What happens when … a failed healthcare system is opened to FDI

So there are many takers for Indian hospitals.This is very interesting given the fact that India’s healthcare spending as a percentage of GDP (~ 3.9% including private sector, ~1.8% excluding) is one of the smallest in the world whereas it has the second largest population in the world.

In this ‘what happens when’ we explore this scenario a bit. In India the demand is definitely there for healthcare. The supply is skewed towards urban areas and the variance in availability and quality of service is massive, especially when comparing Government run hospitals and private hospitals.

What cannot be argued against is that there is a massive gap between demand and supply with demand far outstripping supply. This gap is likely to further widen as the population ages. This gap, for sure, increases as we move down the wealth ladder.

In theory – investment is supposed to increase the supply (if used to build capacity). But that model works for products more than services. Especially where services are specialised in nature (e.g. MRI scanning, Gamma knife) or require extensive training (e.g. general practitioner, dentist etc.)  or both (e.g. neuro-surgeon, heart specialists, cancer specialists, neo-natal specialists etc.).

Therefore more money in today does not mean more doctors tomorrow. It means higher packages being offered to currently qualified doctors and specialists irrespective of whether they are in the private or public sectors. This would mean an increased demand for a resource in limited supply. In turn, to recoup the higher input costs the hospitals will have to find ways of either increasing their charges, reducing other costs or somehow battle to increase occupancy rates (perhaps by connecting with Health Insurance schemes?). This becomes even more important when we take into account the fact that any investment will require a return. Whether it is over a longer term or short term, fixed or variable.

So it leads to some disturbing conclusions:

  1. Brain drain away from the public sector into the private
  2. Providers sticking to safe markets (e.g. urban areas)
  3. Increased gap between quality and availability of healthcare as the costs rise
  4. Rising inequality in terms of access to healthcare
  5. Increased reliance on insurance to come in and plug the gap between treatment costs and income (insurance – healthcare provider nexus)

To think positively one can look at the silver lining:

  1. It would encourage setting up of integrated medi-cities (treatment, training and research) and expansion of medical education (suddenly all those medical colleges churning out MBBS will have more incentive to expand and improve quality of education – especially if the foreign owned healthcare facilities are more discerning than their local counterparts)
  2. There may be some risk takers driven by new investments, who may want to explore newer markets (e.g. smaller cities, villages) and come up with innovative business models for healthcare delivery
  3. Increased accountability and a driver to improve medical insurance (the US model)
  4. Turning to medical tourism to ‘subsidise’ treatments for locals (in the same way UK universities use foreign students to subsidise home students)
  5. Faster and (hopefully) cheaper access to advanced treatments

In all of this the Citizens of India and the Government will have to make sure that they act as watchdogs to make sure FDI does not result in exploitative practices or long term mis-alignment of the healthcare system in India.


Please Gamble [Live] Responsibly

In UK there is a habit of trying to plan and manage everything. While this habit is one of the main reasons for the advanced state of development enjoyed by the countrys’ residents, sometimes it can be pushed to insane limits.

For example, out here  all gambling websites, shops and even advertisements need to have information pointing to ‘GambleAware’ along with the advice: “Please gamble responsibly”. The main purpose for this is to remind people to ‘gamble responsibly’ and to show people with gambling related problems a way out.

All that is well and good but my question is how can one gamble ‘responsibly’?

Gambling itself is an act of taking a risk. So they are asking us to ‘take a risk’ with responsibilty? If you were responsible for something would you take a risk? The obvious answer to that is ‘depends’ on what you were responsible for and what was the associated risk, but that brings us to the question of what exactly is involved in gambling. What is it that we are risking?

