What India Can Learn from the Failing US Health System

Notwithstanding its innovation and greatness, the US health care system is in a state of crisis. The health situation in the US has worsened to such critical dimensions that the country now ranks behind other high-income countries on several critical performance indicators. This downswing holds invaluable lessons for countries like India, which are still in the process of refining their systems. India can thus learn from the root causes of the failures in the American health care system and avoid similar pitfalls while scaling up its healthcare services.

The US Healthcare Crisis: An Overview

Below is a discussion of the Commonwealth Fund’s “Mirror, Mirror 2024” report that was covered in The New England Journal of Medicine against the claims of key areas where the US health system has failed. Although spending for healthcare remains high, if not exorbitant, the ranking of the US health system in performance still remains last compared to nine other countries from high-income nations such as Australia, Germany, and the United Kingdom. Precisely, this poor performance falls into access to care, administrative efficiency, equity, and population health outcomes.

What really sets off an alarm is that the US, while being proud of its highly advanced medical treatment, still has the lowest life expectancy compared to the other nine countries surveyed. The span of preventable deaths, mortality due to treatable conditions, and the heights of self-harm deaths due to suicide and gun violence give a very grim outlook toward health responses in the US.

High Costs, Low Value

An important problem with the US health System is its inefficiency. While it spends significantly more compared to other countries, Americans get less value from this investment in health. This is further exacerbated by a very fragmented system in its delivery and financing of care. This creates a very huge administrative burden resulting in substantial financial costs to health care providers and patients alike, fuelling the high costs of care and contributing to delays or denials of care.

For instance, a large number of the people residing in the United States are either not covered or have inadequate cover due to high deductibles and copayments. Most of those with coverage have still faced financial barriers to care, which perpetuates health disparities. There is also a shortage of primary care clinicians, reducing major health service access and management of chronic illnesses in the US system.

Lessons for India: A Way to Steer Clear of US-Style Failures

India, with its emerging health care needs, can learn a few important lessons from what is going on in the US today. During this development of health infrastructure, it should not commit the same mistakes at a systemic level that have brought the US to the crisis that it faces today.

1. Achieving Universal Coverage

One of the huge failures of the US health system is that it has not yet succeeded in guaranteeing universality of health coverage. Even after the passing of the Affordable Care Act, millions have been left without health insurance. The US spends a lot more on health but maintains a fragmented, inequitable, inefficient insurance enterprise that is divided between public programs—namely, Medicare and Medicaid—employer-based insurance, and private insurance. Those few countries which have managed to achieve universal health coverage consistently outshine the US regarding health outcomes; for example, the UK and Sweden.

The country needs to recognize universal health coverage to achieve equity in access to care. Only very recently, efforts such as Ayushman Bharat, which has ambitions to extend health insurance to over 500 million people, begin to be in the right direction. India instead needs to focus on building a comprehensive system which offers adequate protection without financial barriers seen in the US.

By fostering public-private partnerships and expanding coverage to marginalized communities, India can avoid the costly and inefficient outcomes seen in the American model.

2. Strengthening Primary Care

Another important lesson learned from the US relates to a strong network of primary care. Poor health outcomes in the US partly stem from a shortage in the number of primary clinician care. This shortage in the US makes many Americans, especially those living in rural areas, have far less timely access to needed prevention and chronic disease management services. Conversely, other countries like the Netherlands with robust primary care have better health outcomes at lower costs.

These are also some of the challenges being faced by India, especially in rural and underserved areas. Whereas urban centers might boast of state-of-the-art healthcare facilities, more often than not, it is a different story altogether in rural India. Strengthening primary care at the grassroots level, training general practitioners in larger numbers, and incentivizing doctors to work in underserved regions will thus remain vital for building an equitable health system. India must avoid the over-reliance on specialist care that has contributed to inefficiency in the US system.

3. Controlling Healthcare Costs

Large costs of care remain one of the biggest drivers of inefficiency in the US healthcare system. Relatively, the prices of healthcare services, such as all hospital stays, procedures, and medications, are very high in the US compared to other countries. This partly could be attributed to market consolidation where large providers of healthcare dominate markets, raising prices with no competition.

Especially in India, with the increased privatization and therefore prices of health services, there will be a requirement for ensuring that such situations are avoided through careful regulation of prices. The openness of pricing in health care, along with the prevention of monopolies in the markets, will contribute to the containment of costs. There has to be competition among health care providers with strict controls on quality to help ensure that health care is available at affordable costs to the people.

4. Addressing the Social Determinants of Health

A major reason this happens is because the US health system has failed to address these basic social determinants of health, such as poverty, housing, and education. As significant as healthcare delivery may be, these broad-based determinants have a much greater impact on health. Income disparity, homelessness, and food insecurity are major broad-based contributors to poorer health status in the United States, falling disproportionately on the most vulnerable populations. With the various socio-economic challenges different parts of India face, a more integrated approach is necessary when it comes to healthcare policies. Such policies will have to focus on the social causes of illness, which means better sanitation, housing, improved education, and nutrition. A typical example of such a program that is already engaged in these determinants is the Indian government’s Swachh Bharat or Clean India mission and needs to be integrated into broader healthcare strategies.

Conclusion

The US health care system serves as a cautionary tale for India. Going forward, India’s efforts to build health infrastructure should focus on universal coverage, investment in primary care, cost containment strategies, and action on the social determinants of health. Drawing from the experience of the US, India is in an advantageous position: it strives to establish a more equitable and efficient system, truly responsive to the needs of the populace.

Reference: The Failing U.S. Health System.

Dr. Prahlada N.B
MBBS (JJMMC), MS (PGIMER, Chandigarh). 
MBA (BITS, Pilani), MHA, 
Executive Programme in Strategic Management (IIM, Lucknow)
Senior Management Programme in Healthcare Management (IIM, Kozhikode)
Postgraduate Certificate in Technology Leadership and Innovation (MIT, USA)
Advanced Certificate in AI for Digital Health and Imaging Program (IISc, Bengaluru). 

Senior Professor and former Head, 
Department of ENT-Head & Neck Surgery, Skull Base Surgery, Cochlear Implant Surgery. 
Basaveshwara Medical College & Hospital, Chitradurga, Karnataka, India. 

My Vision: I don’t want to be a genius.  I want to be a person with a bundle of experience. 

My Mission: Help others achieve their life’s objectives in my presence or absence!

My Values:  Creating value for others.