Healthcare Problem & Our Moral Dilemma

For what's a good business without moral dilemma

It is best to run with the headline,
‘India has one doctor for 1,700 people while the WHO suggests a benchmark of one for every 1000 people’.

But that doesn’t capture it.

Doctors tent to gravitate, indeed as other professionals, towards the cities making the ratios much worse in rural areas.
Disclaimer: We do not judge doctors for seeking a better life. We all seek it in our respective ways.

But that doesn’t capture it.

Doctors have been told, as indeed many of us in different fields, that they should specialise, and when they have done that they should specialise some more. So, there are ~10,000 PG seats for ~50,000 doctors who complete their MBBS every year. Many of these doctors, duly qualified, spend a year or three to prepare for PG entrance while doctor time is the scarcest resource in this game. Also, GP-first systems (like the NHS in Britain) lead to the best outcomes for patients, but the GP, in India, is quite likely to be preparing for PG entrance!
Disclaimer: Similar to the previous one.
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But that doesn’t capture it.

There is an alternate, entirely organic system of healthcare providers in the village — pharmacists, RMPs of various types— who do not have the wherewithal to be the healthcare providers, and sometimes end up promising silver bullet solutions that are counter-productive.
Disclaimer: Not all RMPs are bad guys. Some of them are genuinely in that position because it is thrust upon them.
For more on the nuance on this topic Click here

But that doesn’t capture it.

Information asymmetry plagues the space. Some of these healthcare providers make more money playing agents (or, touts, if one may) of private hospitals, which have business models that can be best described as extortionary.
Disclaimer: Not all private hospitals are money-grabbing villainous enterprises, but some of them are.

But that doesn’t capture it.

Governments, irrespective of their political affiliations, do not see healthcare as an integral part of their compact with the public. So, citizens foot the healthcare burden themselves. In India, ~74% of all healthcare spend is out-of-pocket, which means that the healthcare spending is disproportionately footed by a largely impoverished citizenry.
Disclaimer: Yes, tax to GDP ratio.
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But that doesn’t capture it.

A wide range of factors get together to ensure that there is a further skew in terms of the poor footing bigger healthcare bills than the affluent—likely to pay more for medicines, for tests, and indeed treatments, with a much lower penetration of health insurance to support it— making it one of the major reasons for bankruptcy and household indebtedness.

No. It will not capture it. Hence it is wicked problem.

Or rather, a ‘wicked’ problem, because ‘wicked’ is not an adjective brought in to establish that we are cool (which we are but that’s another story).

Wicked in terms of it being a problem not easy to formulate, not quite like a game of chess where the objective is clearly articulated as are the rules. This is not something we came up with, but is more from the ‘shoulders of giants’ territory (

Moral Dillema

  1. We think the state should deliver healthcare to all of its citizens
  2. Given that we hold that view, should one:
    1. Work on getting the state to do so (as an NGO, probably)
    2. Try to win elections and change policy
    3. Step into the gap and potentially make money
  3. 2C is what we choose because that’s what we are good at
  4. But does success in 2C mean that we are helping relieve the state of the responsibility
  5. Well...