The Healthcare Paradox: Why Do the Poor Avoid Cheap, Lifesaving Healthcare?

Good afternoon and welcome back to The Poor Economics Blog! Today we are exploring an essential question:  Why do the poor tend to avoid cheap, effective technologies in healthcare?

Sachs’s theory states that poor people are stuck in a health-based poverty trap and that money can get them out of it. These technologies are so cheap that everyone should be able to afford them.

The problem is the lack of demand — studies have shown that the poor don’t seem to be willing to sacrifice much money or time to get clean water or bed nets. This suggests that the ladders to get out of the poverty trap exist but are not always in the right place — this is the fundamental difficulty of the problem of health.

However, the poor do care about health. The poor spend a considerable amount of their own money on health care. Therefore, the issue isn’t about how much the poor spend on health, but instead what their money is spent on. Likewise to food where the poor like purchasing expensive, tasty food, they tend to spend money on expensive cures rather than cheap prevention. 

Studies found that the poor in Udaipur seem to select the expensive plan: cure from private doctors where most of them have no formal qualification in medicine at all (referred to as “Bengali doctors”),  rather than prevention from trained nurses the government provides for free. 

Moreover, the unqualified private doctors and tend to underdiagnose and overmedicate.

Now here comes the puzzling question—this is also our Quote of the Day: “Why do many of the poor reject inexpensive effective sanitation —the cheap and easy way to dramatically improve people’s health—in favor of spending a lot of money on things that don’t help and might actually hurt?”

The book suggests two reasons why we should blame the government for making easy things much less easy than they should be:

1. High absenteeism rates

2. Low motivation among government health providers

Oftentimes, government health centers are closed when they are supposed to be open. These absences are also unpredictable, which makes it hard for the poor to rely on these facilities. Even when government doctors and nurses are around, they don’t treat their patients well. 

The 3-3-3 rule: the interaction lasts three minutes on average, the provider asks three questions and the patient is provided with three medicines (but they are only given instructions half the time and get follow ups only one third of the time)

From this, we have a possible answer to why people tend to avoid the public health system: it simply doesn’t work well. However, this can’t be the whole story, since even when there aren’t high absenteeism rates and government nurses do come to work, the number of patients demanding their services doesn’t go up. Therefore, we must accept the possibility that people are also not interested in receiving the services that public health centers offer. But here comes another question: Why do people demand so much health care, but show such indifference towards the preventive services and all the cheap, effective gains invested by the medical profession? 

Let’s leave it here for today. Tomorrow, I’ll read and share more about poor people’s behavior behind health-seeking. Read my next blog if you’d like to know why! 

Image: https://designtemplate.io/images/best-cartoon-design-healthcare-and-medical-illustration