

The solution is to make the consumer participate in driving costs down.

In the US, one employer I know of has an excellent solution to the problem: Make employees pay 100% of the bill up to a certain amount, such as $6000. That's a large amount, but the employer then contributes a large amount to your Health Savings Account (HSA), such as $4000. This amount is for you to keep regardless of whether you have any health bills or not. (This money can be used for medical expenses only, but can be used any time, including after retirement). So the maximum you will spend out of pocket per year is $2000. How does this encourage the consumer to scrutinize and control medical expenditure? Because the first $6000 of medical spending in a year is "your money". This is money you'd be able to keep in your HSA if you didn't have any medical expenses. This gives the consumer a strong incentive to reduce costs, question charges, avoid unnecessary services, and so on.

$4k is not a “large amount”. I buy my own insurance and cheapest plan that covers anything at all is $13k/yr for a family of 3. If that’s all this employer is contributing, the employees are getting shafted.

The GP was probably just making up numbers or basing it on costs for a single person.

This is not a problem in India as a lot of treatment s in govt run hospitals is free for low income people. But then, the problem is that such hospitals are hugely overused and the quality of care suffers. By enabling the poor to use private options the demand can be better distributed between private and public.

That is one of the best ideas I have heard on healthcare so far. I wonder which company that is.

One thing I would add to that plan is to provide free annual/biannual preventive health checkups.

The incentive shouldn’t be so much that consumers stop going to a doctor at all.

With all due respect, the premise of this comment--that consumers reduce costs by "shopping around" and being cost conscious--is being misrepresented. The plan type I believe you are referring to is a high-deductible health plan. HDHPs have a little success at reducing costs, but mostly at the expense of compromising quality of care. They can be a part of the solution, but they are not "the" solution as you put it.

“Most Americans in HDHPs are not doing things that can help them get the care they need at the lowest possible cost, and even those who are doing so could realize more benefits,” says lead author Jeffrey Kullgren, M.D., M.S., M.P.H., an assistant professor of general medicine at U-M. (https://jamanetwork.com/journals/jamainternalmedicine/articl...)

"Research published last year in the American Journal of Managed Care showed that switching to a consumer-directed health plan—an HDHP paired with a health savings account—did, in fact, result in lower outpatient spending. But the researchers, led by Neeraj Sood, vice dean and professor at USC’s Price School of Public Policy at the University of Southern California, found no change in spending on 26 commonly used, low-value services." (https://www.managedcaremag.com/archives/2018/6/hdhps-cost-sh...)

"Current evidence suggests that HDHPs are associated with lower health care costs as a result of a reduction in the use of health services, including appropriate services" (https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0...)

The proposal seems to be for an HDHP with an employer-funded HSA, which would remove the inventive to save that money for non-healthcare-related expenses. It's not clear to me that those studies are valid for that particular model.

> the maximum you will spend out of pocket per year is $2000.

Do the employees have to pay all of their medical costs up front out of pocket and are later reimbursed $4000 through the HSA? So an employee must have the available funds to pay more than $2000 up front.

Lol « participating for costs » is a staple of American healthcare and it’s 10x more expensive than not participating for cost literally every other country :-).

And then you get the usual people not going to the doctor when they’re sick (staple of american life) and infecting everyone.

Exactly "participating for costs" is exactly what is destroying the American health system. And it's what sets it appart from most other developed nations where helthcare works. The idea that this is what is missing, is one of the worst conclusions I've ever seen.

My understanding is that there are several countries in the EU where you are expected to pony up money for healthcare. It's usually token amounts, but the fact they do that indicates that's not what's "destroying the American health system".

Token amounts means you're never going to ask yourself "can I afford this 3 euros ?", compared to the "should I really do this x-ray and eat up my 500$ deductible ?"

There is merit in having a deductible, however there are several ways in which this system is flawed.

First, employers should be out of the healthcare equation entirely, except in as far as either taxes or salaries are used to fund health costs the employee bears. After all, employers don't participate in many other common expenses people bear, from housing to educating their children.

Second, individuals are generally not capable of "shopping around" for the best value healthcare; they simply don't have sufficient knowledge to properly evaluate the various options. This is why you need some form of independent assessment of treatment costs and benefits, such as the UK's National Institute for Health and Care Excellence [1].

