Medical crowd-funding and State’s failure to control healthcare costs

Vaccination drive is underway in India since January 16. (Image: Reuters)

On February 12 in an Op-Ed in USA Today, the CEO of United States-based crowd-funding website GoFundMe, warned about the overuse of the platform for essential services such as healthcare, education and food. In last few years, medical crowd-funding in India has also witnessed tremendous growth. The medical crowd-funding ecosystem in India may not have grown as much as the one in the US, but its rise here highlights larger State apathy and inaction over rising costs of healthcare.

Estimates show that multiple crowd-funding platforms have raised around ₹272 crore for healthcare. In last five years, all medical crowd-funding activities might have raised Rs 1000 crore. Both Milaap and Ketto have registered a 300 percent and 50 percent growth in terms of number of medical crowd-funding campaigns respectively with thousands for medical crowd-funding campaigns being launched every month.

Rising Cost Of Healthcare

While growing digital penetration and retail donation has a significant role to play in the growth of medical crowd-funding in India, the rising costs of healthcare and the largely unregulated prices at private healthcare facilities seem to be prime drivers.

Exposing the government’s failure to regularise private healthcare providers the 15th Finance Commission observed that “70 per cent of outpatient utilisation and 58 per cent of all inpatient utilisation now occurs in the private sector, but this is fragmented and largely unregulated.” Oxfam India’s analysis of the latest National Family Health Survey (NFHS) showed worrying trend of rising out-of-pocket expenditure (OOPE) even at public health facilities.

Burden Of Healthcare Expenditure

The latest available National Health Accounts (NHA 2016-17) also depict exponentially rising healthcare costs over the last few years. A staggering 63 percent of health expenditure in India is out of pocket as per the NHA. In absolute numbers, Indians are spending around Rs 3.4 lakh-crore on healthcare from their savings. This is roughly 4.5 times higher than the budget allocations for the Government of India’s Ministry of Health and Family Welfare in 2021-22.

A Symptom Of A Sick Health System

Average Indian medical crowd-funding websites make tall claims such as making healthcare accessible for all, and bridging the gaps in the healthcare financing, or that they are aiming to create a safety net for those whom the public and private healthcare systems fail to support. These claims fall flat if one analyses the scale of problem in India’s healthcare financing which pushes almost 50.5 million people into poverty every year.

The NHA 2016-17 shows healthcare financing from Non-Profit Institutions Serving Households (NPISH) which includes philanthropic funding and donations from public is just 1.7 percent of the total health expenditure. Also, what is important to note here is that private hospitals are often beneficiaries of medical crowd-funding and the platforms are raising money without holding private healthcare providers accountable for price regulations.

Inadequate Health Cover

The Ayushman Bharat or the Pradhan Mantri Jan Arogya Yojana (PM-JAY) have been the government’s answer to make healthcare accessible for all. In November, the parliamentary standing committee on health observed that many have been left out of the PM-JAY beneficiary list due to relying on dated Socio Economic and Caste Census 2011 data.

A coverage of Rs 500,000 per annum per family under the PM-JAY is often inadequate to finance secondary and tertiary healthcare for a family of four. In February, the National Health Authority requested the health ministry to extend the coverage of the PM-JAY up to ₹15 lakh under the Rashtriya Arogya Nidhi (RAN) scheme for patients requiring kidney transplant, bone marrow or liver transplant. Interestingly, medical crowd-funding platforms also have several campaigns running for similar ailments.

Rare diseases are another area where medical crowd-funding is very prominent and often helps those in need. The Government of India in its Draft Health Policy for Rare Diseases, 2020 has recommended medical crowd-funding for rare disease treatment. This is an anti-thesis to the government’s vision of achieving universal healthcare.

Holding healthcare providers accountable is not a job for medical crowd-funding platforms. But the exponential growth in these platforms should alarm successive state and central governments that have failed to regulate healthcare costs for decades. No country in the world has achieved Universal Healthcare Coverage through philanthropy and crowd-funding. The government, private hospitals and medical crowd-funding websites need to come in terms with it.

Time has come for legislate the constitutionally guaranteed ‘Right to Health’ to ensure universal access to healthcare by strengthened public health services, combined with better regulated private healthcare. This will ensure healthcare is accessible to all marginalised people, not just those who use crowd-funding platforms.