Healthcare in the United States and India
The healthcare systems in the United States and India have starkly different origins: the former arose out of employer based insurance coverage while the latter began through government funding. As Sai Ma and Neeraj Sood document in a report on India's healthcare challenges, the Indian government faced the challenge of redesigning their healthcare infrastructure after their independence in 1947 (2008). The Bhore Committee, assembled by the central government, established that unsanitary conditions, poor nutrition, inadequate health education and a lack of prevention must be addressed in order to improve the quality of life for India's population. To meet these needs, the central government established a three-tiered system consisting of primary health centers (PHCs) to meet basic health needs, subcenters (SCs) for public health concerns, and community health centers (CHCs) for more specialized care. Doctors employed at these facilities received training at publically funded universities and patients could access care at no cost. The central government provided funding and oversight while the primary responsibility for healthcare administration fell to the states. Despite the establishment of this national infrastructure, the Indian government never intended to abolish private practice. In the 1950's, private healthcare services made up a small percentage of India's total healthcare system; since the 1980's, medical tourism, government cuts and a push from the middle class for more high tech care have all resulted in the rise of the private sector. This trend has reduced the quality of public care while creating private care that the vast majority of Indians are unable to afford (Ma and Sood 2008). Juxtaposing India's healthcare challenges with the United States' unique set of issues elucidates the problems inherent to both systems.
The United States health insurance system grew out a need to fill hospital beds during the Great Depression: Blue Cross pioneered employer based insurance for schoolteachers (Roberts 2009). The effectiveness of their system caught on and led to a period during the 1950's where consumer demand for services was high and doctors received ample reimbursement from insurance providers. However, coverage for the poor and elderly was still low. During Lyndon Johnson's administration, Congress passed a law that established Medicare and Medicaid, which covered citizens over 65 and the poor, respectively. With increasing coverage and guaranteed government reimbursement, cost soon became the nation's primary concern. For cost control, Nixon introduced the idea of a Health Maintenance Organization (HMO), which he argued would reduce expenditures through competition and reward groups for keeping people well (Roberts 2009). The American Medical Association lobbied against HMOs and they did not have the completely revolutionizing effect that Nixon desired. They reached their peak popularity during the 1990s, when President Clinton introduced his healthcare proposal (Roberts 2009). The proposal, which never passed, argued for a national health board that could regulate groups of competing insurance providers while putting a cap on premiums. The problem of rising costs has continued to the present. The Patient Protection and Affordable Care Act, passed in 2010, aims to reduce costs: however, the subject of improving U.S. healthcare infrastructure has never been more pressing (Manchikanti et al. 2010).
India experiences poorer health outcomes than the U.S. By most metrics: life expectancy is 64 years in India and 78 years in the U.S.; infant mortality is 69 per 1,000 live births in India and 8 per 1,000 live births in the U.S.; the incidence of tuberculosis is 190 cases per 100,000 people in India and 3 cases per 100,000 people in the U.S. (WHO). The majority of life years lost to poor health in India are attributable to communicable diseases (56%) like malaria and tuberculosis, while noncommunicable conditions and injuries make up the remainder. Vaccine preventable illnesses are responsible for 7% of the total life years lost in India (Ma and Sood 2008). In the U.S., noncommunicable conditions, like diabetes, cancer and heart disease, are responsible for the majority of life years lost (76%) while communicable diseases (9%) and injuries (18%) have a less significant impact (WHO 2011).
There is a dramatic difference in the proportion of...
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