Insurance based systems with government oversight are the norm in most of Europe.

https://www.nice.org.uk/

> First, employers should be out of the healthcare equation entirely,

This. A million times. If there's one thing that's bugged me a hell lot as an immigrant in the US it is this. It's insane to give employers control over something as personal as your healthcare. I have been lucky enough not to have major issues with this arrangement but I have heard far too many horror stories from colleagues.

Yet somehow this works e.g. in France, or for GPs and dentists in the UK. A lot of socialised universal healthcare systems socialise the insurance part but rely on private actors to deliver all or part of the service. They tend to keep the prices down by either regulating them, or having the socialised insurance provider negotiate a fee structure on the basis that the insurance provider can offer the lowest amount that gives sufficient capacity of the required standard.

E.g. in the UK, general practitioners negotiate as a block, and individual practices can take or leave whether or not they want to provide services for the NHS or private services. The NHS needs to offer contracts attractive enough for enough practices to take NHS patients and ensure continued recruitment, but no better. It's a market, but skewed by a very large actor with a strong interest in keeping prices down.

If they "just" let people shop around without regulating or negotiating prices (and leveraging the volume of business), then it would be a problem. But having the consumer participate in driving costs down is demonstrably not necessary. On the contrary I'd argue it's counter-productive, because when dealing with people with less money it creates a risk that people gamble on options that cost less in the short term at the expense of creating higher costs in the long run.

There speaks the healthy...

... when you or your family are on death´s door because of an accident/cancer/heart attack/stroke/bug/immune disorder etc., you may find comparison shopping isn´t the first thing that comes to mind.

Terrible idea. The $6000 should instead be a percentage of your income (above a certain point, like poverty)... i.e.: ($60,000 - $12,000) * 0.05

> When insurance pays for everything patients stop worrying about costs, which in turn causes hospitals and drug companies to raise prices. This is what has caused Health Care to fail from a costs point of view.

There's also the problem that there isn't any price transparency in the US health care system. You literally can't find out how much many procedures cost ahead of time.

Most first world nations have government bodies with medical experts setting maximum costs for drugs and procedures. Their costs for healthcare are much lower than the US.

The idea that "The solution is to make the consumer participate in driving costs down." has been demonstrated in none of those nations for healthcare.

As a well-educated white collar worker in a non-medical field, if I broke a bone and a doctor gave me three different options and costs for setting that bone, I would really have no basis for being able to choose the right option for the best long-term cost/quality of health.

This idea is like asking regular computer users to determine what software stack they should buy to use in their cloud computing provider.

The math doesn't check out.

"Each family would get more than $7,200 in annual coverage"; "better health care for 1.3 billion people" and "Modicare is expected to cost the Indian government less than $2 billion annually" seem to be mutually exclusive. There's no reasonable way for health insurance/coverage to be so underutilized that on average only $1-$2 of $7200 would get used.

When they say it'll cost $2b I think that's in addition to what's already being spent.

$2 billion across 1+ billion people is the $1-2 he refers to. The implication is that the additional $7,200 is purely coming from efficiency gains, which he suggests seems improbable.

A lot of the maths in insurance seems improbable.

You should hear our respected PM's (PM Modi) speeches (pick pretty much any) and ruling party's (BJP) statements and you would get used to math and facts not checking out.

I used to think those were just slips and mistakes. It took a couple of years for me to finally understand that those were indeed mistakes but "calculated" ones.

It works like this - you declare "every household will get X by the end of 3rd year" and you know that 80% will be just euphoric to hear that and after 6 months they will forget it was 3 years - they are your fans. Once you say something they take it onto them to defend you and what you said forever, no matter how absurd it was. You will also know that out of remaining 20% like 1-2% will dig into it and out of that 1-2% a minuscule will have the guts and acumen to speak out and if they do that previous 80% will take care of this fractional percentage who speaks out either by drowning their voice with their collective noise or bully or silence them somehow. "Somehow" also includes "non-peaceful" means (very effective in silencing people).

Can you explain what is wrong with the math here? Are you expecting 1.3 billion people to fall ill every year? This is coverage we are talking about. I can't understand how some people don't know what coverage means.

Great observation. You are absolutely right. Unfortunately, the public does not care about, or understand, numbers, probability, expectation or black swans, and the politicians know that at a gut level. I wish there was a consistent way to call out such bullshit in a way that matters.