So I went to the GambleAware website to try and figure out what they highlight as ‘risks’ of gambling without responsibility… in other words what is their definition of ‘gambling responsibly’. This is what I found (from their website http://www.gambleaware.co.uk/responsible-gambling):


A person who gambles responsibly:

  1. gambles for fun, not to make money or to escape problems.
  2. knows that they are very unlikely to win in the long run.
  3. does not try to ‘chase’ or win back losses.
  4. gambles with money set aside for entertainment and never uses money intended for rent, bills and food.
  5. does not borrow money to gamble.
  6. does not let gambling affect their relationships with family and friends.
1) Gambles for fun … : Well I don’t know about making money but as far as escaping problems is concerned then they should put the ‘Please escape from reality responsibly’ advice up on each and every source of entertainment. From movies to sports! Isn’t that what we use these things for? To escape from reality which is usually full of problems?
2) … very unlikely to win … : They should put ‘Please create babies responsibly’ advice in each and every hospital’s maternity ward. To warn the newborns that life is a game that is impossible to win. Everyone dies in the end!
3) … win back losses. : I thought it was a good thing to overcome odds and to ‘win back’ what one lost. Some of the greatest people did this to ‘achieve’ greatness. I also thought this was part of human nature to try and overcome loss. This is what allows us to go on in face of great odds and rebuild our life. This calls for the following general advice: ‘Please loose responsibly’.

4) … money set aside for entertainment … : This calls for the following advice in all shops: ‘Please spend money responsibly’ because we know that whenever we go into a shop or supermarket or a mall, hundreds of offers/sales/deals are thrust into our face! That is why expensive brands (which we really can do without) are reduced marginally in price so that the average person, thinking of it as a deal, tends to buy them leading to overspending.

5) … does not borrow money to gamble. : This is a good one. All the banks out there distributing credit cards like they were going out of fashion listen up! Put the following advice in bold letters on your credit card: ‘Please borrow money responsibly’. So that people don’t run up huge credit card bills buying things they don’t need and cannot afford just because they are able to ‘borrow’ money easily.

6) … affect their relationships …  : Another good one. All offices should have the following advice in all public areas: ‘Please work responsibly’. Also all managers and senior managers should be sent on special ‘working responsibly’ courses! We know work is one thing that affects our relationships the most. It keeps us away from our loved ones even after work hours. Gives us stress which we often take out on people we love.

Maybe we just need one advice tattood on the arm of all newborns: ‘PLEASE LIVE RESPONSIBLY’.


So what do you think guys? Do you think we will see these bits of good advice popping up anywhere soon?

UK General Elections: What I saw…

This was my first time voting in any kind of national election. Therefore I was quite excited to go and vote. Throughout the day I was feeling like an excited puppy who has been tied to a post.

Since the day of voting was NOT a holiday I had to finish off my work before I could go and vote. I had to control my excitement till the evening. The voting hours were 7am to 10pm. With 15 hours to cast your vote I was quite surprised to hear, later that night, that many voters had to be turned back as they waited in the line outside because they were not able to get a ballot paper before the polls closed. I guess the issues on which these elections were fought really motivated the people to come out and make a difference.

The polling station near our house was in a local school. When I reached the location around 7pm and found the area to be deserted. There were small posters pointing the way to the polling station. That was the only thing there to indicate that the polling station was somewhere near by. As I stood outside the school, trying to figure out where exactly the polling station was located I saw few people walking out of the school through a side entrance. That is how I located the polling station.

Once inside I handed in my voters card (which had been sent by post) and they handed me a blank ballot paper. I went into the booth and cast my vote by marking my chosen candidates name with a pencil.

I was surprised to see such a basic, no-fuss no-mess voting system. No electronic voting machines, no tamper proof ballot paper, no sign of police and absolutely no crowds. The whole process took about 5 mins.

The results are obviously now out. I did stay up till the Conservative party had achieved a healthy lead on Labour. My prediction of Nick Clegg joining hands with Gordon Brown was partially right. It was a hung parliament and Nick Clegg did tie up with one of the two big political parties, just that it was not Labour.

In India the elections are a whole lot more spicier and logistically speaking very difficult to organize. Seeing the process at work in UK for a relatively small population I had even more respect for the Indian election system, however more complicated it may be for the average voter.

