Good health is central to human happiness. A Human may be a happy human without much
wealth but he cannot be a happy without good health. There is the old saying - where there is
health there is hope. Because of this, Health care must remain a central
subject of healthcare policy of governments. Recently, this author has
contributed many of his thoughts on the topic to leadership of US and India on twitter where this policy is under
active debate and transformation. However, twitter, because of its brevity and
informality cannot explain points fully. This note shall attempt to do that. A
blog note also has a wider and more durable presence for the world at large and
all do need to devote their attention to this topic some of the time, so
central it is to life.
Ranking Countries by
Healthcare Outcomes
Several different ways and methods exist to rank countries
of the world on healthcare but the simplest is infant under five mortality
rates in a country. It is a reflection of a lot else within a country on the
health front. It is not a perfect criterion but it is also least amenable to
manipulations and bias and a fairly good one for a quick check. Such rates can
be found in lists
on Wikipedia and elsewhere easily. Some countries fare well with infant
mortality rate under five deaths per thousand live births. The worst touch near
hundred.
Three factors influence health and infant mortality rates
most, first is the life style and environment of people that includes the air,
water and food they consume: second the general level of prosperity in a
country and lastly public spending on health by governments for public and not
private healthcare.
Thus Monaco a small
city state seems to have the healthiest population in world, scoring high on
all three fronts. Japan and Scandinavian
countries score very high because of high second and third factors. Cuba a
small country has lower infant mortality rate than USA because of public
healthcare even though the latter is much richer that depends on private for
profit care and insurance. Ikaria an island in Greece has perhaps the
healthiest population on the planet for lifestyle reasons.
Private for profit
versus non-profit charitable or public healthcare
An unfortunate reality of human life is that humans are
driven by greed. Only a few saintly persons among them escape its grip. Perhaps
humans are much too recent in evolution on a planetary timescale to have
reached a higher level of existence yet.
Human traits regarded as bad in general play a role for good in special
cases for humans too, not just animals. It is for this reason Nature has
created such traits. Fear helps a human to learn and protect, anger has helped
humans to overcome injustice, lust is essential for procreation and so it is
with greed too, it has a role to play in human welfare.
While humans have been wise to exploit greed for some of its
needs through capitalistic mechanisms with careful control in many areas to create
prosperity and provide services, the profit motive fares badly in some areas. One area where profit
motive does badly is care of infants. Rich persons have tried to provide care
for their children through hired nannies but only in rare cases is such care
better than that by love of a mother. In many it is disastrous. Secret
cameras installed by mothers have revealed some of the most horrific of
treatments of babies by nannies in some cases. Seems a nanny in a British
royal family would pinch a royal baby’s bottom every time she handed it to the
mother so that it would begin to cry and she could secure her job. A second
area where ‘for profit activity’ has failed in human experience or at least
fared very badly is healthcare. It can
lead the’ for profit healthcare’ industry consciously and subconsciously to
make people sick rather than healthier while giving an impression of caring for
them. The daily deaths by the opioid crisis in America are a proof of this as
is widespread prevalence of prostrate and other cancers in richest countries of
the world. For profit healthcare tends to create unnecessary fears and
procedures for profit. A human can choose if to buy a facial cream or car but
he has no choice when fears of death or severe pain are raised. In India,
patients are routinely pushed into ICU for high profits by some hospitals and
then kept there even after near dead on artificial support to prolong the
profit.
Wise nations such as Iceland and Japan have banned for
profit private hospitals realising
this truth about human nature and healthcare and ended up with some of the best
healthcare in the world. If policy makers of some countries offer arguments to
the contrary, it is because of three reasons: First because of ignorance or
brain washing by peers, second because of trying to hide a government’s
shortcoming in providing public healthcare to people and lastly because of the
loot and exploitation of public for profit. The entire for- profit chain of the
for-profit healthcare industry shares the loot and this includes some lawmakers
too.
It goes without saying that when healthcare is publically
funded healthcare, the health insurance industry has no role to play. It only
has a role in the for-profit healthcare system.
Private Practice by
Medical Practitioners
While inadequacy of for-profit hospitals has been made amply
clear in the last section, there is a useful role for the family or
neighbourhood doctor or dentist on payment basis in society to meet lesser
healthcare needs of society that do not need care of a larger facility or
hospital. An individual doctor may not design organised practices of loot as a
larger business organisation may and can provide convenient help. Such a
practice may be carried out from homes or an office in a commercial area. However,
to ensure that private practice by medical practitioners does not morph into
private hospital care some regulations are necessary. An example of such
regulations is
1 A doctor on salary in a public or charitable hospital may
not carry out private practice because it will compromise the former.
2 Private practices by a doctor must employ no more than two
full time employees and two part time employees and shall be carried out in an
establishment of no more than five hundred square feet in carpet area.
Minimum and Maximum
Charges
Around two decades ago in a note comparing the good and bad
of communism and capitalism this author had published an online note that
suggested that while government funded healthcare is a good idea it is also a
good idea to charge a small fraction of costs from patients. This realisation
of the author had emerged from his experience in a fully paid healthcare system
in Canada. A small charge say around 10% of costs with caps prevents misuse and
increases public participation in improving quality of healthcare in a country.
It also improves the efficiency of public hospitals. This author is glad to
note that this practice exists in places like Iceland, Norway and Japan with
some of the best healthcare systems in the world. However more thought is
needed on the minimum and maximum charges
Minimum Charge:
The famous doctor A J Cronin had described how a
practitioner with private practice could make good money by pampering
hypochondriacally or leisurely rich old ladies by pampering them with placebos.
While this is fine on high street it compromises public hospitals. A minimum
charge of around a few dollars for visiting hospitals prevents misuse by
public. Many a person would then just take a day of bed rest with a common cold
rather than knock on the door of a hospital. A percentage of total treatment
cost is also a good idea for minimising unnecessary hospitalizations and
treatment. The minimum charge could be simply charged by issuing a ticket at the gate of the hospital to all who enter, not just one in need of consultation but also others. It would help to keep a hospital less crowded and serene as needed in a place of care. So open have some hospitals in India become that some recent reports have shown even dogs and cows roaming not just in its grounds but also the corridors.
Maximum Charge:
While charging a minimum as a percentage has been explained
it is also necessary for fixing a maximum to prevent citizens from getting
Bankrupt in case of serious needs. Norway has fixed a cap of three hundred
dollars a year. An even better idea is to make this cap equal to the income tax
paid by a citizen in the preceding year.
This note ends with a wish that may God grant humans wisdom to lead healthy and happy lives as long as they live.
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