Introduction
Health care is a crucial component in a country’s effort to attain its desired level of development. Dernberger (1980, p.253) opine that, there is a strong correlation between social and economic development. Paying more emphasis on the economic aspect and neglecting the social aspect of country’s development leads to unbalanced development thus giving way to a slowdown in a country’s rate of economic development. In a bid to achieve economic prosperity, it is important for governments of both developed and emerging economies to include health care amongst their top priorities (Srinivisan, n.d).
Over the last 25 years, India and China have undergone a notable economic growth. Reduction in mass poverty is one of the aspects that best illustrates the two countries’ economic growth. The health care sector in India and China has attained considerable health gains (Ma & Sood, 2008, p. 35). However, this crucial sector in the aforementioned two countries has continued to experience numerous challenges compared to other countries. In an effort to promote health care provision, China and India have incorporated a number of reforms. Despite the reforms, the two countries experience structural deficiencies in the health care sector. The objective of this paper is to illustrate why India and China cannot be the top in health care.
Health care challenges in India and china
The Indian and Chinese health care systems face a number of challenges. These challenges fall into socio-economic-political challenges, unregulated growth and development of private health care, and inequality (Deogaonkar, n.d).
Inequality and out-of-pocket health care system
Economic and social inequality plays an important role in health care provision (Wong, Tang, & Lo, 2005, p. 45). A high level of poverty is a threat to the health of a particular population. For example, inequality contributes towards a high rate of morbidity, life expectancy, and mortality. The Indian government has not implemented effective resource allocation strategies. According to Deogaonkar (n.d.), there has been unequal spending within the Indian health care sector. Consequently, this aspect has led to health care becoming ineffective. The socially disadvantaged coupled with the marginalized are the most affected groups by the growing inequalities in the sector, which is well illustrated by the discrepancy in mortality rate between the rich and the poor.
China and India have not been effective in meeting their populations’ health care needs in order to maintain sustainable economic growth given the fact that their health care systems have been unbalanced between the rural and the urban population. Additionally, Ghuman and Mehta (2009) assert that health care accessibility and affordability in the two countries has been a major challenge to most citizens. For a considerable duration, China and India did not have universalized health care plan covering the total population. Therefore, health care in India and China has been characterized as being out-of-pocket. This element presents a great challenge to the two countries’ population in their quest to seek health care services.
Out-of-pocket health care payments pose a major financial challenge to most citizens in India because they are under-privileged. Health care costs in India are relatively high thus making it difficult for households to recuperate from such high costs. Consequently, households become poorer and poorer (Mondal, et al., 2010, p. 3). The poorest population in India has become the worst affected in seeking medical services. Approximately, more than 25 per cent of the hospitalized population, in India, slips into immense poverty after seeking medical services for major illnesses. The high cost of health care also explains why most citizens who have received loans from banks default on their payment (Mondal, et al., 2010, p. 3). Approximately, 32.5 million people in India fall below the country’s poverty line due to the out-of-pocket health care payment (Garg & Karan, 2005, p. 2).
Most economists are of the opinion that shifting away from an out-of-pocket health care system is paramount in a country’s effort to minimize health catastrophes. In an attempt to deal with this challenge, China and India should reduce the out-of-pocket burden incurred by citizens in seeking health care, which can be attained by formulating an effective nationalized insurance system. Alternatively, the two countries should encourage the development of private insurance.
In line with its commitment in reforming the health care sector, China implemented a number of health insurance packages. Despite this move, the country’s health care plan only covers 55 per cent of the total health care expenditure. Consequently, 45 per cent of the total health care expenditure has to be covered through an out-of-pocket payment. This percentage is relatively high when compared with out-of-pocket payment in the United States, which is approximately 11.8 per cent.
According to Freeman and Boynton (2011), the Chinese health care delivery system is highly socialized. However, the financing system is not. As a result, more than 50 per cent of the total medical cost area is covered through out-of-pocket payments. Additionally, 95 per cent of the country’s hospital beds are government-owned. Despite this aspect, the government only covers 10 per cent of the hospitals’ recurrent costs, which means that most hospitals have to rely on charging patients.
China and India should implement effective health care reform strategies to become global leaders in health care provision. One of the ways through which the two countries can achieve this goal is by implementing managed care models such as Managed Care Organizations, which would aid in dealing with the issue of affordability. Adopting such a model would aid in integrating health care and health insurance, thus containing the cost associated with health care (Ma & Sood, 2008, p. 35).
Access of health care services
Access refers to effective availability of a particular product or service. Therefore, to promote economic growth, accessibility of health care services in India and China is considered a basic right. However, the two countries have continued to experience a decline with regard to accessibility of health care. In China, accessibility of health care has deteriorated due to increased focus towards curative care rather than preventative care.
Currently, it is not possible for the Chinese citizens to access free medical services, such as immunization against contagious diseases (Ma & Sood, 2008, p. 35). The gap in accessing health care services is also wide between the urban and rural populations. Over the years, China has experienced a significant decline in growth of hospitals located in the rural areas. Most health care facilities are concentrated in urban areas.
