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How India can provide healthcare for all

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7693 (Published 12 November 2012)
Cite this as: BMJ 2012;345:e7693

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  1. Devi Shetty, heart surgeon and founder and chairman of Narayana Hrudayalaya Health City, No 258/A, Bommasandra Industrial Area, Hosur Road, Anekal Taluk, Bangalore 560099, India
  1. devishetty{at}hrudayalaya.com

Every day 60 to 80 patients consult me, mostly children.1 Typically, I might examine a child and tell the mother that an operation is needed to save the child’s life. She has only one question: “How much will it cost?” I tell her 80 000 rupees (£920; €1150; $1460). If she does not have the money she will lose her child. Most people cannot afford to pay for treatment themselves, and society does not make it available. Few government hospitals operate on babies, and even here at Narayana Hrudayalaya Health City often treatment is not entirely free.

A huge 60% of all spending on healthcare in India is paid for by citizens out of their own pocket, says the World Health Organization.2 Many people borrow money or sell assets to pay medical bills, and this is a key cause of rural indebtedness. Our maternal and infant mortality healthcare indicators are only slightly better than those of sub-Saharan Africa. Even government employees with means and influence—for example, police officers—rarely get reimbursed their medical expenses, despite struggling with the …

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