Joke #2 (as told by Woody Allen): Two people are eating dinner at a restaurant. One of them says, “The food in this restaurant is terrible.”
“Yes,” responds the other. “And the portions are so small.”
Throughout South Asia, the quality of public spending in health is astonishingly low. In India, some 33 percent of this spending goes to the richest, and less than 10 percent to the poorest quintile. Doctors in primary health clinics are absent about 40 percent of the time. Even when present, in poor neighborhoods in Delhi, public sector doctors give worse service than unqualified private sector doctors. Yet the policy in India is aimed at increasing public health spending from around 1 percent of GDP to 2-3 percent by 2010. Everyone acknowledges the problems with the quality of health spending (“the food is terrible”), but then calls for increasing spending (“the portions are too small”).
Mariam Claeson
Wed, 12/05/2007 - 02:24
"Even when present public sector doctors give worse service than unqualified private sector doctors.Yet the policy in India is aimed at increasing public health spending from around 1 percent of GDP to 2-3 percent by 2010"
What are you suggesting ?
Wed, 12/05/2007 - 17:56
I am suggesting that the focus on increasing public health spending when the effectiveness of that spending is so poor is misguided. Remember that much of this spending goes to paying the salaries of these public sector doctors, who give worse service than private sector doctors. Furthermore, some of the money goes to training these public sector doctors. But if the qualified (i.e. better trained) doctors give worse service than unqualified private sector doctors, the value of this training is questionable. There are many things we can do to improve the quality of health care for poor people. Having the money follow the patient, rather than the doctor, would be a start. Health care vouchers would be an example. We could also make the doctors accountable to local, district-level governments, who are in a better position to monitor them. But these reforms are deeply political, and resisted by powerful interests. Governments are reluctant to propose them in case they lose the next election. It's easier to say "let's increase public spending on health." But there is little evidence that this increase in spending will result in an increase in the quality of health care received by poor people. Worse still, when these people's health does not improve, the special interests can say the problem was that we didn't increase spending enough. Yet the opposite is true.
Tue, 06/24/2008 - 15:36 I completely agree. The amount of spending isn't the problem. The United States already spends literally twice as much on health care per person than the second most inefficient country (Australia). The solution lies in smarter spending of the money we're already using, not more spending. This has historically involved in increase in prevention and primary care.
Fri, 08/01/2008 - 02:41 When we speak of GDP allocation in health to be increased from 0.9% to 2-3% of GDP this itself is too less. Remember the allocation for US and UK during 1950s, which were 13 and 20% of GDP resply and has only increased afterwards. There is long way for our country to go in that. Secondly, when we talk of GDP allocation in health it includes a range of public health interventions like medical care, prevention and control of comunicable diseases, sanitation and so on. We are always comparing it with the kind of medical care rendered which is only one part of Public health. Thirdly, why is that doctors in public sector doesn't offer better services. They are the same persons who work better when placed in a private setting. One of the major reasons identified is lack of basic infrastructure facilities in the public setting. This is because never in the Indian history did we allocated more than 3% GDP for health which always compromised in the building of infrastructure. This becomes obvious when it was rightly said that most (80%) of the funds in the health sector goes as salaries finding it difficult to allocate for deliverables (goods).