As most of the countries, both rich and the poor, have been fighting the Covid-19 pandemic, the question that cropped up whether the healthcare system of these countries particularly the wealthy one, who are known for being highly efficient, have the equipment and the organisation best able to protect the population and avoid a health catastrophe.
Instead of offering an analytical answer to this question, let us observe the responses from different healthcare mechanism of various countries to this outbreak. At the very outset, we would like to cite one example from the Japan, which is considered to be one of the most advanced nations in the globe.
Recently a case has been reported in the global media which exposed that an ambulance carrying a man with a fever and breathing difficulties was rejected by 80 hospitals and forced to search for hours in downtown Tokyo for one that would treat him.
According to reports, the hospitals in Japan are increasingly turning away sick people as they struggle with surging coronavirus infections and a collapsing emergency medical system. The Japanese Association for Acute Medicine and the Japanese Society for Emergency Medicine also has recently admitted the fact that many emergency units have refused to treat people, including those hit by strokes, heart attacks and external injuries.
Alike this example, the outbreak has highlighted the underlying weaknesses in medical care in most of the developed countries, which have long been praised for its high-quality insurance system and huge infrastructures. The United States of America which has long been acknowledged as the land of best medical system has already failed to cope with the present epidemic and as a result we are witnessing the highest fatality rate in that country. In a recent interview published in The Dose, (Source:https://www.commonwealthfund.org/publications/podcast/2020/mar/coronavirus-reveals-flaws-us-health-system) the Commonwealth Fund’s David Blumenthal, M.D., and Sara Collins have revealed certain shocking gaps in the United State’s healthcare system that forced the entire population at risk in the COVID-19 outbreak.
In that interview Sara Collins (vice president for coverage and access at the Commonwealth Fund) said,“…We are much more vulnerable to the kinds of spread of illness that David highlighted, because so many people don’t have health insurance coverage in the United States. About 30 million people are currently uninsured. Another 44 million people have coverage all the time, are all year long, but they don’t have health plans that keep them sufficiently protected from health care costs. We know from survey data and lots of research that people who are uninsured, who are underinsured are much more likely not to seek care even when they’re quite sick.”
The interview has also revealed one very surprising fact about the insurance coverage. In the United States, by law, people with incomes under 138 percent of poverty, which is about $30,000 for a family of four, are eligible for Medicaid, but only if their respective state expanded eligibility for Medicaid under the Affordable Care Act.
Currently 36 states and the District of Columbia have expanded their Medicaid programmes. 14 states — including some of the most highly populated states in the country; Florida and Texas — have not yet expanded. So people in those states who have incomes under poverty do not have access to an affordable source of health insurance right now.
While medicaid has come to the rescue in past catastrophes like 9/11 and Hurricane Katrina, recent changes to the programme deprived millions of Americans living below poverty line to access needed care during the time of their health emergency.
In comparison to the insurance oriented healthcare system, some countries which medical services are totally controlled and owned by the state seem to be weathering the corona virus pandemic better than the developed countries.
One country that moved rapidly to deal with the emerging threat is Cuba. The communist Cuba has several advantages over many states, including free universal healthcare, the world’s highest ratio of doctors to population, and positive health indicators, such as high life expectancy and low infant mortality.
Like many previous health emergencies, this time as well a good number of Cuban doctors have offered their volunteer services in different parts of the globe for building up and supporting other countries’ healthcare systems so that these countries could combat the epidemic properly.
Apart from offering voluntary services to the other nations the country has also showed a good success rate in the tests of Covid 19. Around 40% of Cuba’s recent positive results are from asymptomatic cases. If Cuba’s contact-tracing and testing regime gets the disease under control, its experience might offer lessons for controlling the pandemic, and more of its doctors will be available to help with the effort to combat the pandemic abroad.
As India has declared a war against Covid-19, we must remember the expenditure that the Indian State spends on the public health. According to the National Health Profile (NHP) data, India just spends a little over 1 per cent of its GDP on public health which is lower than some of the world poorest countries like Nepal and Bhutan.
Despite an increase in health expenditure since 2009, India spent only 1.28 per cent of its GDP (2017-18) as public expenditure on health. The figure was 1.02 per cent of the GDP in 2016-17. While India’s per capita public expenditure on health has increased more than twice from Rs 621 per person in 2009-10 to Rs 1,657 in 2017-18, it still remains very low compared to other countries.
The United States spends the most on public health — 18 per cent of its GDP, which is over USD 10,000 (nearly Rs 70,000), per person a year. Now the most vital question is if the wealthiest county of the world has failed in combating the present epidemic even after spending 18 per cent of its GDP in public health, how a poor country like India that spends only 1.28 percent GDP in public health could save its citizens from a deadly pandemic!