SONGSOPTOK: Do you consider primary healthcare to be a fundamental right? Is it deemed as such in the society you live in? Please explain your answer with a few examples if possible.

SUTAPA: Health is defined as  “a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease”. Primary health care includes all aspects that play a role in health, like access to health services, environment and lifestyle. As a Pediatrician, I strongly believe that no child (and no patient)should be deprived of  basic healthcare. USA spends a maximum amount on health insurance, yet it lags behind other developed countries in both population health and health system performance. It is apparent even in its affluent, insured, and majority population- is in part a consequence of decade long failure to emphasize primary care within the healthcare system.

SONGSOPTOK: What is the system of healthcare in the country and the society you live in? Is it a just and equitable system in the sense that all citizens enjoy the same benefits across economic and social classes?

SUTAPA:     33 million Americans, 10.4 percent of US population, were without insurance in 2014- they were disproportionately poor, black and Hispanic, 4.5 million of them children. Affordable Care Act (implemented in 2010) aimed to insure everybody in US.

Government Health Programs:
Federal Employees Health Benefit Program
Indian Health Service
Veterans Health Administration
Military Health System/Tricare
State Children’s Health Insurance Program (CHIP)
Program of All-Inclusive Care for the Elderly
Prescription Assistance

Private Health Coverage:
Health Insurance in the United States
Consumer driven Health Care
Flexible Spending Account
Health Reimbursement Account
Health Savings Account
Private Fee for Service

Managed Care
Health Maintenance Organization
Preferred Provider Organization
Exclusive Provider Organization
Medical Underwriting

People living below poverty line get a lot of support from the Government.  Those holding good jobs get insurance through their employer. Noncitizen immigrants do not get any support from the Government. People who fell in “Medicaid Gap”- lacked insurance- their incomes were too high for Medicaid eligibility, and too low to receive subsidies on the new healthcare exchanges.

SONGSOPTOK: Do you think that free healthcare cannot be a right, but it can be a privilege and a shared burden of sacrifice for the sake of the social contract?

SUTAPA: Healthcare is both a right and a privilege. We do not have any health care system in India- patients have to pay for everything upfront. Sometimes hospitals in India do not release dead bodies if full payment has not been made. In USA, a good percentage of income goes towards Medicaid and Medicare. As a privileged member of the society, it should be our duty to lend a helping hand to the people who need it, but at the same time, it is perturbing when our hard earned money is sometimes misused.

SONGSOPTOK: What, in your opinion, should be the role of the government for ensuring equal healthcare to all citizens? What role is played by the government of the country you live in?

SUTAPA:  As mentioned in Question (2) the different Government programs. Medicaid and CHIP is free for those who qualify. There is no copay, no deductibles- almost everything is covered. But many private practitioners do not take Medicaid, as the reimbursement is quite low.  All US citizens and legal residents, residing in US for 5 years, after age 65, get Medicare benefits.

SONGSOPTOK: According to the data published by World Health Organization (WHO), nearly 16 000 children under the age of 5 die every day in the world (5.9 million in 2015) from infectious, neonatal or nutritional conditions. Is this a reality in the country you live in? If so, what would your suggestions of improvement be?

SUTAPA: Death rate of children in USA is 16/100,000 population. Unintentional injury is the leading cause of death In infants- congenital and chromosomal abnormalities, prematurity, low birth weight, and sudden infant death syndrome (SIDS) are the leading causes. Black children have the highest death rate, Asians- lowest, Hispanics/Whites in between.

SONGSOPTOK: “Free access to healthcare is a fundamental human right. Access to free healthcare is not” – do you agree with this statement? Please explain your choice.

SUTAPA: Healthcare is delivered by health professionals- physicians, nurses, midwives, pharmacists, dentists, optometrists, psychologists, chiropractors etc. It includes primary, secondary, and tertiary care and public health.  Public health is what we as a society do collectively to assure the conditions in which people can be healthy. Healthcare can contribute to a significant part of a country’s economy. In 2011, Health care industry consumed 17.7% of GDP (gross domestic product) in USA, Netherlands 11.9%, France 11.6%, Switzerland 11.2%, Canada 11.2%, Germany 11.3% Every member of the society should play a role in contributing to the healthcare system.

SONGSOPTOK: How important is the role of the private sector for providing healthcare and related facilities in your country? What it is your opinion about it?

