What looks ethically admirable on paper can always be turned into something dubious in practice. The Indian government has a national insurance scheme -- called Rashtriya Swasthya Beema Yojna -- that compensates private hospitals and nursing homes when they operate on patients who cannot afford the surgery. The idea should warm the hearts of anyone concerned about health inequalities and improving the lot of those most vulnerable in society. However, it appears that the insurance scheme in India is being seriously gamed
: the patients may not be actually getting the operation or they are getting operations that they did not consent to. The private hospitals and nursing homes in question, according to the accusations, then bill the national insurances scheme to the greatest extent possible. Some think that millions of dollars worth of fraudulent medicine is involved. Only after an outcry from dissatisfied patients and some media attention did the Indian government initiate an official inquiry, which some believe is currently moving at a snail's pace
. The final report should be interesting reading. Given that this was apparently corruption of a government health scheme, to what extent is there government involvement, considering how long it took for it to come to light? Were government officials, doctors, private hospitals and nursing homes milking the government by facilitating or conducting unwanted and unnecessary surgery on the poor? And why were the victims disproportionately women and their reproductive organs? India has a controversial history of sterilization campaigns that have traditionally focused more on hysterectomies than vasectomies, despite the latter being an easier intervention. One can only hope that what we see surfacing here is not an unofficial sterilization campaign on poor women with tacit government approval.
Labels: bioethics, consent, corruption, India, reproductive health, women