The chasm in India’s healthcare system forces many people to turn to crowdfunding

Inclusive health.
Inclusive health.
Image: REUTERS/Cathal McNaughton
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Indians are under-insured, public healthcare schemes are insufficient, and private medical facilities are expensive. In the gaping chasm between its private and public healthcare systems, medical crowdfunding platforms like Milaap, Ketto, and ImpactGuru have become a crucial bridge.

The country of 1.3 billion spends a mere 1.28% of its GDP on health, according to the government’s own estimates. Public healthcare is not universally free, but rather consists of a patchwork of free or subsidized primary care services that vary across states and often do not cover more significant treatment. As a result, India has one of the highest proportion of out-of-pocket expenses for medical bills in the world. These healthcare expenses pushed 55 million Indians into poverty in 2017, according to a study by the Public Health Foundation of India.

This may seem counterintuitive in a country that boasts a comprehensive health insurance plan for the impoverished. Launched by Narendra Modi’s administration in 2018, “Ayushman Bharat” covers medical expenses of up to Rs5 lakh ($6,500) per family, per year. It is available to over 100 million Indian families who meet the criteria—such as families living in one-room tenement houses, and households headed by women or people from marginalized castes. Some states also offer their own version of healthcare coverage for the poor.

But this coverage is woefully inadequate for those needing advanced surgeries and treatments, with cancer and transplant surgeries costing upwards of Rs25 lakh ($32,950), says Piyush Jain, co-founder and CEO of crowdfunding platform ImpactGuru. And because it is limited to poorer families, middle class families continue to struggle to cover the costs. Only 20% of Indians have any private health cover to make up this shortfall, an analysis by EY found.

“Families have to resort to selling homes, mortgaging jewelry, spending all their savings, or borrowing money from lenders at very high interest rates due to the urgent need to finance such hefty bills,” Jain says.

Enter crowdfunding.

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Sure and steady

Decisions around specialized healthcare in India are often made under great pressure. Families may be able to get advanced treatments for organ transplants, cancer surgeries, and birth defects at government-run hospitals, but not necessarily in time.

“The waiting period at a government hospital is often very long. And while healthcare may be free at some hospitals, not getting timely surgery could be fatal for those who need it urgently,” explains Dr Mandeep Malhotra, department head for Head, Neck, and Breast Oncoplasty at the private Fortis hospital in Vasant Kunj, an affluent neighborhood in Delhi. Here, crowdfunding campaigns can offer patients a chance to access treatments they cannot afford, and which the government’s healthcare scheme can’t adequately cover.

Malhotra says that several of his patients have turned to crowdfunding to pay for immediate treatment at private hospitals. For ongoing, post-operative care, such as chemotherapy or dialysis, they visit hospitals and charities run by the government or charities.

Indian crowdfunding platform Ketto, which was launched in 2012, has seen the proportion of medical crowdfunding campaigns in the past few years rise to 60%, according to its co-founder and CEO Varun Sheth. Milaap, which pivoted from facilitating micro-loans to crowdfunding in 2016, reports that 55% of its campaigns are dedicated to medical expenses. “The support they receive constitutes 80-85% of the total funds raised through the platform,” says Anoj Viswanathan, Milaap’s co-founder and president.

Based on his own estimates, ImpactGuru’s Jain says that Indian crowdfunding platforms today raise approximately Rs250 crore ($32.9 million) every year collectively—a figure he projects will grow exponentially.

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Middle of the pyramid

The growth in campaigns asking for help for medical emergencies mirrors a phenomenon seen in other countries with poor or non-existent public healthcare systems, such as the US. As in the US, success with campaigns is not democratically guaranteed.

India has benefitted from an explosive growth of internet access and social media in recent years. But on crowdfunding platforms, campaigns are often created by the middle class patients or their networks —“internet-savvy colleagues or employers of people who need the funds,” explains Sheth, not necessarily the people who need it most. “The story that goes with a campaign, including the photographs, require some amount of digital awareness, if not proper marketing prowess,” says Sheth.

“In my experience, the biggest gap lies in the fact that those who truly need these funds are not able to create campaigns because of a lack of literacy, digital and otherwise,” says Malhotra of Fortis.

First, patients have to overcome their pride towards receiving what is effectively charity. “It takes patients a while to get used to the idea of putting their story out there and asking for money,” says Malhotra.

A schoolteacher from a small town in India who turned to crowdfunding for breast cancer treatment was one such patient. “I needed to undergo a complex surgery that also came with post-surgery recovery expenses,” says the 38-year-old, who requested anonymity to avoid her family revisiting the traumatic period.

She chose the private healthcare route because the surgery needed to be done immediately and there were no available beds in the government tertiary care hospital in her city. After exhausting her health insurance and a significant amount of savings, she chose the crowdfunding path.

It wasn’t without hesitation. “I felt like my neighbors had started looking at me differently, with a mix of pity and confusion,” she says. “When we think of giving money to charity, we cannot imagine paying bills for someone who is living in a two-bedroom apartment with a fixed monthly salary.”

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Crowdfunding has become so crucial in India that many of the crowdfunding platforms have direct relationships with private hospitals or healthcare chains such as Apollo, Aster, and Foster, to enable campaigns. They engage with campaign managers employed by the platforms to recommend crowdfunding as a viable financial option for patients.

Through this engagement, especially with specialized surgeons and doctors involved in targeted therapy, Ketto, for instance, has been directly able to get some campaigns on its platform. “It works like cashless insurance, and when we go through the hospital, all the bills are verified. So there’s complete transparency,” says Sheth.

Jain’s ImpactGuru has a dedicated relationship with Apollo private hospitals. “In May 2018, not only did Apollo invest in our company and led our Series A Round, but it also agreed to offer our healthcare financing solution to thousands of patients in its 70-plus hospitals across the country for free,” Jain explains.

The advantage, in such cases, is that transfer of payment can be swift and the patient doesn’t need to engage with different entities for raising money.

However these relationships remain limited, and aren’t an overall solution for the massive gaps in India’s healthcare system. “Oftentimes, the doctors who are aware of these platforms direct the patients themselves. But I haven’t had crowdfunding platforms come to me with sustainable solutions for this,” says Malhotra.

Malhotra estimates that just a small number of his colleagues are aware of crowdfunding as a financial solution, and there’s a lot more that both doctors and platforms can do to make the money reach where it should.

But the success of medical crowdfunding has raised concerns amongst some, including Chhaya Pachauli, a coordinator for Jan Swasthya Abhiyan, a health advocacy movement. “As it becomes more popular in India and a large number of people begin to benefit from it, it might make the government quite complacent towards making efforts to further strengthen the public health system or to invest in it more,” cautions Pachauli. And with easy availability of funds, private healthcare could become prohibitively more expensive.

Still, healthcare coverage in India “is a complex problem and will take years, if not decades, to fully fix,” Malhotra says. Until then, “crowdfunding could be that bridge where healthcare systems are well utilized, and patients are the true, direct beneficiaries.”