
India Aims for the World's Biggest Health Care Overhaul - happy-go-lucky
https://www.npr.org/sections/goatsandsoda/2018/08/14/638187029/india-aims-for-the-worlds-biggest-health-care-overhaul
======
petilon
>> _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.

~~~
vsr_pg
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...](https://jamanetwork.com/journals/jamainternalmedicine/article-
abstract/2664065))

"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...](https://www.managedcaremag.com/archives/2018/6/hdhps-cost-shift-no-
swing-high-value-care))

"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...](https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0610))

~~~
icebraining
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.

------
PeterisP
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.

~~~
onion2k
When they say it'll cost $2b I think that's in addition to what's already
being spent.

~~~
Apes
$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.

~~~
onion2k
A lot of the maths in insurance seems improbable.

------
sremani
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.

~~~
thevardanian
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.

~~~
allpratik
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.

~~~
thevardanian
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-...](https://money.cnn.com/2017/10/31/news/economy/india-ease-of-doing-
business/index.html)

2012 - 132

2013 - 132

2014 - 134

2015 - 142

2016 - 130

2017 - 130

2018 - 100

[http://www.doingbusiness.org/data/exploreeconomies/india](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](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...](https://timesofindia.indiatimes.com/india/highway-construction-
doubles-in-4-years-with-27km-a-day-in-2017-18/articleshow/63601035.cms)

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-...](https://tradingeconomics.com/india/total-electricity-output-gwh-
wb-data.html)

~~~
pavanred
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.

~~~
rohit2412
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.

~~~
pavanred
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.

~~~
rohit2412
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](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.

------
briandear
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.

~~~
intended
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.

------
modi15
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.

~~~
rahulthewall
>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...](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(10\)61894-6/fulltext)

~~~
modi15
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.

~~~
rahulthewall
>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.

------
dmix
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.

------
pm90
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.

------
raincom
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.

~~~
intended
Because scaling this IS hard.

~~~
vidarh
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.

------
mataug
> 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.

~~~
abhiyerra
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...

~~~
sbmthakur
And it's probably saving government some money:
[https://www.livemint.com/Politics/6NgxeSDqmL6BgrL0FS6RRI/Aad...](https://www.livemint.com/Politics/6NgxeSDqmL6BgrL0FS6RRI/Aadhaar-
helped-Indian-government-save-9-billion-says-Nanda.html)

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neil_s
The best thing about this article is the moniker Modicare

~~~
namanyayg
Hope it doesn't catch on

------
ForFreedom
That is a scam in the making...

