Indians Already Ravaged by Virus Now Hurt by Medical Debt | India News

Indians Already Ravaged by Virus Now Hurt by Medical Debt |  India News

NEW DELHI: In the shadow of the Taj Mahal, shoemaker Shyambabu Nigam worked for years to save enough money to buy his wife Anju a small house overlooking the iconic 17th-century mausoleum. However, in just a few months, they were forced to give it up.
After Anju became seriously ill from COVID-19 Last year, the couple turned to a combination of subsidized government hospitals and more expensive private clinics to treat the disease and pay for the two open-heart surgeries that followed. The total costs amounted to more than 600,000 rupees ($ 8,230), roughly six times Nigam’s annual income.
While the sale of his modest two-bedroom house covered most of that amount, he was also forced to borrow money from friends and sell one of his three leather sewing machines.
“First we fought to save his life and now we fight to survive with a huge financial burden,” said Nigam, 42, from the room he now rents in a low-income village of Kachhpura near Agra in the northern state of Uttar Pradesh. . . “Please give us some work. My two children and I will work day and night to get out of this crisis ”.
Nigam is between about two-thirds of Indians who do not have health insurance, compounding the problems facing India’s economy as it tries to recover from the impact of a rare contraction last year. Overcrowded public hospitals with long lines and poor facilities encourage people to spend out of pocket for better treatment in the private sector.

While the virus has affected the poor around the world, the impact may be exponentially greater in countries like India, where public spending on health care is among the lowest in the world. The signs of pain are everywhere: lending against gold and debt defaults are increasing while savings, vehicle sales, business profits and government revenues are falling.
There has also been a clear shift in consumer spending from clothing, shoes, and personal care items towards pharmaceuticals, as drug shortages and panic led many Indians to sell motorcycles, gold, and even their farm animals for pay for life-saving treatment on the black market. . The high expenses included vials of the antiviral drug remdesivir, as well as private ambulances transporting desperate families searching for hospital beds and oxygen cylinders.
“This time what we see is the double whammy of health spending plus loss of livelihoods and related food insecurity,” said Dipa Sinha, professor of economics at Ambedkar University in Delhi. “If people are selling assets to earn a living, that will also have an impact on future earnings.”
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To make matters worse, until recently, government-approved treatment guidelines included some medications not recommended by the World Health Organization. Until the beginning of June, the treatment protocol approved by the Indian Ministry of Health included remdesivir despite the fact that the world health body discouraged the use of the drug for Covid-19 in late 2020 after a large international clinical trial. showed that it offered negligible protection against death in hospitalized patients.

The government had also recommended other unproven therapies, such as hydroxychloroquine, an antimalarial drug, and ivermectin, an antiparasitic treatment. Convalescent plasma therapy remained on the list even though the Indian Council of Medical Research’s own studies found little benefit.
Officials from the National Health Authority, responsible for implementing the country’s flagship public health insurance program, did not respond to multiple requests for comment, nor did a spokesperson for the federal Health Ministry.
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In rural areas, “people die or go bankrupt trying to find that life-saving drug or other solution,” said Ajay Mahal, professor of health economics and global health systems research and deputy director of the Nossal Institute for Global Health. Health at the University of Melbourne.
“The state should start by offering people a choice, a strong and affordable primary care sector, rather than leaving them with their devices in the hands of unqualified providers and looking for drugs from pharmacists, fake or genuine,” he added.
In 2018, Prime Minister Narendra Modi unveiled a flagship program called the world’s largest health insurance plan that offers financial risk protection against catastrophic health expenditures to approximately 107 million poor and vulnerable families, or close to 40 % of the population. However, the new policy has not “effectively improved” access to health care, according to a working paper by researchers at Duke University.
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Even government-run hospitals can be costly for the poor: Nigam said he paid a subsidized fee of Rs 200,000 for one of his wife’s bypass surgeries. “I don’t have government health insurance because I didn’t know I was eligible,” he said. “Now I am trying, but there is a lot of backlog.”
The ascent medical debt poses a risk for Modi ahead of next year’s key state elections, including one in Uttar Pradesh, the country’s most populous state, where Nigam lives. His government’s approval ratings have fallen to 51% this year from 75% in 2019, according to a poll published on May 29 by LocalCircles, an India-based polling company. Modi’s personal approval rating fell to 66% on June 8, down from a high of 76% a year earlier, Morning Consult’s Global Leader Rating Tracker found.
Even before pandemic India’s out-of-pocket spending on healthcare is among the highest in the world, accounting for around 60% of total healthcare spending. Spending on public health, including the federal and state governments, remained well below 2% of gross domestic product, a figure that rises to 3.5% if the private sector is included. That compares with 5.4% of GDP in China and a world average of nearly 10%, according to World Bank data.
Health costs
While there is no data on how many Indians have been pushed into financial ruin by medical debt, researchers at Azim Premji University found that the virus erased decades of gains by pushing an additional 230 million – more than the entire population of Pakistan, into poverty last year. . More than 90% of people borrowed an average amount of 15,000 rupees during the pandemic, they said, adding that the impact is expected to persist.
Loans taken to cover out-of-pocket health expenses can be more damaging than other household debts because illness “limits one’s ability to work, leading to depletion of household savings and unforeseen economic shocks,” Sunil said. Kumar Sinha, Indian Research and Ratings Economist.
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A study in April and May among a poor community in the eastern state of Jharkhand found that 58% had already borrowed money and 11% had sold assets during the pandemic, according to John Paul, director of the Rural Development Center at The / Nudge. Foundation. “Without alternative options like savings or insurance, even basic necessities like food have become a challenge for poor households,” he said.
Deep in the interior of India, the crisis is even more dire, as villagers are forced to reduce their food intake to pay for treatment.
In Jharkhand, 24-year-old Soni Devi borrowed 10,000 rupees and sold three of the family’s six pigs to pay for Covid treatment for her mother and three children. Now he is struggling to feed his family.
“There isn’t much rice left at home,” Devi said. “We will die if we don’t get a job.”


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