But the history of humanity vis-a-vis rhetoric from the time of Demosthenes is not entirely inspiring.

Coverage up to X does not mean people will use X. 7200$ is a shit ton of money in India.

Sure, people will not use X but they'll also use more than 0.02% of X; Even a ridiculously unrealistic low utilization of 0.2% is 14$/year and would cost ten times more than the "estimated" cost.

No they won't. You aren't discounting those who already hold health insurance because it's a deduction for their tax returns. So for such people it's an investment. You are also not discounting those who are covered by their employers group health insurance. Not to forget those people who already have enough to spend for private healthcare. Not all 1.3 billion people in India are poor who depend on government health insurance.

These factors don't need to be explicitly discounted because they are far too small to matter. The number of people covered by various private group health insurance in India is something like 100 million, so it's just a 10% difference when we're talking about order-of-magnitude differences. Yes, not all 1.3 billion are poor and depend on government health insurance, but the numbers are so outrageously off that it doesn't work for 1.3 billion people; doesn't work for 1.0 billion people, doesn't work for 0.8 billion people (who are currently uncovered by other gov't subsidies including RSBY). Unless you're arguing that it applies to a tiny, tiny fraction of Indias population, the math doesn't work out, either the cost estimate or the benefits will be entirely different.

Again, you are considering that all 1.3 billion or 1.0 billion or 0.8 billion people will fall ill. How can you not see that it's an unrealistic scenario?

Coverage is only provided for those who fall ill. Only critical illnesses require the entirety of $7,200. The rest of the diseases are treatable in the $1 to $200 range. The government hospitals already provide free treatment for a majority of these diseases. It's the critical illness treatment which has become a burden for the government hospitals as they don't have either the equipment or the staff or the infrastructure to cater to the patients. That's where this insurance will come handy. Instead of spending $100 billion dollars bringing the government hospitals to match state of the art private hospitals just reuse the existing private hospital infrastructure and subsidize the illness instead of wasting money on infrastructure/equipment/staffing. I can't understand how this doesn't make sense? This even lessens the load on the government hospitals so they can focus their energies treating curable diseases and leave the critical illness part to be handled by private hospitals.

Trust me, we can argue however much we want, but the poor of India see this and understand the significance of this move. Many poor cancer patients (especially those with mouth cancer due to smoking tobacco/chewing gutka) who couldn't get any treatment in free government hospitals due to lack of infrastructure/equipment/staffing can get themselves treated in state of the art private hospitals. And the poor are not beggars to misuse the scheme by claiming insurance for even the simplest of diseases. They will get themselves treated in government hospitals if the particular disease can be cured for free because that's where they are comfortable going (many build rapport with the government doctors too). Only if it's not possible, would they approach the private hospitals. You need to be on the ground and understand the poor of India to be able to think beyond numbers. If numbers is all you see then there is nothing further to argue about.

Why is this so hard to understand? Why would 1.3 billion people want $7,200 in coverage at once? If that happens then it's a mega catastrophe of proportions that the entire World would not be prepared to bear. That would also mean the end of the World as we know it.

So let's be realistic shall we? Of those 1.3 billion people hardly 0.1% of them might fall ill in any given year. That's 13 million people. That's still a huge number. Of them how many do you think would be critically ill? 100%? 75%? 50%? 25%? Let's take 25%. That would still be a huge number of critically ill patients (3.25 million). The total number of cancer patients in India per year is around 7 lakhs, which is 0.7 million (http://cancerindia.org.in/statistics/) so my guesstimate of 3.25 million makes sense (even though I feel it's higher then what the actual stats are). Only such kind of people would need the $7,200 insurance because critical illness care is cheaper in India compared to any other country. You don't need $7,200 to treat malaria or flu or to get your wisdom tooth removed (https://timesofindia.indiatimes.com/city/ahmedabad/Wisdom-li...). You need that kind of amount if you get cancer/stroke etc. Of those 3.25 million patients what percentage do you think are people who can afford private healthcare and those can't? Of those who can afford how many of them are covered by their employers group health insurance or have their own insurance purchased as part of tax saving initiatives? Now you do the math and you'll get your answer.

