Between Healthcare Access and Excess

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 U.K. for the year 2004 was 5.3, while it was 6.7 in the U.S. and a dismal 80.2 in Pakistan. Similarly, the life expectancy in the U.K. for the year 2004 was 78.5; it was 77.4 for the U.S. and 64.9 for Pakistan. U.S. 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 that think that the U.S. 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 U.S. 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 U.S. In this case, it is the lack of universal and basic healthcare in the U.S. that sets it back.

Public heath experts in the U.S. have long argued this point. According to the U.S. 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 the in the U.K. 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 U. S. and Pakistan highlight the same fact – albeit in starkly different ways. The U.S. 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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This article was also published at the Pakistan Link website.