Political economy of healthcare

As Pakistan climbs up the ladder of development, healthcare has and will become a bigger part of the economy

Political economy of healthcare

Since I write for a section in this newsmagazine called ‘political economy’, I thought it worthwhile to talk about the political and economic importance of healthcare. When most of us come across the phrase ‘healthcare’, what we think of is the doctor or hospital or the pharmacy that we last visited when we or somebody close to us was sick. That from a personal perspective is correct but when looking at the big picture; the amount of money spent on healthcare in a country like the United States is really a very big part of the national economy.

In Pakistan, overall healthcare expenditure is obviously not as big as in the US or other developed countries but as Pakistan climbs up the ladder of development, healthcare has and will become a bigger part of the economy. As it is over the last fifteen years that I have been involved in healthcare in the Punjab, especially in Lahore I have seen a tremendous increase in the size and scope of institutions and businesses involved in healthcare.

So what exactly is the healthcare segment in the private sector made up of? Everything related to medicine in any way! It includes the companies that make or import the medical equipment and the medicines we consume on to the roadside pharmacy that sells these things and all levels of distributors along the line.

It also includes the one person private practitioner in a one room office with a nurse and a ‘compounder’ all the way up to the fanciest private hospitals that can charge an arm and a leg to fix just an ingrown toenail. And of course this includes all the physicians, managers, nurses, pharmacists and a legion of ancillary staff both of a specialised and a non-specialised nature. And then there are all the mushrooming private medical colleges and universities, some good, most mediocre and more than a few absolutely awful.

The private sector in medicine also includes all the thousands of inadequately trained and unlicensed informal medical practitioners also known as quacks. I might venture to say that much, if not most, of the medical care available to the poor and those that live in small villages or in semi-rural towns is from these quacks. Fortunately, for these quacks the only competition they have is from ill-equipped and under or even unstaffed government-run rural healthcare facilities.

Basic healthcare is a right and not a privilege. Every citizen should have basic healthcare made available.

Even though the medical establishment and the bureaucracy are always fixated on these quacks, these informal medical practitioners provide a valuable service since they do provide basic healthcare. In my opinion, rather than trying to get rid of these quacks it is better to formalise them, license them and provide them with some regular training to help them work better.

As far as the public sector is concerned, there has been some expansion but nothing compared to the private sector. The emphasis is not in expanding basic services or improving existing facilities but rather on building big, mostly un-needed specialised medical centres and inadequately staffed medical colleges named after politicians in power.

From the provider side, let me move to the economic importance of healthcare for the consumers or us the people. A few months ago, I had written in these pages about ‘stunting’ of children. Evidently, almost forty per cent of our children are small for their age and perhaps have not also had a chance to develop intellectually either. These children as they grow are poor students if they get a chance at an education and are physically less capable of performing adequately at a manual job. This situation is preventable with adequate basic healthcare at an early age.

Then we have what we physician call preventable deaths. Death is of course not preventable but many young people die from preventable and treatable conditions. Young mothers dying during delivery of a child often leaving one or more children without a mother. Young men and women dying from infections carried by contaminated water, from hepatitis spread by unnecessary injections with contaminated needles or unchecked blood transfusions and a host of other treatable and preventable conditions. And the worst are undiagnosed treatable conditions like high blood pressure and Diabetes that when discovered have often already led to irreversible damage that can only be treated but rarely successfully.

All these situations can lead to the loss of a bread earner of the family or a caretaker of the family imposing major economic burden on the survivors in particular and the society at large. Also, when people do get sick from preventable cause and fortunately get treated and return to health and work, the time lost has serious economic consequences.

Finally, there is the ultimate economic bomb that is blowing up almost all economic gains in the country. That is the rapid growth of population. As long as the economy does not grow many times faster than the population, we will never be able to pull our people out of poverty. And control of the population is thus the ultimate healthcare problem that needs to be addressed otherwise it will prevent economic growth from being meaningful.

So in essence healthcare has an enormous economic impact on our lives individually and collectively. And I have yet to see any formal examination of this issue at the official level on a national or provincial scale -- or even by any political party. No, building more and better roads will not cure hepatitis or heart disease. And that leads me to the politics of health care.

One of the basic questions most nations have to face is about the nature of a ‘safety net’ that should be provided to the people of a country. As a liberal, I have an expanded list of what should rightfully be provided to people in the least but for now let me concentrate on healthcare.

I believe that basic health care is a right and not a privilege. Every citizen should have basic healthcare made available and more advanced care as needed. Of course, all advanced and expensive care cannot be freely provided but as a country gets more developed, the amount of care available should expand.

Most ‘conservative’ political parties prefer that services like healthcare and education should not be a right but must be earned at some level. And as believers in free markets, most conservative parties like the ruling Pakistan Muslim League-Nawaz want to privatise all medical care and that includes privatising the entire government-owned and run medical infrastructure in the Punjab starting from the basic health care units (BHUs) all the way up to the major teaching hospitals.

For such political parties, healthcare for the poor should be not from state funds but from charity. I find this idea repugnant. It is the responsibility of the state to take care of the poor and the disadvantaged. And yes philanthropists have every right to contribute to public hospitals or build all the hospitals they want as long as they run them in a properly ‘charitable’ fashion.

Political economy of healthcare