"hardly 0.1% of them might fall ill in any given year" is a very unrealistic assumption - is service is available (which is not universal in India at the moment, but is promised to be with this reform) the expected number of annual per capita doctors visits is at least 1 (OECD country average is 7, poorer countries get 1-2), not 0.001, a thousandfold difference. Not all people won't get ill in a given year, but a large portion does; it depends on how severe illnesses you count but it's 30-60%, not 0.1% or 1%; and some people (much more than 0.1%) get multiple illnesses in a single year.

I'm arguing that on average people (all 1.3 billion of them) need much, much more than $1 of coverage each year. You don't need $7200 to treat common diseases, but many of them will need more than $1. For every person that needs $0 of coverage there will be one that needs more than $2.

If the estimate was comparable to $10 per person (so, excluding private insurance, roughly $10 billion total not $1-2 billion), then it might be worth starting a discussion about the details and how much what costs. But $1/person/year is so ridiculous that it's off the charts.

> "hardly 0.1% of them might fall ill in any given year" is a very unrealistic assumption

It's very realistic. Because if a 100 million people fell ill in India, we would have classified it as a national health emergency and the World would start taking notice. You are talking about bubonic plague level proportions. That is a world-wide emergency. That's the reason I say your numbers are absolutely ridiculous.

Stop being so blinded by numbers that you forget the human element behind it. The realistic number is somewhere in the range of what I said. Let's be sensible when talking such things.

> is service is available (which is not universal in India at the moment, but is promised to be with this reform) the expected number of annual per capita doctors visits is at least 1 (OECD country average is 7, poorer countries get 1-2), not 0.001, a thousandfold difference

Doctor visit is not the same as being eligible for $7,200 worth of coverage. In India, doctor visits are generally free unless you are visiting a really high profile doctor. It's not the USA where even the visit requires you to deposit hundreds of dollars in consultation fees.

> Not all people won't get ill in a given year, but a large portion does; it depends on how severe illnesses you count but it's 30-60%, not 0.1% or 1%; and some people (much more than 0.1%) get multiple illnesses in a single year.

I already gave you figures. 0.7 million are cancer patients per year in India. Cancer is classified as a critical illness. The cost for it is approximately $7000 dollars. $7,200 dollars is more than sufficient to cover the expenses. So you are totally wrong here. I don't understand how you can say it's 30-60% when the national statistics I linked to say 0.7 million are cancer patients per year (which is 0.0538% of India's population). Don't throw numbers in the air without some facts backing your claims. Considering cancer is one of the major critical illnesses I extrapolated that number to around 3.25 million people with critical illness. That is almost 5 times the cancer number stats put out by reputed source (http://cancerindia.org.in/statistics/).

> I'm arguing that on average people (all 1.3 billion of them) need much, much more than $1 of coverage each year. You don't need $7200 to treat common diseases, but many of them will need more than $1. For every person that needs $0 of coverage there will be one that needs more than $2.

That's the reason I talked about specific critical illnesses like cancer/stroke etc. I guess you decided to skip that entirely.

> If the estimate was comparable to $10 per person (so, excluding private insurance, roughly $10 billion total not $1-2 billion), then it might be worth starting a discussion about the details and how much what costs. But $1/person/year is so ridiculous that it's off the charts.

Sorry to say but it's your argument that is ridiculous because it stems from the fact that $1/person/year is the coverage when it's not. No insurance company works that way in any part of the World. Seriously, learn how insurance works first.

The beauty of (Indian) democracy is that every 5 years the year before election an innovative world saving scheme that is expensive would be implemented or started.

Across almost all metrics, infrastructure, corruption, ease of business, electricity, even cleanliness India has improved on. This isn't just another election year innovation, this is just another list of innovations that have been added, which also include things like investments in clean energy, and providing rural impoverished citizen with gas to cook (people in rural areas would cook in wood fired stoves that would produce a lot of smoke and be terrible for their health).

You can be a pessimist, but I don't see that, and most investors are very optimistic about the Indian market.

>> Across almost all metrics, infrastructure, corruption, ease of business, electricity, even cleanliness India has improved on.

Source?

Isn't this true almost everywhere in the world most of time?

> Across almost all metrics, infrastructure, corruption, ease of business, electricity, even cleanliness India has improved on

You are drinking ruling party’s a lot of cool aid

What are you talking about? There are very few metrics that you can list that show a decline. So how about you show me the data for decline.

How about freedom of press as an example (World Press Freedom Index)

2018: 138

2017: 136

2016: 133

A good rule to follow, formulate an opinion after you gain enough facts to argue the other side, else you'll keep seeing only what you want to see.

