Farewell to India

After nearly 24 hours of travel (layover included) we finally exited the airport and ventured out into the bright cold sunlight of Boston. The heavy moisture of the Indian air laced with the smell of smoke and sulfur was replaced by the cold crisp breeze lightly scented with coffee from one of many airport Dunkin' Donuts (a scent voiced as a much missed luxury of the two Co Founders of Mitra Biotech with whom I had the pleasure of dining last Thursday).  As we flew through traffic, the proportion of vehicle speed to level of anxiety was in complete opposition to that experienced on the roads of Delhi, Mumbai and Bangalore. The absence of the many volumes and peculiar ditties of horns was particularly noticeable, even the occasional shout and fist shake by my sister (our driver) which in the past had seemed loud and volatile now was merely a slight noise in comparison to the din of the past two weeks. The awareness of these basic environmental changes illustrate the impact that India has had on my perception of the world around me, I have no doubt that as time goes by more and more of what I observed and experienced in India will effect the way I see and participate in both my studies and my community. The largest contrast for me was the apparent transparency and consumer based structure of the healthcare industry.  A lot of what my classes focused on in evaluating the health care system in America was the moral hazard inherent in use of insurance in health care.While most Americans have little to no idea of how much their health care costs nor do they care to learn, in India prices are put on walls of hospitals and clinics because the patients pay out of pocket and need to know how much procedures will cost before deciding to go through with them. While the American patient is more likely to have unnecessary procedures and tests run because it does not have a direct impact on them, the Indian patient must weigh the value and quality of the procedure against the cost.  As we learned in our many visits India is likely to move towards an insurance based healthcare system as the middle class emerges.  It will be interesting to see whether patients will choose to have procedures keeping in mind the value and necessity or if they will become less involved in the decision process as the costs are contained within the insurance system.