美国国家公共电台 NPR India Aims For The World's Biggest Health Care Overhaul

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DAVID GREENE, HOST:

We have brought you more than a few stories about the Affordable¹ Care Act, or Obamacare. But Modicare, nicknamed for India's prime minister, Narendra Modi, is actually the biggest government health plan in the world. Modi wants to give poor Indians health insurance they can use to buy private care. NPR's Lauren Frayer reports.

MIHIR DALAL: This is the largest physical medicine and rehab unit in the private space in India.

LAUREN FRAYER, BYLINE²: Dr. Mihir Dalal shows me around Mumbai's Kokilaben Ambani Hospital. It's one of the top hospitals in Asia. There's a robotics rehab unit and a state-of-the-art cancer center. They also do gender³ reassignment surgery here. There are marble hallways, free Wi-Fi.

DALAL: So we are in the lobby. We have a large waiting area.

FRAYER: Looks like a hotel lobby.

DALAL: Chandeliers, large French windows. We have the Starbucks cafe.

FRAYER: Private hospitals like this one cater⁴ to paying customers. Medical tourists come from as far as the U.S. to get hip⁵ replacements⁶ and other surgery much cheaper than back home. But most locals cannot afford this. Ninety percent of Indians go to public hospitals. Care in those is free but nowhere near as sophisticated.

In a one-room house in a Mumbai slum, Shaheen Khan sits cross-legged on the cement floor in pain. She's got gallstones.

SHAHEEN KHAN: (Speaking Hindi).

FRAYER: She explains how her family rushed her to the city's Sion Hospital, a government facility, back in June. Doctors told her they would operate, but after eight days, they discharged her. There weren't enough beds. Patients were sharing mattresses⁷ on the floor.

KHAN: (Through interpreter) They said we don't have space in our hospital. There are so many patients, and there's a risk of infection spreading. So it's better for you to go home, they told me.

FRAYER: They said they'd call when a bed opens up. It's been six weeks. Her phone hasn't rung. Shaheen is a widow unable to work living off her brother. Just like in the U.S., illness often bankrupts whole families in India. People like Shaheen are the target of Prime Minister Narendra Modi's new health plan, offering the poorest half of India - more than 500 million people - health insurance to apply toward private care.

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PRIME MINISTER NARENDRA MODI: (Speaking Hindi).

FRAYER: "Health care should be accessible and affordable," the prime minister said in a radio address this spring. Each family would get more than $7,200 in annual coverage⁸, he said, which might not buy a lot of health care in the U.S. but goes a long way in India. The program is expected to roll out by the end of this year. Modi is running for re-election next year.

RAVI RAMAMURTI: This is a very nice appealing from a political perspective, as you can imagine.

FRAYER: Ravi Ramamurti is a professor of international business who's studied India's health system and its government hospitals.

RAMAMURTI: They are poorly staffed. Equipment there often doesn't work. They have employees who sometimes don't show up. Even the poor, if they can at all find the means, often will look for a private solution.

FRAYER: Modicare could help them, and it's easier to shepherd patients into less crowded, private hospitals then revamp all the public ones.

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FRAYER: A hundred miles outside of Mumbai, a big, rural government hospital is completely full and a bit chaotic⁹ - a world away from the private hospital's marble lobby. There's a bloody¹⁰ gurney in the hall here. But every patient we approached was satisfied with their care.

SURESH JAGDALE: Health scheme - it's total free.

FRAYER: Because it's totally free says the director of the Nashik District hospital, Dr. Suresh Jagdale. He feels proud. India is a developing country that has managed to provide free health care, however rudimentary. Now Modicare seeks to improve it. India spends only about 4 percent of its GDP on health care. The U.S., by contrast, spends nearly 17 percent. Ravi Ramamurti, the health care expert, says the Indian government can afford Modicare, at least for now.

RAMAMURTI: One or two billion dollars is not more than what the Indian government can afford. But these programs have a way of exploding over time. Then it can actually get to be a bigger constraint¹¹. These are programs you can never pull back.

FRAYER: For Modi, this is good politics. For India, this may be a giant step toward better health care for 1.3 billion people. Lauren Frayer, NPR News, Mumbai.