Editorial: Insuring India’s healthcare ecosystem

Two weeks ago, the Indian Medical Association (IMA) released its findings concerning fatalities among doctors fighting on the frontlines of the war against the pandemic. According to the IMA study, as many as 99 doctors across the country have succumbed to COVID-19, with the majority of them being general practitioners. The report went on to say that over 1,300 doctors in India have contracted the virus. The Case Fatality Rate (CFR) among doctors is 7.6 per cent and the national CFR currently stands at 2.6 per cent. Stakeholders in the healthcare space say the actual number of casualties could be thrice as much, as the figures released by IMA only includes its 3.25 lakh members, 10 pc of those being employed with government hospitals. The number of registered medical practitioners in India is close to 11 lakh.

The casualties among frontline workers including that of doctors and healthcare staffers point to the need for a reassessment of the risk factors these professionals put themselves through, in the battle against COVID. The high viral load due to constant exposure to COVID-positive patients is one of the reasons for such casualties among doctors. There is a range of factors that have contributed to such deaths, including the unavailability of adequate PPE kits, a shortage of hospital beds, ICUs, and testing facilities.

Another cause for concern is housekeeping and hygiene within hospital premises. For a virus known for its speed of transmission, contagion can occur through any potential fomites. This is why provision of adequate sanitisers and hand-washes in public areas such as restrooms and corridors is imperative - no matter the size of the facility. There is also a need for the respective state governments to commence launching infection control audits across hospitals. This will help in determining the scale of dangers that healthcare workers put themselves through during the pandemic, that has witnessed India breaching 16 lakh cases by the end of July.

There are a few grey areas that the government must address on priority. One of them is insurance. Doctors associations have over the past few months, tried to get the government to provide insurance covers to doctors who have succumbed to COVID-19. One of the impediments to their demands is that healthcare is a state subject, as far as India is concerned. And rules applicable in one region might be null and void in another. The clauses within such policies are also a bone of contention as doctors have expressed doubt on technicalities that may or may not render them eligible for insurance cover, for instance, a doctor being infected by an asymptomatic carrier as against a doctor contracting the virus while on duty.

The recent death of a 27-year-old doctor in New Delhi prompted professionals in the healthcare delivery space to demand for cashless and zero balance treatments for mission-critical workers like doctors. If the government is looking at a cost-benefit analysis, their demands actually make sense. Announcing solatiums in the range of Rs 20 lakh to over Rs 1 crore, every time, a healthcare practitioner dies, exerts a greater strain on the taxpayer. Instead, guaranteeing these professionals treatment on priority would go a long way in keeping everyone in good stead. Think of it as insuring the country’s healthcare system for the long-drawn battle that lies ahead.