UK Elections: The First Debate

In my view the pre-election debate is an excellent idea.  Today in the first debate it put the politicians in the middle of the arena to face the UK public for the first time.

Since it was a live debate with audience questions and a very strict presenter the politicians were not able to get away by arguing and making unrealistic claims like a bunch of 10 year old kids.

Now the three personalities standing in the firing line Nick Clegg from Liberal Democrats, David Cameron from the Conservatives and Gordon Brown from Labour are quite impressive.

Gordon Brown, starting with the disadvantage of having faced some of the toughest times ever seen, brings a certain mature, almost elderly, calm and solidity. After having faced the pressure he appears as a person who has seen and done it all. Not a very good feeling to give out if you are running for four more years as the leader of the country. The new leader needs to have some fire in him, I believe.

David Cameron was the Poet Parrot in th debate. Whenever he was asked a question he started by confirming the issues raised in the question were important and valid (duh! David that is why they asked the question!) and then mixed in words which would befit a poet writing a song to raise the moral of troops on the frontline… something like ‘we shall over come’. There were certain moments in the debate when both Gordon Brown and Nick Clegg were ganging up against him and he looked positively peeved.

Nick Clegg was the winner of the debate for me. He did appear to tackle the questions head on with some common sense and logic. He smashed his earlier image of being a ‘radical’ and emerged as a person with some real ideas and thoughts on how to run the country out of troubled times. He made sure that the public sees Lib Dem as a real option and not just a fringe party which is in there just to kick down the established order.

For their closing statement Gordon Brown played the roles of a grandfather talking about things to come. David Cameron recited a few rousing lines as to why Conservatives and Nick Clegg spread some fairydust around trying  hard to make people believe that Lib Dem are a real option.

The other day I heard on Radio Four someone saying that if Nick Clegg won the elections he would be the most surprised man in UK. After today’s debat he seems to have come one step closer to ensuring that Lib Dems are seen a real alternative. I hope he doesn”t forget that sometimes trying too hard can leave you with a red face. 😉

My prediction after the first debate: Nick Clegg and Gordon Brown ganging up to form the next government.

UK Elections: A Ringside View

UK Government elections are coming up in a few weeks time (May first week).  This election is a face-off between the Labour Party, who have been in power for the last 12 years, and the Conservative Party, who are sensing a real chance to form the government this time. There is a third party – the Liberal Democrats, dream of becoming king-makers and in reality can seriously affect the base of the two established parties.

One issue which, according to those who claim to be the ‘experts’, is going to dominate the voter’s minds is the economic crisis that gripped UK last year.

I believe that in politics your point of view is decided not by logic or analysis but by the political party that you belong to. Keeping this in mind, the fact that the UK economy has just about limped clear of the recession can be seen from three different prespectives.  

The Labour view is that they have taken some ‘very difficult’ decisions through some of the ‘toughest times’ seen by ‘world’ economy and have guided the UK economy out of the battlefield. According to the Labour government the economic crisis was not of their creation but something external in which the UK economy got dragged into.

The Conservatives have the view that Labour was responsible for the country facing such difficult times. That if they had been in power they could have helped UK sustain the storm better.

The Lib-Dems do not have a clear view of things. They keep changing their views depending on what the two major parties are saying.

There is one thing though, that all three of them agree on:  they have to take some ‘very difficult’ decisions and  some of the ‘toughest times’ are still ahead for the country.  

All three are saying there have to be big cuts in Government spending to reduce the deficit. But what exactly should be cut and how the resulting gaps will be filled, changes with the party. Great fear is also being generated regarding cuts in frontline services (e.g. Police and NHS).

What no one is willing to admit is the fact that the road ahead is not full of options. The steps that can be taken are limited. Yet the voters are being fooled into believing that there are multiple roads out of the mess and that each party holds the map to a different route.

Looking at these things from a temporary resident’s point of view I can say if frontline services like NHS and Police are cut then it will surely make the country less attractive for skilled workers. Free healthcare and a safety are two major requirements especially when it comes to people with families.

