Can the German health care system be adapted to India?

Seminar Paper, 2016

17 Pages, Grade: 1,75


Table of Contents

1 Introduction

2 The Indian health care system
2.1 Private health care
2.2 Public health care
2.3 Reasons for the current state
2.3.1 Poverty
2.3.2 Population
2.3.3 Illiteracy
2.4 The Problem

3 The German health care system
3.1 Basic information
3.2 Statutory Health Insurance
3.3 Private Health Insurance
3.4 Other types of insurances for health
3.5 Conclusion

4 German system adapted to India
4.1 RSBY - Rashtriya Swasthya Bima Yojana
4.2 NHAM - National Health Assurance Mission
4.3 Chances
4.4 Difficulties

5 Conclusion

6 Bibliography
6.1 Printed sources
6.2 Digital sources

7 Declaration of Originality

1 Introduction

“It is health that is real wealth and not pieces of gold and silver.”[1] – Gandhi

The health care of every country is utterly significant for the well-being of every citizen. Gandhi recognized the importance of health. And he was right. Health has to be achievable for every person. A good health care system provides help when needed and moreover also often bears the costs of the treatment. When a good system is given, the life expectancy increases, because many diseases are recognized earlier if a doctor is visited. With the growth of the population the significance of the health sector increases continuously. [2]

Even when no medical treatment is needed, many people feel safer when they have the guarantee to get one if it is required. This gives a secure feeling to the inhabitants of the country. It makes the citizens believe in their own government. Although a well-organized health care system has so many advantages for all of the population, sadly most of the Indians do not have medical insurance at all.[3]

Good health care needs to be affordable and available for every single inhabitant of a country. Therefore you need proper infrastructure and a very thorough organization. In my thesis paper I will explain the current situation in medical care in India and the problems connected with it. I will list the reasons that led to this state and picture their influence on India. After that, I want to shortly summarize the problem India has with its healthcare system. As a next step, I will be explaining the German healthcare system with the German health insurances. In addition I want to list some advantages and disadvantages the German insurance system has. In the next paragraphs I will check whether the German system is adaptable to India to improve the Indian health care situation. For that two different projects in India will be explained to illustrate the attempt to improve the system. The answer whether the German health care system would be possible in India will be stated in the last part of the paper, the conclusion.

2 The Indian health care system

2.1 Private health care

India´s medical care is full of contrasts. If you are wealthy enough, you can get access to the best clinics around the world. India´s leading universities spawn some of the best medics. Furthermore through the last few decades a lot of modern, western hospitals were built in India. These hospitals are equipped with latest technologies. Unfortunately about eight out of ten people are not rich enough to afford treatments in corporations like “Apollo” or “Fortis”, the biggest groups of healthcare in India.[4]

Nevertheless it is estimated that private sector hospitals are responsible for around 70% of the medical care in urban areas as most of the people avoid public clinics. Whereas owing to bad access in rural areas, people outside big cities depend more on public health care.[5]

2.2 Public health care

Abbildung in dieser Leseprobe nicht enthalten

Fig. 1: Health expenditure, total (% of GDP) (data based on )

If you compare India´s expenditure on health care, you will probably be very surprised. In comparison to other countries it is very low. India´s expenditure is about 4.7% of the GDP Germany´s is about 11.3%.(Fig. 1).[6] Germany is representative for many European countries like Switzerland, the Netherlands and France. India´s expenses on the other hand serve to illustrate a similar situation in some African developing countries just as several Asian countries. The slight increase in India’s expenditure during the last ten years could be explained by several projects and missions India launched. The projects should lead to an improved health care system. In later parts of my thesis paper some of these missions will be explained.

Due to bad infrastructure and mostly poor areas, private clinics are rarely found in rural India. As mentioned before, here usually people depend on public hospitals. [7]

This results in a catastrophic situation in government clinics. The part of the citizens who lives below poverty line has free access to public health care. Though this fact seems rather helpful for poor people, rural hospitals mostly offer just a very low quality of treatments. In addition the hospitals are often too crowded, there is insufficient space for every individual and waiting times are so long that you rarely get the treatment or operation in time.5

2.3 Reasons for the current state

There are countless reasons for the current situation in India. The following points, “poverty, population and illiteracy” are not the only ones. More reasons could be wrongly set priorities from the government in the past or not estimated effects of decisions the government made. Nevertheless the following three arguments are crucial for the development of the country. Even though the three reasons all depend on each other and determine each other, every single one of them has its own aftermaths.