You can't pick one index to your convenience and even then, I have looked at the website - https://rsf.org/en/india which I think is your basis of the rankings.

Their headline was > Deadly threat from Modi’s nationalism

Scaremonger much? I don't buy the fact that in the Internet age, you have to be some reporter to write against the government policies. If someone has any groundbreaking evidence against anything wrong the government is doing, all it takes is one youtube video anonymously.

They rank the United States at 46, the United Arab Emirates at 128(better than India) and India at 138. Seriously? There has been a mention of 3 isolated incidents against journalists who were affected. All these are criminal incidents where the police have started investigating, just like the thousands of criminal incidents against ordinary Indians.

There has never been a prime minister who was hated this much by an Opposition and god forbid there will never be. I really hope the opposition in India talks about development than scaring ordinary citizens, after 4 years of peace, you can't scare them.

> I don't buy the fact that in the Internet age, you have to be some reporter to write against the government policies.

We don't need reporters anymore because we have the internet? :)

I won't engage further. You're free to believe what you want, but here's what I would like to say - You can interpret the current situation however you want, but others might disagree. And, anyone that disagrees with you or criticizes the govt, isn't necessarily the opposition or the enemy. - The govt is not a victim of opposition's hate, opposition and press are free to and supposed to criticize the govt, and they always have.

India has been in a downward trend in terms of freedom of press since 2011. Unfortunately.

Rather than being prentious and accuse others of being half asses, or ignorant, I suggest you only stick to facts as you claim you do.

I am most definitely not denying that everything is perfect. There are things that have gotten worse, however the benefits of what have gotten better are far more tangible, real, and affect daily life than this one data point you provided. There are others which are more tangible that India has faultered on, but again the good far outweighs the bad.

This is totally wrong information about the current state of affairs of India.

1. Ease of doing business

The Indian government had stopped LLP registrations all together for no official reason. For Pvt ltd registrations from past June 10th rejections to form a new company or even subsidiary company has skyrocketed.

Source: LLP halt is reported in media, which still has some spine to stand against the government. Regarding rejections, all data is hidden even from RTI but you can talk with literally any CA/CS to understand the nightmare of MCA.

2. Investors

Its straight 5th-year FII has removed billions of dollars from the Indian market. Still, Indian Sensex is surging on the wave of the domestic mutual fund industry. Those "mutual funds Sahi hai" ads didn't start out of nowhere. There's no problem with the rise of the mutual fund industry, but to use it as a parameter for Indian economy's performance is nuts. Actually, rational investors are actively avoiding the Indian market.

Source: moneycontrol.com

Regarding corruption, infrastructure, education, jobs, credit rates and liquidity and other macroeconomic parameters, in general, are totally telling a different story. It would be really good to have the facts for all of the above claims. If I get to see the facts, I'll be satisfied with the claims.

Wake up before its too late! I just want people to question their government rather than defending them, irrespective of any political party.

Edit: Fixed indentation.

1. Business Ranking

"India climbs global business ranking. But it's not that simple" https://money.cnn.com/2017/10/31/news/economy/india-ease-of-...

2012 - 132

2013 - 132

2014 - 134

2015 - 142

2016 - 130

2017 - 130

2018 - 100

http://www.doingbusiness.org/data/exploreeconomies/india

Samsung is also opening the world's largest Mobile phone manufacturing plant in India. That's a tremendous investment from them.

2. Corruption

India's Corruption Ranking

2011 - 95

2012 - 94

2013 - 94

2014 - 85

2015 - 76

2016 - 79

2017 - 81

https://tradingeconomics.com/india/corruption-rank

3. Infrastructure

Road construction by km per day built / awarded

"While a total of 4,410 km highway stretches were constructed in 2014-15, it increased to 9,800 km in 2017-18." Furthermore just look at the spending. It's booming.

https://timesofindia.indiatimes.com/india/highway-constructi...

4. Electricity

There's pretty consistent growth, although growth isn't the only story. A strong reliable grid is also important, along with having investments in green technology to make the electricity generation more green. Reliability isn't up to standards yet, but it has gotten better, in my opinion. There have also been tremendous investments from the government in green tech, like solar.

https://tradingeconomics.com/india/total-electricity-output-...