Immigration is the second point where these parties will clash. Again there are not that many options out. Already immigrations laws are very strict. Apart from closing the Tier 2 (Work Permit) and Tier 1 (Migrant Worker) schemes to South Asians (which will damage the UK economy and push work out of the country) they really can’t do anything.

To clamp down on illegal immigration will require increased government spending (for better border security and tougher enforcement) but the question remains: where will the money come from? Also the government will never admit this but illegal immigrants contribute a lot to the UK economy. They do the kinds of job which the locals will not do. Illegal immigrants, in fact, help the UK economy by providing cheap labour. They don’t pay any tax but even if they were legal the amount they earn would keep them well below the tax bracket.

In my view this election is going to be about whichever party screams the loudest and is able to convince the UK voter that yes indeed they can pull rabbits out of hats and pennies out of thin air!

Ab baat pakki…. the deal is fixed…. X 4

The second season of Swayamvar starring Rahul Mahajan is currently the number one TV show of  India. The show is supposed to end on the 6th of March and this time they have promised us a marriage!

I like this program because it blows away some serious concepts in marriages. At the same time it exposes the dark side of human nature.

In last nights episode he travelled to meet the family of the first girl (Harpreet Chhabra). Harpreet’s family members were obviously treating it is if a boy had come to meet the family for her marriage. They asked him whether he has any ‘demands’ [for dowry]. Did they realise he was on camera being view by half of India? Even if he wanted something would he have said so on air? Women activists would be buring his effigy all across India if he had. But this shows that dowry is still a big issue.

Now the second point: usually when marriage is being discussed between two families it is usually between TWO families! The process is quite sequential.

 In this case he has to visit three other families who are expected to discuss marriage equally seriously! He has to interact with girls at individual level as if SHE is the one, which is impossible at the deepest level. The problem is that this can be taken in two ways:

1) Either he is really good at compartmentalising emotions and such deep interactions… which means there is full scope for other women in his life, perhaps even after marriage.

2) He has already made up his mind and all this is acting.

But this show has made bride hunting similar to buying a house where you have multiple deals going on at once. A new concept indeed in marriages. Will this be used by families to parallelise bride hunting? Make it more efficient? Especially keeping in mind, like good houses, brides are in short supply?

About respect…

I feel respect is more important in any kind of relationship than merely liking a person.

Likes and dislikes tend to change. A person you dislike today you may end up liking tomorrow.

Respect is a whole different story. Respect is gained over a period of time and once lost, is hard to regain.

Relationships cannot survive without mutual respect. It forms a deeper bond which can sometimes hold a relation together even when like has turned to dislike.

So remember people respect should come before love!

The Taliban within us all….

The other day I read a news item about the US forces killing 40 Taliban fighters somewhere in Afghanistan. A question came to my mind almost immediately: How many Taliban fighters are there out there? I always thought Afghanistan was a sparsely populated country. Where are all these people being killed coming from?

Then I realised a fundamental truth which I should have realised a long time ago: There is a piece of ‘Taliban’ within us all. ‘Taliban’ is more a thought process than the name of a terrorist, pro-radical-Islam organisation. We all have had ‘Taliban’ like thoughts of intolerence, hatred and sheer blind stupidity in our minds and hearts during our lives.

Every time we have ever shown intolerence for other religions, sexual preferences, skin-color, height, weight, language, region etc. is a time where our mind was thinking ‘Taliban thoughts’. Every time we ever acted without thinking, in the flow of negative emotions, we are allowing the Taliban fighter within us to take control. 

The dividing line between good and bad is very narrow and fuzzy.

Sometimes it only takes a gentle nudge to cross it and allow the ‘Taliban’ within us to guide our thoughts and hands.

At the same time we all have good within us. We all have a Buddha within us. We all are capable of love and care, both receiving and giving of it. Then let us try hard to bring out the Buddha within us.

Next time you feel like punching someone for any reason remember to throw away the Taliban in your thoughts and bring out the Buddha!