Similarly, India has also continued to experience a challenge with regard to accessibility of health care. In addition to a shortfall in the number of health care facilities in India, transportation also poses a major challenge in accessing health care services. Transportation to public health centers is usually infrequent while private transportation is expensive, which locks a large proportion of the country’s population from accessing health care services. In summary, one can assert that poor access to health care limits most Indians and Chinese from receiving health care services. Additionally, the high cost burden associated with seeking health care services is also a major challenge and thus China and India are limited from becoming leaders with regard to health care provision.
China and India should allocate substantial resources to aid in building adequate primary health care facilities. The two countries should focus on both curative and preventative care in order to stimulate their countries’ economic growth. Additionally, accessibility to health care facilities in both rural and urban areas is another major health care facility that should be taken into account. Some of the measures that governments should consider undertaking include sensitizing the public on health issues and providing transportation assistance (Ma & Sood, 2008, p. 35).
Over-utilization of heath care services
In their effort to deliver health care services to their populations, it is crucial for governments to consider undertaking quality assessment of their health care systems. According Ma and Sood (2008, p. 35), China and India do not have an effective national structure that is charged with the responsibility of undertaking continuous assessment of the quality of health care. Previous studies reveal that China and India have continued to overuse new health care technologies, which are expensive. Additionally, the two countries have continued to purchase expensive drugs especially antibacterial drugs.
Such over usage of new health care technologies and expensive drugs has led to an increment in the cost of medication. Considering the economic situation of most citizens, overuse of health care services has made the cost of health care become prohibitive to most patients, and thus their health care accessibility is adversely affected. A study conducted in 2005 in both China and India revealed that there has been an increment in the number of prescriptions of newly introduced drugs.
The price of these drugs is relatively high. The study further revealed that more than 25 per cent of expenditure on drugs is unnecessary. Another study conducted in 2000 revealed that China over utilizes antibiotics. Findings of the study revealed that more than 80 per cent of Chinese patients use antibiotics. This percentage is way above the global average level (Ma & Sood, 2008, p. 35).
India has also experienced overutilization of health care services, which is well illustrated by the fact that most individuals in India, especially the wealthy, prefer the private sector compared to government hospitals. Increased overutilization of health care services in India has led to a skewed health care system in India. The emergence of private health care services in India has led to increment in cases of overcharge for health care facilities are motivated by profit maximization thus overriding the rationality and equality in a country’s health care provision. In addition, the high cost of health care relies on out-of-pocket payment system, and thus India’s health care system has become skewed. The poor population cannot access high quality health care.
Therefore, to deal with this challenge, it is essential for India and China to reduce overutilization of health care services, which can be attained by reformulating their health care contracts; for example, by shifting from fee-for-service type of contracts. The two countries should develop an alternative drug reimbursement mechanism thus separating drug prescription and dispensing mechanisms. An improvement of quality with regard to health care delivery should also be undertaken (Chernichovsky, 2009, p. 203). India and China can accomplish this goal by conducting a quality assessment of their health care system. Additionally, it is important for the two countries to consider nurturing a culture of professionalism in the sector (Ma & Sood, 2008, p. 35).
Efficiency
For a country’s health care system to be efficient, it must maximize on health-status gains of the total population at the lowest cost possible. In a bid to achieve this objective, the health care system must develop two types of efficiencies, which include technical and allocative efficiency. Technical efficiency refers to the ability of a health care system to generate outcomes in the right manner and at the lowest cost possible. On the other hand, allocative efficiency entails generating the correct output to optimize collective gains.
Despite the fact that it is difficult to determine the efficiency of a particular health care system, China and India have not incorporated any measures aimed at measuring efficiency. This aspect is a clear indication that health care system in the two countries is very inefficient. The high level of bureaucracy and fragmentation with the countries’ national health care agencies are some of the reasons that explain the prevailing inefficiency. In an effort to deal with emerging diseases, most government agencies in China developed Center for Disease Control Centers. However, the centers did not have clearly defined roles and polices to direct their operation, and thus health care provision in China has become inefficient.
The Indian health care delivery system can be categorized into vertical and horizontal health care. The horizontal health care services are comprised of regular health care services, while the vertical system is composed of specific disease control plans, for example polio eradicating. However, one of the major challenges facing the country’s health care system is that there is disconnect between the two systems. Despite the importance of vertical disease control programs in containing disease burden, they usually disrupt the provision of basic primary health care.
Conclusion
China and India appreciate that their likelihood of attaining economic development goal is greatly dependent on the effectiveness of various economic sectors such as health care. In a bid to realize this goal, the two countries have undertaken numerous reforms on their health care systems. However, the involved authorities have implemented the reforms poorly, thus limiting the countries’ ability to reach the top with regard to health care. A number of reasons stand out as the major cause of this limitation. One such factor relates to the high level of inequality with regard to resource allocation in the two economies.
The two countries do not have an effective health care program. Consequently, most patients depend on their own source of income to cater for their medical costs, thus making them impoverished, which has also made it difficult for a large proportion of the countries’ population to afford health care services. Accessing health care services is a major challenge that most Indians and Chinese are currently facing. On the other hand, the countries’ health care systems are characterized by over-utilization of health care services thus increasing the cost of care. Additionally, the implemented health care systems in the two countries are very inefficient. Therefore, to deal with these challenges, it is essential for China and India to review their health care programs and make the necessary adjustments.
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