2.3.1 Poverty

The international poverty line is defined on $ 1,25 income per day. An estimated third of India’s population is living below this line.[8] Some even think that more people fall below the poverty line because $ 1,25 are not enough to afford proper shelter and enough food, not to mention proper conditions in hygiene and access to decent toilets.[9]

There are other groups of inhabitants, who are not even mentioned in the poverty count. Some of the poorest people are the so-called “untouchables”. They are not counted, because they live at the bottom of society and are not accepted.[10]

As already said, poverty has lots of effects on health. Not being able to afford decent shelter means being exposed to the environment and all its circumstances. Rain, storm, drought and heat affect the human body. Heat strokes, heart strokes and dehydration are only some of the effects.

Further, big parts of Indian population are malnourished because they cannot afford decent, nutritious food. As a result, children and adolescents develop slowly or even die at a very young age. 98 out of 1000 children die before their fifth birthday.[11]

In addition more than 2/3 of all people in India are not able to go to a hygienic toilet or lavatories. Consequently, bacteria colonies have the chance to grow rapidly. Not being able to wash oneself, diseases will spread even faster.10

On average, an Indian adult has an income of less than $120 per month.[12] In comparison, a cheap surgical operation in India costs about $500. This may seem cheap for European standards but is rather expensive for a normal local worker.[13]

2.3.2 Population

India has a very high population in comparison to other countries. With it’s 1.2 billion inhabitants it is the country with the second largest population after China. Nevertheless this is not as important as the population density. In Indian big cities it is multiple times higher than in big cities in Germany. For instance Berlin has a population density of 3.900 per km2. This seems like nothing in comparison to the density in Mumbai, the biggest city in India. Mumbai has a density of 20.000 per km2. The huge number of people especially in metropolises like Mumbai has a lot of aftermaths, not only on the health care situation.[14] [15]

High population growth in India is also one of the reasons for growing resource use. The growth rate 2013 was 1.25%. The fertility rate is almost 70 % higher than in Germany.[16] Increasing population needs a growing number of resources like water or food, better infrastructure, more area for living and many more things. That can be utterly expensive for a country.[17]

One of the effects the overpopulation has in India is the bad water supply and waste disposal. This leads to a catastrophic situation in hygiene. When clean water is not available, people cannot drink as much as they need. To add, they do not get the opportunity to wash themselves or their hands. As a consequence bacteria can get in uncleaned wounds, or viruses and germs can get into the body through the mouth while eating. This can cause infected wounds, gastritis and almost any contagious disease.

The government is trying to improve the situation in India by controlling growth of inhabitants by eliminating or lessen the reasons for overpopulation. Illiteracy, which is another point in my thesis paper, is hoped to be decreased by sex education and spreading awareness. This would not only help decreasing birth rate but also hinder sexually transmitted diseases to spread.[18]

2.3.3 Illiteracy

Literacy is simply known as the ability to read and write. Consequently illiteracy is not being able to do so. In the following paragraphs I will not focus on the ability to read, but rather on all the things connected to it. Literacy also can mean to be aware of consequences that actions have and being aware of how illnesses and STDs spread. Furthermore it can mean going to school, understanding, interpreting and also being able to use common sense to question specific issues.

India’s illiterate population is known to be the largest in the world. Nearly 300 million adults in India cannot write nor read. This cannot just cause a lower income or even unemployment. It can also have impacts on the health of the individual. As mentioned before, illiterate adults often are not aware of their illnesses or diseases. Some misuse medication, some do not understand the importance of medical care. Therefore many underestimate the significance of their health.[19]

There are particular tribal populations who have their very own way of dealing with diseases. They do not see an illness as a biological effect of germs but rather as some kind of punishment or lesson for the person. As a result they have their own cures and methods to heal. An example for this is Ayurveda. It’s a traditional, plant-based system of medicine from India.[20] Although there are people who believe that Ayurvedic medicine can cure almost any disease, on the contrary there is also lot’s of criticism. Researchers from the University Of Pennsylvania School Of Medicine tested the effectiveness of some Ayurvedic methods. They claim that the tested treatments had no effect at all.[21]

Taking everything into account, illiteracy and the resulting wrong methods of dealing with illnesses cause unwanted effects on health. Increasing literacy rate and making people aware of risks would help to diagnose and treat diseases before they become a real danger. It follows that this would relieve hospitals, increase life expectancy and help to eliminate illnesses.

2.4 The Problem

On the whole you can say that the health care system only works well for those who can afford it. Latest technologies and well-educated doctors are available only for the wealthy.

In contrast to private clinics stand government hospitals. In view of the low expenditures on health care from the government in the past years, an undeniably poor situation resulted. Government hospitals seem to be available for everyone but nevertheless they solely offer an inferior treatment.