The multi-Billion Dollar Scam: Selling unsustainable dreams…

The real estate sector is booming in India. Areas just outside the four metro cities have seen land rates shoot up like a NASA rocket.

A textbook case is the suburb of Gurgaon touching the southern border of New Delhi. Till 10 years ago it was a dusty under-developed area with bad infrastructure. It was not a hot favourite for house-hunters and real-estate developers. How can I say all this? I had relatives living in that area and have been visiting them since I was 11-12 years old. I have seen that area develop as I was growing.

Then came the multi-national corporations, the call centers and the big brandnames. These were followed closely by the shopping-mall culture and a major empowerment of the young working Indian. All this meant that within a short span of time on a 4 km stretch of the Meherauli-Gurgaon road there were 6 shopping malls standing shoulder to shoulder.

While individually these were no where close to their western counterparts, taken together they formed a solid block of shops surrounding on of the busiest roads connecting Gurgaon with South Delhi. Within months the Meherauli-Gurgaon road became a nightmare for regular commuters. Being stuck in traffic for hours became normal.

Yet the property prices in Gurgaon kept increasing. New real-estate projects started springing up all over the place. There were buildings but no roads. Homes but no water or electricity. The boom was fueled by the ITeS boom in India and rise of home loans where young professionals starting their first job were able to buy flats and land. People made a lot of money selling dreams.

But what is the reality? Infrastructure is still trying to catch up with Gurgaon. Non-existant transport facilities are being supported with a new metro system. But what about water?

What about sustainability?

A crore’s worth of property is not of any use if you do not get water when you want to have a bath or electricity when you want to sleep. While power shortage can be removed (if your children are lucky then maybe in their lifetime) what will we do about water?
Study sees dramatic drop in Indian groundwater – longterm prospects are anything but bright for a good supply of water.

With a declining water table, unpredictable rains the long term forcast for Haryana points towards it becoming an extension of the Thar desert.

What will happen to the billion dollars worth of real estate? The investment in our future will be equal to a pile of sand?

Lack of sustainable development and blind destruction of the natural shield that is Haryana does not give a solid foundation to any kind of long term investment (for e.g. property investment).

The above factors make the real estate boom in India a bubble waiting to burst. When this bubble bursts a lot of people will be left with shattered dreams.

Few people though, will be left with a load of money they made selling unsustainable dreams.

The Fact of Indian Elections

Every conflict has three sides. The side which won, the side which lost and the side which sits on the side to watch the conflict to take all possible advantage.

During the current election period we find parties in power taking fire from parties which lost the last election. The loosers blaming the winners for the almost continuous sorry state of affairs in India. The winners in turn blaming the losers who were in power previously. This blame game has no end unfortunately.

In all this one critical fact never gets highlighted: the amount of time a government gets to plan and implement development work.

Is it right for Congress to blame BJP which was previously in power? Is it right for the BJP to blame the Congress? Is four/five years enough time for the party in power to prove itself?

Given the slow speed of the Indian state machinary any project typically takes a long time to be planned and completed. Especially if the project spans multiple states (like the National Highway Project).

Take the Delhi Metro Project for example: The plan for the metro was passed, guess when? Maybe you thought 1980s or 1990s? No way! The concept of the metro was finalised in the 1960 Delhi Master Plan. The legal framework was setup in 1978 (the Metro Railways (Construction of Works) Act) (see this). When did the construction start? 1998. I guess that is why the Metro project is considered to be a miracle.

In my view each Government should be given at least a 6-8 years period to plan and implement projects before cursing them. We have seen how bad governments are when it comes to handing over and giving credit.

The situation is even worse when it comes to State-level projects. Uttar Pradesh is famous for this. Key infrastructure projects stop and start based on which Government is in power.

Then what is the fight and posturing about? Can any Government claim that they are the masterminds behind development projects when each major project has its roots in history? I don’t think so.

I think we should be honest with ourselves and evaluate the parties based on what NEW things they did. What new initiatives were put in place? We should never go by the chest-thumping and shouting as politicians try and take credit.