From the article:

> Another criticism is that countries get credit for passing laws, even if they haven't been widely implemented yet.

This would be my biggest concern with these rankings. India might sound better on paper (from a very high level abstract look comparing countries) for ease of business but that doesn't mean it has translated to day-to-day business life there.

The recent additions are not just laws, they're tangible initiatives, and infrastructure the government has built.

Creating infrastructure, and reducing friction is the only thing a government can. The government is merely a mediator, a facilitator, that lays out the field and its rules, but it's up to the citizens to independently exploit that opportunity.

Care to also publish rankings of the country over the years in freedom of press, law and order, mob violence, transparency, economic growth, journalists/writers murdered, appointments/shortages of RTI commissioners, RTI rejection rate, lack of lokayuktas, appointments/shortages of judiciary by govt etc. (or just look it up for yourself)

> There have also been tremendous investments from the government in green tech, like solar.

The goal setup was a 100GW of solar capacity by 2022. It was about 2KW in 2015 and is about 20KW in 2018. We are most definitely not going to achieve the goal, perhaps not even get close. Lofty goal, sound familiar? I am sorry, I take lofty goals and promises of the Govt. with a pinch of salt until I see some actual implementation.

Did you deliberately change GW to KW?

20 GW in 2018 with process falling 15% year on year can lead to a sudden increase. Let's pass judgement in 2021 when things are clearer.

Edit: ...2GW in 2015 and is about 20GW in 2018...

Typo, and HN doesn't allow me to update it now. Anyway, my point was that in the past 4 years we achieved 20GW and we expect to achieve 80GW in the next 4 years.

But it isn't linear. Price is falling exponentially (15% every year). And adoption will be more rapid as solar suddenly becomes economically viable.

For a benchmark, look at China's adoption. https://en.m.wikipedia.org/wiki/Solar_power_in_China . Not at how many years they too from 20gw to 175 gw, but how much solar became viable for them last year.

Yes. Go ahead and publish them. I dare you to. At best there are only marginal negative shifts. So please list all the data that you have.

Furthermore you’re behaving as if having ambitious goals for a government is bad. I would rather have an optimistic, ambitious government that gets somewhere near the goal than a lazy “realistic” government that always ends up underestimating itself.

Reaching a goal isn’t necessarily as important as simply producing a better product. Having a high expectations is a prerequisite to creating a great product. There are, again, so many improvements that India has achieved recently.

The best way to judge your theory that the overseas investors are so very optimistic about India is to simply follow the money.

Contrary to what you are saying, the data actually says that there is a huge outflow of funds from India.

https://www.moneycontrol.com/news/business/markets/fiis-pull...

Those customary bribes are not going to hand themselves out.

That sounds pretty similar to most democracies.

New Zealand now has free tertiary education because of the last election. Sadly it does nothing for my $25,000 of fees I had to pay for my fancy piece of paper. That's almost half a house deposit in some parts of the country.

Sadly it does nothing for my $25,000 of fees I had to pay for my fancy piece of paper.

That's just a semester in some US schools (when you add living costs) so don't be that upset :)

What happens when 500 million people start to go to the few private hospitals? It looks like there could be some nice election-year “progress,” but that isn’t going to magically make more private beds appear. Perhaps funding and fixing the public hospitals might be a higher priority otherwise, private hospital prices will increase. This plan has the potential to create some serious health cost inflation. If everyone now has $7200 to spend, that’s just going to raise the prices because long waiting lists will lead to people who are private pay being able to access care more easily if they are willing to pay higher prices. But, “health insurance for all” sounds better as an election slogan than “we are going to fix the structural issues with our public hospital systems.”

Employees not showing up to work in the public hospitals? Pay them more and fire them when they don’t show up. Medicine shortages? Then buy more as well as audit the current usages of medicines to reduce waste. Not enough beds? Buy more. Fixing the public system is going to be far more sustainable than suddenly giving everyone $7200 when there isn’t enough capacity. The math doesn’t work with 500 million people unless they expect utilization rates to stay the same — which they won’t there are probably 10s of millions that don’t use the system at all, but they sure will when they can afford it. I think this politician is making promises he knows will be impossible to keep, but will help him win an election before the people realize that it was an plan with no possibility of actually increasing availability of care.

> What happens when 500 million people start to go to the few private hospitals? It looks like there could be some nice election-year “progress,” but that isn’t going to magically make more private beds appear.

