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A Crisis of Plenty
The poor in India have access to surgeries but not basic healthcare.
ven as the past few decades have witnessed a steady deterioration of public health services in India, health activists and
medical journals, apart from the World Bank, have been
warning about our medical overuse crisis. This crisis has three
main causes: increasing insurance cover, mushrooming of private
hospitals and misuse of the financial provisions of government
health welfare schemes. A recent media report points out that in
the five years between 200910 and 201415, the number of major
surgeries conducted under the National Health Mission (NHM)
has shot up remarkably. This category which includes Caesarean
section (C-section), hysterectomies and other emergency surgeries
has increased by 979% in Maharashtra, 470% in Karnataka,
400% in Bihar, 258% in Jammu and Kashmir, 2,214% in Sikkim,
1,178% in Andaman and Nicobar Islands and 1,501% in Nagaland. What appears on the surface to be increasing access to
health services carries with it not just the risk of the vulnerable
and gullible being cheated financially but also having their
health compromised. The poor and women pay the highest price.
The skewed scenario was further emphasised in 2014 when
the World Bank warned that Indias excessive healthcare situation can harm patients whilst providing marginal benefits. The
Jan Swasthya Abhiyan has pointed to the Rashtriya Swasthya
Bima Yojana (RSBY) which offers below poverty line (BPL) families
a cashless yearly insurance of Rs 30,000 as one of the schemes
which is being misused by unscrupulous doctors. Then there is the
Janani Shishu Suraksha (JSS) programme that offers pregnant
women free delivery and aftercare with free medicines, diet up
to three days or seven days depending on whether it is a normal
delivery or a C-section along with a cash component if they
agree to have an institutional delivery rather than at home. In
Andhra Pradesh when health activists showed that unnecessary
hysterectomies and C-sections were being done to claim money
under the Arogyasri scheme, to its credit the state government
in 2010 revised the rules. Similarly, Chhattisgarhs uterus
scam in which women as young as 20 were subjected to hysterectomies by doctors led to international media attention though
the doctors involved got away with light punitive measures. The
side effects of hysterectomy include osteoporosis, a higher risk of
heart disease and tendency to depression. These poor women
have access to hysterectomies but not to much simpler treatment for their other health issues. The World Health Organization (WHO) has categorically said that the C-section should only
april 9, 2016
vol lI no 15
EPW