Different River

”You can never step in the same river twice.” –Heraclitus

January 30, 2005

India is Improving

Filed under: — Different River @ 1:16 am

Ashish Hanwadikar reports from a recent visit to India that many practical aspects of daily life have improved substantially in the last two and a half years.

Perhaps the most interesting thing (to us health economists anyway) is that he had to get some medical treatment, and found the quality of physicians and their equipment to be on par with that in the U.S. — but the process of getting treatement was much faster than in the U.S. This is particularly interesting, because treatment in the U.S. is much faster than in most (rich) countries, which have nationalized health care and formal waiting lists for services.

Still, in the U.S. it often takes from a few days to a few weeks to get an appointment with a specialist, particularly if you want to see a particular individual. In a moderately large city in Maharashtra (Akola, 1991 population 328,000) Ashish was able to see a primary care doctor, a specialist, and get a sonogram and treatment in a single day. In the U.S., this would probably have taken a week to a month, unless the problem were considered urgent enough to get the coveted “OK, I can fit you in at the end of the day” appointment(s).

This suggests that doctors in India are working at less than full capacity, which probably means that lots of people can’t afford to see them. It could also mean there are too many doctors, but I really doubt that, since India has only one-fifth as many doctors per 100,000 population as the U.S.

Still, it is better to have a service for people who can afford it, than not to have it at all — and the rest of Ashish’s post suggests that more people can afford more things than before. If a service is affordable and easily available to the middle class, this provides increased incentives to work, save, and invest to enter the middle class — if it seems possible to do so. If something is only available to people much richer than oneself, and/or the system makes it unlikely that hard work, savings, and investment will be rewarded, then people won’t find it worth the trouble to do those things. So often in developing countries, the difference between stagnation and a virtuous circle is whether or not economic policy allows upward mobility. The issue is not just how well the poor live, but how hard or easy the system makes it to join the middle class.

This certainly speaks well of India’s economic reforms in the last 10-15 years.

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