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Medical debt bankrupt Indians already ravaged by coronavirus

In the shadow of the Taj Mahal, shoemaker Shyambabu Nigam worked for years to save his wife Anju enough money to buy a tiny house with a view of the iconic 17th-century mausoleum. Yet within a few months, he was forced to leave it.

After Anju fell seriously ill with Covid-19 last year, the couple turned to subsidized government hospitals and more expensive private clinics to treat the disease and then pay for two open-heart surgeries. The total cost was over Rs 6 lakh – almost six times the annual income of the corporation.

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

“First we fought to save his life and now we are fighting to survive with a huge financial burden,” said 42-year-old Nigam, now a low-income resident of Kachhapura near Agra in the northern state of Uttar Pradesh. Rent in the village. . “Please give us some work. Both my sons and I will work day and night to get out of this crisis.”

The corporation is one of nearly two-thirds of Indians who have no health insurance, adding to the problems facing India’s economy as it tries to recover from the shock of a rare contraction last year. Overcrowded government hospitals with long lines and poor facilities prompt people to spend from their own pockets for better treatment in the private sector.

While the virus has affected the poor around the world, its impact could be sharply greater in countries such as India where public spending on health care is among the lowest in the world. Signs of pain are everywhere: loans against gold and loan defaults are rising while savings, vehicle sales, company profits and government revenues are falling.

There has also been a clear shift in consumer spending from clothing, footwear and personal care items toward medicine, as drug shortages and panic forced many Indians to buy motorcycles, gold and even their farm animals for life in the black market. The defender was prompted to pay for the treatment. . The mounting expenses included vials of the antiviral drug remdesivir as well as private ambulances, harassing families desperate for hospital beds and oxygen cylinders.

“This time we are seeing a double whammy of health expenditure as well as loss of livelihood and associated food insecurity,” said Deepa Sinha, professor of economics at Ambedkar University in Delhi. “If people are selling assets that give them a livelihood, it affects their future income as well.”

Making matters worse, some of the drugs recommended by the World Health Organization were not included in the recent government-approved treatment guidelines. As of early June, India’s health ministry’s approved treatment protocol listed remdesivir, even though the global health body discouraged use of the drug for COVID-19 in late 2020, when a large international clinical trial Trials showed that it offered negligible protection against death in hospitalized patients.

The government had also recommended other untested treatments such as the anti-malarial drug hydroxychloroquine and ivermectin, an anti-parasitic treatment. Convalescent plasma therapy remained on the list, despite finding little benefit from the Indian Council of Medical Research’s own studies.

Officials from the national health authority responsible for implementing the country’s premier public health insurance program did not respond to multiple requests for comment, nor did a spokesman for the federal health ministry.

In rural areas, “people are either left to die or go bankrupt,” said Ajay Mahal, professor of health economics and global health systems research and deputy director of the Nosal Institute for Global Others are trying to find solutions.” Health at the University of Melbourne.

“The state should start by offering people an alternative – a robust and affordable primary care sector – rather than leaving them at unqualified providers and rushing to pharmacists to get counterfeit or genuine medicines,” he said. .

In 2018, Prime Minister Narendra Modi unveiled a flagship program, dubbed the world’s largest health insurance scheme, that provides financial risk protection against catastrophic health expenditures for nearly 107 million poor and vulnerable families – or 40% of the population. provides. According to a working paper by researchers at Duke University, the new policy has not “effectively reformed” access to health care.

Government hospitals can be expensive for the poor too: Nigam said he paid a concessional rate 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’s a long backlog.”

Rising medical debt poses a risk to Modi ahead of next year’s major state elections, including in Uttar Pradesh, the country’s most populous state where the corporation resides. His government’s approval rating has dropped to 51% in 2019 from 75% in 2019, according to a survey released on May 29 by LocalCircle, a polling company in India. Morning Consult’s Global Leader Rating Tracker found that Modi’s personal approval rating dropped to 66% on June 8, from 76 percent a year ago.

Even before the pandemic struck, India’s out-of-pocket expenditure on health care was among the highest in the world, accounting for nearly 60% of total health expenditure. Public health spending – including both federal and state governments – hovered well below 2% of GDP, a number that rises to 3.5%, including the private sector. According to World Bank figures, this compares to 5.4% of GDP in China and about 10% of the global average.

While there is no data on how many Indians have been pushed to financial ruin by medical debt, researchers at Azim Premji University found that the virus pushed an additional 230 million – more than Pakistan’s entire population – into poverty last year. Decades of profit wiped out. . Over 90% of people borrowed an average of Rs 15,000 during the pandemic, he said, adding that the impact is expected to continue.

Out-of-pocket health loans can be more harmful than other home loans because illness “limits one’s ability to work, which leads to a reduction in household savings and unexpected economic shocks.” Sunil Kumar Sinha, an economist said. India Ratings and Research.

A study 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 property during the pandemic, director of the Center for Rural Development in The/Naz Foundations according to John Paul. “With no fallback options like savings or insurance, even basic necessities like food have become a challenge for poor families,” he said.

The crisis is even more acute in the hinterland of India, as villagers are forced to reduce their food intake for medical treatment.

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

“There is not much rice left in the house,” said Devi. “If we don’t get work, we will die.”

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