SUTAPA: Largest 125 US health insurance companies collected $744 billion in 2013 in premiums. Obviously they play a major role in this country, and they make a fortune. When they have the option, everybody in the US choose to work for a company/University which will pay their insurance. In most Universities, healthcare is free for the employee, except for dental and eye care. You can go to any physician, you do not have to go to your primary doctor for referral if you need to see a subspecialist. Of course there is a copay every time you visit a doctor. If you have surgery or any procedure there is copay (which is 20% of the whole amount) and deductible. For medicines, every member of the family has to meet the deductible every year. Also if you need MRI, you call your insurance beforehand, they give you a number, and if you go to a place which is contracted with the insurance, you do not pay anything. (MRI usually costs around $5000)- all these are about the insurance I have from my University. Most people are not this lucky. But you must have insurance; otherwise you cannot get medical care. Also if you get sick, and get admitted to a hospital, there will be a huge medical bill.

SONGSOPTOK: Are charitable and Non-Governmental Organizations (NGO) active in the domain of public health? If yes, then in what spheres? Do you think that the civil society, either independently or through these organizations, should become the prime actor for ensuring healthcare for all?

SUTAPA: NGOs provide valuable resources and funding in the field of global health research.
International Organizations:
Global fund to fight AIDS, TB and malaria
Joint United Nations Program on HIV/AIDS
World Bank- very important source to developing countries
World Health Organization (WHO)- responsible fr providing leadership on global health matters
Scientific Organizations:
American Association for the Advancement of Science
American Thoracic Society
American Society of Tropical Medicine and Hygiene
American Society for Microbiology
Consortium of Universities for Global Health
The Global Health Network
Infectious Disease Society of America
International Diabetes Federation
Advocacy/Policy Organizations:
Center for Strategic and International Studies Global Health Policy Center
GBC Health
The Earth Institute- from Columbia University
Global Alliance for Chronic Disease
Global Health Council
Global Health Technologies Coalition
Kaiser Family Foundation US Global Health Policy
Research America Global Health R & D Advocacy
Accordia Global Health Foundation
Bill and Melinda Gates Foundation
Foundation for NIH
UN Foundation
Welcome Trust

Obviously NGOs play a vital role in global health, but they cannot be a replacement for the healthcare policies existing in each and every country.

SONGSOPTOK: Do you think that multinational pharmaceutical and healthcare companies are responsible, to a certain extent, for the widely variable quality of healthcare in different countries? Can you please illustrate your reply with some examples?

SUTAPA: Pharmaceutical companies play a huge role in the disparity of healthcare. They invest billions of dollars annually on marketing drugs they manufacture. They use methods such as direct sales to consumer marketing, physician speakers, representatives and catered foods while introducing products to a target audience. When we are giving a lecture and refer to a drug, we have to mention if we have a conflict of interest or not. Also medical representatives are not allowed in any of our clinics or hospitals. But in many countries including India, they buy expensive gifts for physicians, pay for their trips, to name a few. So they can set the price of the drugs to whatever level they want.  Since greed knows no bounds, they do not like paying taxes, like Pfizer is moving their headquarters to low tax Ireland.

SONGSOPTOK: Do you think that adopting the Social Security model implemented in a lot of countries in Europe which ensures primary health coverage to all citizens and is financed by the totality of the working population can be relevant and efficient in all countries?

SUTAPA: There are big differences in the way different EU countries have organized benefits, healthcare and other social security services. Each EU country has its own law determining what benefits you are entitled to, how much you will receive and for how long. The benefits also depend on how long you must work there before qualifying for unemployment benefits, the rules for calculating benefits, and the duration of benefits.

In USA the vision of public health is “Healthy people in Healthy Communities”. In this country there is a gross disparity in reimbursement between primary care providers, and subspecialty physicians. The medical students, while rotating in the hospitals realize that their lives, both personal and financial, will be much better if they become subspecialists. That is one of the reasons for USA lagging behind other developed countries regarding population health and health system performance. But there are grounds for optimism- policy holders realizing the importance of primary care providers (internal medicine, family practice, pediatrics)- goal is to move 50% of active patient care clinicians to move towards primary care. This will be possible if they do loan forgiveness for medical students who stay in primary care, if half of GME funds for training residents is targeted towards primary care training.


We sincerely thank you for your time and hope we shall have your continued support.
Aparajita Sen

(Editor: Songsoptok)


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