“In India, the size of your pocketbook determines the length of your life” – Nephrologist interviewed in Delhi
I know this observation, spoken over a coffee in a New Delhi hospital, likely holds true in many parts of the world, but the disparity in healthcare in India is shocking. I spent my summer as an intern with Baxter Healthcare’s Business Model Innovation group, traveling to India and Indonesia to map the current renal care market. I met with physicians, administrators and dialysis patients to understand how renal care is currently delivered to people with kidney failure – a disease that is growing with the rise in diabetes and hypertension in both countries.
India: What really shocked me were the differences when visiting public and private hospitals. The first hospital I went to in Delhi was a large public institution, and the desperation was palpable. I consider myself fairly well traveled and have seen incredible desperate situations in Central America – particularly in Juarez, Mexico. However, I was almost paralyzed when walking into this public hospital – the dirt, the lines, and the heat scared me. The nephrologist I met with sees up to 100 patients a day; the need is extreme.
In the very same day I traveled to a brand new private hospital in the area where I met with a nephrologist who acknowledged the quote above. Patients waited in chairs in air-conditioned rooms – not on the sidewalks in 117-degree heat as I saw earlier. The nephrologist in the private hospital understood that his patients could afford a higher quality of care, while the majority in India does not. Current estimates indicate that only about 10% of Indian renal failure patients actually receive treatment.
During my time on the ground, I noticed that India is a country of entrepreneurs. I met with a group of local young college and PhD graduates and all worked at a start up companies The country does not have the same level of government involvement as other large emerging markets, like China. The government institutions really lacked the basic necessities to treat patients most in need. One doctor at a large public hospital in Hyderabad just wanted more hospital beds and a proper way to bring patients into the hospital from stretchers. Standalone clinics, like DaVita clinics in the United States, are growing quite rapidly. These clinics recognize the need to make healthcare more accessible and affordable.
Indonesia: In many ways, Indonesia feels like a completely different world than India. The government just passed universal health coverage in January 2014, so theoretically all citizens will be able to receive care for free or a very low fee (around $1-4/month). However, the infrastructure is not ready to meet the needs of the entire population. Dialysis centers are full in many hospitals, and the only way to get an appointment is to wait until a current patient passes away. I spoke with one patient who cannot get dialysis treatment at his local hospital, so he travels 2 hours each way to a hospital with space. This trip is too costly for him to do the prescribed three times per week, so he only goes in for treatment once a week. His healthcare costs are covered, but he still doesn’t receive optimal treatment.