Not health, but a Fintech solution needed

Although any macroeconomic problem is far too complicated to be simplified using a couple of personal experiences, I strongly believe that the patterns observed in personal experiences are worth starting with to explore macro phenomena, as I want to do in the case of healthcare in India, especially in this post-Covid phase where savings have really sunk.

Over the past few months, each and every one of the home’s small group of four employees (all migrant workers, wages between fifteen and twenty thousand, agriculturalists, landless or not viable farming due to land being divided over generations) has been affected by a health problem in the family.

My former chef has a wife who complains of chronic back pain, now replaced by another chef diagnosed with severe diabetes. My servant’s father is recovering from a stroke and my gardener has just lost his terminally ill mother.

Each has a story, not related to physical health, but to the financial health of the whole family.

If we talk to some of our cousins ​​living in the developed world about the kind of delays they face in accessing quality healthcare, we feel that we Indians must be doing amazingly well, especially when it comes to getting a good doctor.

If I look at the four cases I have mentioned above, I can see that they have done very well when it comes to going to the doctor.

But does that mean solving their problem? Or is it the other way around?

My chef with a wife who has chronic back pain has been able to access the full spectrum of super specialists, from spine surgeons all the way up to oncologists and now heading towards an immunologist.

My second chef has seen the best doctors, diabetologist and even a top vascular surgeon.

My servant’s father accessed brain CT in a very small town of Gujarat and is now recovering with the help of a qualified physiotherapist.

The gardener was lucky but unlucky as the terminally ill mother has now passed away, but not because the quality diagnosis was not available.

If we look at the ways these reasonably poor people accessed first-class diagnosis, they include government and trust hospitals, social contacts (like my doctor friends) and also because they were willing to pay their best rupee to a private doctor.

The picture looks rosy until you stick to the health part of the story, but if you go one step further, there is one common outcome for all four.

They are now all in a serious situation financially.

The chef with a chronically ill wife struggles to work in the city and provide the best care to his wife who lives five hundred kilometers away, a hopeless equation for anyone with a full-time job.

The chef with diabetes tries not to become a burden to his family by working, but disaster is already around the corner as he is on accelerated deterioration due to diabetes and he knows it.

The servant is thinking of selling his small piece of land to finance the recovery of his seventy-year-old father, who is paralyzed to the point that even after recovery he will not make any money.

The story of my gardener is the worst. He just went home to try to prevent the arrest of his old father for a bounced check made against the loan taken from the local cooperative bank for the money they had borrowed to treat his terminally ill mother, now deceased.

There may be many solutions offered by policy makers to the end-health problem these families face, but they do not address the real social problem.

If we look at the policy thinking we have in place, it is about providing good and affordable health services through government machinery. If I confront a conscientious public health professional with the stories above, he/she can rightly argue that these people could have gotten all the health care they needed for free from the government facilities or could have chosen different government schemes or insurance options.

If these facilities and instruments are there, why do people, especially from the lower middle class, choose financial ruin?

The reason a lower-middle-class family is only one disease away from poverty may be counterintuitive, and that is that we have the best diagnostic infrastructure readily available.

When people purchase other services, cost will always remain a priority, but in healthcare.

The tragedy of the lower middle class is that it has access to information about and partial availability of what it cannot actually afford.

The chefs, drivers, receptionists et al. are aware of what is really the best, and so they have no emotional choice but to try to make use of it, even if it means exceeding their financial means.

Healthcare is unique because everyone feels a social need and pressure to buy the best, kind of like buying a Mercedes even though other cheaper car options are available because Mercedes is what they are socially pressured to get.

This makes the design of health policy very difficult, since the issue is extremely emotional, and therefore one cannot be prevented from choosing financial crisis when it comes to health.

Since the health problem is more of an economic problem in India, the possible solution could be to design better financing tools for health care instead of focusing only on building health care facilities.

India needs fintech solutions that can provide appropriately designed microfinance tools to the middle and lower middle class keeping in mind their earning potential and cash flow patterns.

The Indian state must continue to provide free/cheap and subsidized healthcare as we have a huge mass too poor to afford any level of paid healthcare but there is also a massive middle and lower middle class that lives on ambitions.

It is this group that is socially very vulnerable to financial crisis and desperately needs fintech solutions that can save them from destruction.