shishirJuly 3, 2014health, Indian Healthcare
I was reading a times of India article published on the eve of doctors day which said , quoting British medical journal (BMJ) and the survey conducted by transparency international , its open secret that doctors are getting kickbacks for patient referrals and that Indian healthcare industry is plagued with widespread corruption , second only to corruption in police force . Well , is this rocket science ? Do we need any foreign journal or author to familiarize us with this very obvious reality ? One has got be blind not to have known this , but like in any other case we need western endorsement and pointing to recognize our own failures and achievements .
The old English way of doing business , first create a state of anarchy , chaos and internal distrust into a system you want to rule and then come policing after . There is absolutely no denying the fact that corruption in healthcare sector , like in any other sector , is a reality and many in the medical fraternity have contributed to it and should share the blame but is this all . Why is everyone suddenly talking about the healthcare sector at all ? Who has created this mess and who ultimately stands to benefit from it . These are some of the issue one must address if there is any real intention of finding a solution .
The Problem
Considering healthcare as revenue generating model by government agencies , a capital mistake
The interest in the healthcare system arose because many in the developed and affluent class , both Indian and outside , are eyeing at this sector for its potential , recession free business opportunity .
Healthcare in India was recognized for the nobleness of the profession rather than a business venture , with the influx of corporate culture in medicine , the reality has changed .
The mood of the policy makers and the generated public opinion can be gauzed from this line written in the editorial section of TOI “Heal your Doctor” , it reads ” India’s healthcare sector , potentially a revenue source via medical tourism…….” the idea should be to provide affordable medical services and not generation of revenue and ‘Medical Tourism’!!, building five star hospitals to cater to a select few , mostly international patients , deprived of medical facility in their home land , who feel its their right to come here and abuse our system ? Oh common !
Indian healthcare system…….some points to ponder.
After years of deprivation and neglect which the Indian health sector has undergone ,there could be no better time to debate the merits and demerits of present healthcare system in India .
The lack of seriousness and concern towards this sector shown by the government is evident in the total healthcare spending which is less than 2% of the GDP and the bigger irony is that even this meagre amount is not utilised fully . Citing this inability of the government to utilise these funds completely , a 10% reduction in the healthcare spending was suggested in the last fiscal . In a country which is crumbling under pressure due to the growing demands of infrastructure and resource improvement , this is an absolute shame.
However I am not attempting to dwell into the statistical demographics or the political motivation responsible for such a pitiable scenario , the intention of this writing is to inject some grass root level feeds into the minds of policy makers so as to make a difference in the actual delivery of healthcare facilities , here are a few suggestions .
Firstly we must accept that a major portion of our health sector burden is shared by the so called quacks ,under qualified or the RMP’s . Despite claims to the contrary , whatever little penetration and accessibility , our healthcare system has , especially in the poor and needy population , is thanks mainly to the effort of these quacks . Merely catching them, penalising them and putting them behind bars is no solution , it rather adds to the misery of common man , as the friendly neighbourhood doctor to comfort them in cases of minor problems , even at odd hours , will be gone. System must design ways to identify and train these quacks , by way of short duration courses and not merely on the basis of producing experience certificate , as was done in past . These courses may be started in collaboration with private healthcare providers to reduce the burden on government system .
Medical profession is losing its charm due to lack of adequate safety laws to protect the rights of doctors and absolute zero implementation of the existing laws . Neither the doctor nor general public nor even the police is aware of the existence of such laws and its implications . I know of many doctors who have sworn not to send their children into the same field due mainly to the increasing number of cases of physical and mental harassment by the police and public alike. In the current scenario where the doctor patients ratio is approximately 1:1700 this is surely not a welcome sign . Not only there is need of stringent laws and their efficient implementation but also there is need of restoring the confidence amongst the traumatised doctor fraternity in general . At this point I would like to suggest one more thing , our MBBS courses are designed to produce doctors with knowledge and skills to treat diseases , there is hardly any talk about training them to deal with society, police or the legal system relevant to the practice of their profession . This apathy and lack of knowledge regarding the legal intricacies is putting the doctors in unwanted and probably avoidable situations . I suggest introducing a mandatory training and orientation programme for doctors just prior to entering into active practice.