3 The German health care system

3.1 Basic information

The probably most important difference between German and Indian health care is the fact that Germany has a compulsory health insurance for everybody. Every citizen has to have Statutory Health Insurance. Those, who earn enough money, can even conclude Private Health Insurance. All the money is collected by health care funds and will be paid off when needed.[22] [23]

3.2 Statutory Health Insurance

Employees and employers pay health insurance monthly. The amount of dues is dependent on the income of the person. Generally 14,6% of the gross wage has to be paid to the insurance. With Statutory Health Insurance family members are insured automatically.[24]

Statutory Health Insurance is based on the principle of solidarity. This means that medical coverage will be provided mainly through money collected by the funds. Additional expenses are brought up by taxes, which are paid by all of the inhabitants.[25] As a result, every insured citizen pays for others. In return in case of illness he has the right on a proper treatment, paid by healthy insured inhabitants.[26]

The majority of hospitals, dental clinics and for example physical therapists are paid from the Statutory Health Insurance. It is not necessary to raise your own money in case of illness.[27]

With Insurance important medications are provided freely or reduced in price. In addition, hospitalization and medical or dental treatment is always guaranteed. Furthermore, Statutory Insurance also pays for disease prevention. This means for instance vaccination and cancer check-ups. Besides, insured people always have the right to get screenings and medical check-ups. Methods for early diagnosis of diseases are also provided.[28]

3.3 Private Health Insurance

Those who earn enough money can conclude Private Health Insurance. The main difference between Statutory and Private Health insurance is that Private Health insurance is based on another principle, the principle of individuality. This means that every insured person provides money for its own disease risk. For that the costs will be adjusted individually dependent on health situation, age and extent of the Insurance services.[29]

Germans with Private Health Insurance sometimes have advantages like being preferred when waiting for doctors or being able to choose their services freely. In addition, money for not utilized treatments will be paid back.[30]

On the other hand, private insurance has some downsides to it. For example family members have to pay a reduced due, instead of being included in the insurance. Fees also could climb very high in case of severe diseases. Besides, private insurance always asks you to pay your medical bills yourself first, before later restoring the costs.[31]

3.4 Other types of insurances for health

There are even more types of insurances like the accident insurance, which prevents work accidents and helps injured people to step by step get back to work.[32]

Furthermore there is a long term care insurance which provides nursing when the person is dependent on care. It even covers the case if a person is suffering from dementia or is disabled physically or mentally. This insurance makes sure that assistance is given several hours per day.[33]

3.5 Conclusion

You can safely say that having compulsory health insurance for every inhabitant has many advantages. In case of sickness people do not have to worry about saving money for their medical fees. Moreover surgery and care is always guaranteed.

On the contrary, in many countries people with lower income cannot afford insurance. Sometimes, insurance in other countries like India or the USA even has limited doctor visits.[34] Further it can be very expensive for the government to bring up additional budget from taxes, if the health funds cannot collect sufficient money. In addition it is also rather costly for the whole country to build hospitals where required and improve infrastructure to ensure everyone has access to medical treatment.

4 German system adapted to India

Germany seems to have an utterly well-organized system, where help, care, prescription drugs or surgery is guaranteed when needed. This method is used in many European countries. India saw its crisis several years ago and started projects to improve the situation and tried to offer everybody the care they needed, similar as in European countries. Since average income in India is very low and big parts of the population live below the international poverty line, the government and the provinces have to raise the incidental costs themselves. In the following paragraphs I will explain how India attempts to solve the difficult situation through two different projects. In the next steps I want to analyze whether such a system is even possible and whether it has a future in India. Therefore I will weigh all chances the projects have and all arising difficulties.

4.1 RSBY - Rashtriya Swasthya Bima Yojana

The RSBY is an Indian mission, launched in 2008. Rashtriya Swasthya Bima Yojana, the Indian name for this project can be translated to National Health Insurance Program. The main idea of it is to cover a specific amount of the medical fees for the poorest parts of the population. At first it was supposed to cover all people below poverty line. However, it was later extended for other groups like unorganized mine workers, domestic workers, rickshaw pullers and many others.[35]

RSBY shall pay for hospitalization costs up to 30.000 Rs which is equal to 400 €. Furthermore even transportation expenses to the hospitals will be paid up to a certain amount.[36]


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Can the German health care system be adapted to India?
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Health, India, Health care system, German health care, Health system, Germany, Indien, Gesundheitssystem, Deutsches Gesundheitssystem
Quote paper
Natascha Dremov (Author), 2016, Can the German health care system be adapted to India?, Munich, GRIN Verlag,


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