Between Healthcare
Access and Excess
By Zulfiqar Rana, MD,
MPH
Mobile, AL
The health of a nation is
directly proportional to the type of health care
access it offers. The healthcare access in turn
is mainly dependent upon the amount and manner
of resource allocation.
While healthcare is part of basic rights in the
developed world, people in the Third World still
face an uneven quality and access to health care.
For the public in the Third World the grind of
other pressing issues like food, shelter, and
security often overshadow occasional health bumps.
Therefore, healthcare policy is on the back burner
for the policy makers and the public alike. Given
the facts, is it unrealistic to expect universal
health coverage from your government and society?
Is universal healthcare that critical for the
health of a nation? Finally, and most importantly,
is it even feasible in countries like Pakistan?
Maybe some figures would help. According to the
WHO, the Infant Mortality Rate (IMR) in the UK
for the year 2004 was 5.3, while it was 6.7 in
the US and a dismal 80.2 in Pakistan. Similarly,
the life expectancy in the UK for the year 2004
was 78.5; it was 77.4 for the US and 64.9 for
Pakistan. US data - although vastly better than
Pakistan - still occupies the bottom rung of the
Western world much to the chagrin of public health
experts here and amidst much public disapproval.
This may come as a surprise to some who think
that the US healthcare system is the most advanced
and sophisticated in the world – which it
is. What could possibly explain this disparity?
The US spends 15.2 % of its GDP on healthcare,
the UK only 8% while Pakistan spends a paltry
2.4%. What is the underlying reason for the US
to lag behind other Western nations despite a
very robust healthcare budget? The answers to
these lies in the manner healthcare resources
are allocated in the US. In this case, it is the
lack of universal and basic healthcare in the
US that sets it back.
Public heath experts in the US have long argued
this point. According to the US Census Bureau,
about 16% of the Americans are uninsured. According
to the same source, with an uninsured rate at
19.0 percent among children in 2005, children
in poverty were more likely to be uninsured. While
that in the UK healthcare is universal for at
least basic health services. Contrast that to
Pakistan where there is no health coverage at
all. According to the WHO, 72% of the total healthcare
expenditure in Pakistan is private expenses, of
which 98% are out-of-pocket expenses. This factor
alone puts a damper on the frequency and extent
of medical care sought by the public. These disparities
in health insurance translate into poor health
outcomes as noted above.
Lack of universal healthcare in the US and Pakistan
highlight the same fact – albeit in starkly
different ways. The US with all its excellence
in tertiary care and R&D is still a laggard
in basic health numbers in the Western world.
No matter how much you spend on fancy medicine,
basic health coverage for all (or lack thereof)
still makes a difference. In Pakistan as in any
other Third World country, the conclusions are
more straightforward - no health coverage means
very poor collective health.
Whereas in the US healthcare has become a juggernaut
that is becoming more and more unruly, it is in
dire need of a jumpstart in Pakistan. Experts
have pointed out various reasons for that ranging
from lack of political will to poor resource allocation
to inept allocation processes. On a psychosocial
level, the greatest impediments to a better health
care system in Pakistan come from general public
malaise and institutional cynicism with the deep-rooted
belief that our moribund system is incurable.
Unless we can overcome these psychosocial and
political hurdles through a strong leadership
or grassroots effort or both, the future does
not look too good.
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