Medical debts bankrupt Indians already ravaged by coronavirus


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. Yet in just a few months they were forced to give it up.

After Anju fell seriously ill with Covid-19 last year, the couple turned to a mix of subsidized government hospitals and more expensive private clinics to treat the illness and pay for the two open heart surgeries that followed. The total costs were over Rs 6 lakh, or about six times Nigam’s annual income.

While the sale of his modest two-bedroom home covered most of that amount, he was also forced to borrow money from friends and sell one of his three leather sewing machines.

“We first fought to save his life and now we are fighting 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 state of Uttar Pradesh, in the north of the country. . “Please give us a job. My two sons and I will be working day and night to get out of this crisis. “

Nigam is among the roughly two-thirds of Indians without health insurance, compounding the problems facing the Indian economy as it tries to recover from the shock of a rare contraction last year . Overcrowded public hospitals with long queues and poor facilities make people spend out of pocket for better treatment in the private sector.

While the virus has hit poor people around the world, the impact can be exponentially greater in countries like India, where public health spending is among the lowest in the world. The signs of pain are everywhere: Gold loans and defaults are increasing while savings, vehicle sales, corporate profits and government revenues decline.

There has also been a clear shift in consumer spending from clothing, footwear, and personal care products to pharmaceuticals, as drug shortages and panic have prompted many Indians to sell motorcycles, gold and even their farm animals to pay for life saving black market treatment. . Rising expenses included vials of remdesivir, an antiviral drug, as well as private ambulances that transported desperate families in search of hospital beds and oxygen cylinders.

“This time, what we are seeing is the double whammy of health spending, loss of livelihoods and associated food insecurity,” said Dipa Sinha, professor of economics at the University. Delhi Ambedkar. “If people sell assets that allow them to earn a living, that also has an impact on future income. “

To make matters worse, until recently, government approved treatment guidelines included some drugs not recommended by the World Health Organization. Until early June, the treatment protocol approved by the Indian Ministry of Health listed remdesivir, although the global health body discouraged the use of the drug for Covid-19 in late 2020 after a large clinical trial international has shown that it offers negligible protection against death in hospitalized patients.

The government had also recommended other untested therapies such as the antimalarial drug hydroxychloroquine and ivermectin, an antiparasitic treatment. Convalescent plasma therapy has remained on the list despite the Indian Council of Medical Research’s own studies which 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 ministry spokesperson. Federal Health.

In rural areas, “people are dying or going bankrupt trying to find this life-saving drug or some other solution,” said Ajay Mahal, professor of health economics and global health systems research and deputy director of the Nossal Institute for Global. Health at the University of Melbourne.

“The state should start by giving people an option – a strong, affordable primary care sector – instead of leaving them at their devices to unqualified suppliers and running around to get drugs from pharmacists, fake or genuine. “, he added.

In 2018, Prime Minister Narendra Modi unveiled a flagship program dubbed the world’s largest health insurance scheme providing financial risk protection against catastrophic health spending to an estimated 107 million poor and vulnerable families, or nearly 40% of the population. Yet the new policy has not “effectively improved” access to health care, according to a working paper written by researchers at Duke University.

Even public hospitals can be expensive 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’m trying, but there is a long backlog. “

Growing medical debt poses a risk for Modi ahead of key state elections next year, 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, down from 75% in 2019, according to a poll released on May 29 by LocalCircles, an India-based polling company. Modi’s personal approval rating fell to 66% on June 8, from a high of 76% a year earlier, according to Morning Consult’s Global Leader Rating Tracker.

Even before the pandemic hit, India’s personal spending on healthcare was among the highest in the world, accounting for around 60% of total healthcare spending. Public health spending – including federal and state governments – has hovered well below 2% of gross domestic product, a number that rises to 3.5% including the private sector. This compares to 5.4% of GDP in China and a global average of almost 10%, according to World Bank data.

Although there is no data on the number of Indians driven to financial ruin by medical debt, researchers at Azim Premji University have found that the virus wiped out decades of gains by pushing 230 million people. extra dollars – more than the entire population of Pakistan – in poverty last year. More than 90% of people have borrowed a median amount of 15,000 rupees during the pandemic, they said, adding that the impact is expected to persist.

Loans taken out to cover personal health care costs can be more damaging than other household debts, as the disease “limits the ability to work, leading to depletion of household savings and unanticipated economic shocks,” he said. said Sunil Kumar Sinha, an Economist from Assessments and Research in India.

A study conducted 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 Center for Rural Development at The / Nudge Foundation. “In the absence of fallback options like savings or insurance, even basic necessities like food have become a challenge for poor households,” he said.

Deep in the hinterland of India, the crisis is even more serious, the villagers being forced to reduce their food consumption in order to pay for the treatment.

In Jharkhand, 24-year-old Soni Devi borrowed 10,000 rupees and sold three of the family’s six pigs to pay for the Covid treatment of his mother and three children. Now she is struggling to feed her family.

“There isn’t much rice left at home,” Devi said. “We will die if we can’t find a job. “



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