State vs Private healthcare system: which is better?

The state and the private healthcare systems both possess a fundamental flaw: they are easily corrupted. While a welfare healthcare system is maligned and adulterated with an incessant battle between bureaucracy and power, the private healthcare system is replete with proponents capitalising on ulterior fiscal motives. Pakistan, then, is no exception; with a public healthcare system that sways on the verge of failure, time and time again, Pakistan ought to ameliorate the workings of an organisation as imperative as its healthcare system.

I can vividly recall shadowing Dr. X at a public hospital in Pakistan while I was still in high-school. Every morning, as I’d storm the rusted hospital gates and barge in to make my way into the corridors, I’d notice the rudimentary state that the surgical theatres were in. The operation theatres were relatively well-lit; even amidst copious power-cuts, the beams of sunlight, penetrating through the towering maple trees, would illuminate the theatres, creating a hopeful milieu that stood in stark contrast to the commotions that besieged the theatre. Being a precocious high-school senior, I’d often find myself nonplussed, deject due to how inefficient and partisan the healthcare system that I saw—and therefore grew up to accept as ours—was.

As I rekindle images from such a day in March, 2014, my newfound hopefulness wilts into a deep-pitted feeling of despondence, which I am becoming increasingly inured to.

Mr. P was a patient admitted to the surgical ward, and had had an acute aggravation of peripheral vascular disease, which rendered his limbs in unrelenting agony. He meandered as he made his way into the hospital wards, in a pair of withered jet-black Peshawari-chappals, and wailed in agony. He was a young man—tall, lean, and proud—even in suffering, yet dishevelled with years of struggle against a faltering healthcare system. Seeing him crippled from a pathology that was so easily manageable made me appreciate the colossal flaws that malign Pakistan’s “welfare” healthcare system (although I’d argue—and within substantive realms—that the healthcare system is everything but one aimed towards public welfare).

In a public healthcare system, I’ve observed, the challenges are not those that pertain to advancing medical practice and innovating to resolve the elusive medical conundrums. Instead, most of the quandaries that befall such systems stem from the fact that public funds and tax-payers’ money must be wisely apportioned. In practical terms, this means that while strokes of political parties make it a focal aspect of their election agendas to boast about increasing healthcare spending, it is the physicians, after all, that are left to grapple with a healthcare system that is bereft of funds and resources, but quite glutted with un-kept vows and promises.

On the contrary, a private healthcare system seems to widen the already astronomical gap that exists between the rich and the poor, the wealthy and the needy, and capitalises on the inhumane premise that fiscal privileges should dictate one’s livelihood. Such a partisan healthcare system—while it affords unparalleled medical outcomes, abridged waiting times, and unarguably personalised consultations—is a sure harbinger of calamity for those who cannot afford the exorbitant medical bills that are inherent in such systems.

In a utopian world, private and state medical systems would ideally co-exist in parallel, duly regulated by government policies aimed towards maintaining an equilibrium between medical competitiveness and fiscal feasibility. We do not, however, live in such a utopian world, so we must learn from the examples set forth by nations such as France, the UK, and Germany that have, despite all their flaws, vied to provide an equally accessible healthcare system for both the rich and the poor. On the other hand, in nations such as Pakistan and Ukraine alike, the distinction between private and state meshes into continuity; in order to be treated even in public hospitals, patients must pay the doctor under-the-table, breeding the notion that financial goodness should determine the treatment an individual deserves and in turn receives.

Provision of adequate healthcare remains a luxury in Pakistan. While both the private and the state healthcare systems have inherent strengths and weaknesses, both can and should undeniably be centred around the focal principle of empathy. Empathy refers to crossing the undrawn line that exists between a patient and a doctor, and feeling the suffering that a patient must. Empathy is to remain cognizant of human vulnerability, and to treat it with utmost moral righteousness.

Empathy is also, no less, the humanity that we must impart, hone, and embellish as we treat patients—be this in a privatised setting, or one in which a public healthcare system prevails.

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Talal Almas

Talal is a World-Record holder for scoring the most number of A*s at the British GCSEs/O levels. He is also the first Pakistani to have been crowned at the British House of Lords for his meritorious achievements. Currently a medical student, Talal later plans on becoming a Cardio-thoracic surgeon.

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