Make medical council a stronger and accountable organization and not merely an ornamental tool restricted to issuing of certificates . IMA by its programme , policies ,methodology as well as its intention should participate in disease prevention and management of the society in a proactive manner involving its faculties and members . I will give you an example , epidemics of dengue are now an annual feature in and around Delhi and most doctors aware of the nature , treatment modalities and notifiable status of the disease by way of their own acquired knowledge and media campaign . But few years down the line when the disease has just surfaced doctor community was left to their own wisdom and patchy assimilation of inputs from press and colleagues , without much support from IMA in combating the disease with a larger prospective , even today the situation hasn’t changed much . In my view in cases of such epidemic crisis the council should pro-actively formulate strategies to deal with the situation and issue advisories uniformly to all its members and preferably re educate them by imparting specific training course.
I say chaps , this seems a daunting task but and having a qualified medical professional at the highest echelon of this government functionary is surely a ray of hope .
What about Aam Indian Janta who will look after their need , do they need such five star facility , can they afford it ? Aam Admi is left to dance to the tune of orchestra set by corporate hospitals , newer chain of diagnostics and the medical insurance companies .
Let’s get our money back attitude
Hospitals have invested corers’ of money in creating , luxurious , largely unproductive , building spaces and infrastructure to lure and em-panel corporate houses . The diagnostic chains are forcing the culture of doing frequent health check ups by way of unnecessary , irrational and arbitrary designed packages .The medical insurance companies are forcing the ordinary patients to fall in the trap of these big hospitals . Together the nexus is out to recover the money they have invested , by milking out even the last penny of hard earned income from the patient’s pocket .
A sizeable fraction of doctor community who have earned their degrees by paying capitation fee to private colleges and are dreaming to recover the cost , are party to this nexus .
The government with its short sighted vision , unplanned execution and probably vested personal gains of people sitting in the position of power , is courteously obliging the culprits . How else one can explain the fact that land is allocated to these big hospitals at throw away prices and to other smaller individual doctors , it is auctioned at exorbitant cost .
With a generation of policy makers who have risen to their position of power by way of reservations in the public service system , there is a dearth of intellectual capacity required for quality decision making , And somebody was talking about reservations in super speciality degrees , Aah! Please spare human lives .
I am not surprised when Dr Samiran Nundy writes in his article about lakhs of rupees paid to doctors as incentives against avoidable and unnecessary admissions because , it is pure business out there with management graduate and business houses ruling the sector , completely ignorant to plight of patients .
As for mediocre level health centres and individual doctors , they are in a state of panic , fighting to survive in the scenario of forced , unhealthy and unfair competition . People hardly talk about the reputation of individual doctors any more when they look up for treatment options , instead the quality and the glamour of infrastructure provided by the hospital gains more importance
The solution
The creation of national watchdog to tackle the corruption in healthcare , while may be necessary , without addressing the root cause will only add fuel to already existing fire. A systematic approach to heal the healthcare system diseased with cancer of un affordability ,un accessibility and corruption is the need of hour .
The suggestions
- Please do not think healthcare as a revenue generating business model , more than the medical tourism what India needs is making healthcare facility accessible to larger masses , so strengthen the ailing primary healthcare system .
- Encourage participation of private practitioners by providing them subsidy in land and infrastructure procurement at the same time controlling them by enforcing uniform and standardized practice protocol. This will ensure standard , protocol based medical facility reaches the lower and middle strata of the society , who are largely depended on such private health centres . This will have two very effective outcomes ,firstly it will ease the burden of already over loaded government sector and secondly it will keep the corporate hospitals under check from exploiting the doctors and public alike by way of providing larger and qualitatively at par options.
- The government must embrace the idea of tax funded universal coverageas opposed to contributory or subsidized private insurance schemes as also recommended by AK Shivakumar (livemint.com)
- Finally a pro active ,image building exercise must be undertaken to replenish the lost trust in this , what was once a noble profession .