That seems to be the least serious issue with this. Firstly, the coverage is minimal enough (especially considering their estimates of the rate of payout) that I doubt it would have that great an effect on usage. I don't really see why the market would fail to meet new demand in this case, and certainly I don't see why you think that it would be easier or cheaper for the Indian government to fix their public hospitals (especially if you've seen their other programmes, especially public primary schools).

Hahaha, we wish.

Poor people will be kept in different wards, or some understanding will be reached to ensure that the status quo is maintained.

Nothing in India is done just based on the rules, everything is done with the meta rules firmly in mind.

As for your other ideas- these are things you do when you have the ability and personnel to do it. Huge audits and legal systems capable of prosecuting the vast back log of cases.

Edit; That said, I do hope this takes off, healthcare investment in India needs to expand significantly and affordable healthcare is needed. We will definitely need state healthcare to help a lot of people.

Interesting comments here but imo India already has a pretty fantastic healthcare system. People who argue against spend some time understanding the US healthcare system and the disaster it is.

India already has health insurance by private companies but its probably not used extensively. Something like this is basically a government run insurance scheme - it will most likely be a no-frills service, offer standardized plans with fixed reimbursements and provide some tax benefits for enrollment. There is very little that can go wrong here and probably pretty good upside. This is the kind of things that make for very good politics and there is no harm in the govt. capitalising on it.

That being said most of India has access to govt. run hospitals which offer near free services. The article paints a grim picture of these facilities and that might be largely true but I frequent govt. hospitals all the time even if I can afford private. They are quick, almost free and doctors are pretty good.

>That being said most of India has access to govt. run hospitals which offer near free services.

Nothing could be farther from the truth. I would recommend the following study, published in The Lancet

>In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures.

See: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

I dont really need the study. I stay here and experience this on a daily basis. There is nothing in the study which contradicts what I said. People do visit private hospitals if public hospitals dont meet their needs and such visits can definitely bankrupt people. That doesnt have to mean that the govt. hospitals are doing a bad job or that private hospitals are inaccessible.

>I stay here and experience this on a daily basis.

Your anecdotal evidence is not worth more than a proper study.

>That doesnt have to mean that the govt. hospitals are doing a bad job or that private hospitals are inaccessible.

Private hospitals, in India, are indeed inaccessible for the majority. As for government hospitals, we don't have enough.

People who think Govt hospitals are not doing a bad job should at least visit a Govt hospital once. Govt. hospitals in india are pathetic. I have first hand experience with Government general hospital, Nellore.

Modi announcing big plans and Modi implementating big plans are two very different things.

He still hasnt done hardly any of his original and badly needed economic reforms.

This is absolutely fantastic. Even if it doesn't succeed, it would lay the framework for something to build on next, as often happens in India.

The number of seats in Indian medical colleges is 91040. Why not increase these seats by 10 fold. In a couple of decades, that can help.

Because scaling this IS hard.

Notably, it's unusually hard in that actual practice on humans is still a necessity since there aren't good enough training analogues to substitute for real cases, so even if you managed to scale the basic training it's still an unsolved problem to scale up the number of doctors rapidly in safe way.

E.g. you can't just educate 10x as many heart surgeons without actually having 10x as many cases for them to scrub in on that you have experienced heart surgeons to lead on unless you're prepared to kill a lot of people in the process.

> The plan is to roll it out by the end of the year – ahead of elections expected early in 2019.

Wow that seems to be a highly ambitious timeline. I hope India manages to setup the program enroll people onto it, but I'm also doubtful whether it can be achieved before the elections.

Having just gone to India everything is tied to the Aadhaar Identification: banks, schools, welfare, etc. It has overall completely replaces a bunch of different identifications into a single centrally located entity. However weird I feel about it being Orwellian I can't say it hasn't been good in terms of simplifying access and providing services since you just need a single identification. So it wouldn't be that hard to just add additional information like how much healthcare was used where and can easily be implemented by end of the year.

But the problem is will all the private sector be able to handle the added load of nearly a billion people accessing the resources...

And it's probably saving government some money: https://www.livemint.com/Politics/6NgxeSDqmL6BgrL0FS6RRI/Aad...

The best thing about this article is the moniker Modicare

Hope it doesn't catch on

That is a scam in the making...

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