A cure for India’s health care ills is within reach provided there is political will
In most developed — and many developing — countries today, a 12-year school education and universal health coverage (UHC) are the two primary responsibilities of the state. India has failed miserably on both counts. Let us look at some of the problems of medical and health care:
• Fifty years ago, when there was no commercialisation of medicare that we have today, we had only government hospitals or those run by trusts as public service. There weren’t enough of them but they provided excellent medical and health care (medicare) by dedicated professionals. Today, the government hospitals are a shambles.
• Medicare of reasonable quality is currently largely commercialised and corporatised, the primary objective being to get the maximum money from patients by giving them the minimum possible in return. The irony is that while the average quality of health care provided by commercial hospitals is far from satisfactory, we have in them, taken altogether, world-class expertise in virtually every field of medicare. Therefore, you can get the best possible medical attention in our country if you have unlimited money.
• Many commercial hospitals in the country have been given land at concessional rates and exemption of duty on imported equipment, on the condition that they would treat a certain percentage of poor people free. However, there may not be even one hospital that meets this obligation.
Quality of education
• The quality of medical education — barring in a handful of elite institutions — has progressively gone down. Till recently, recognition by the Medical Council of India (MCI), the accrediting body for medical colleges, was based not on the ability of the proposed institution to provide quality education but its ability to pay the Chairman of MCI (one of whom has been jailed) and members of the inspection team. This expense was more than recovered by the capitation fee charged for admission in the medical college, and a guaranteed degree irrespective of ability or performance.
• The system of general physicians (GPs), which is the backbone of the National Health Service in the United Kingdom that provides one of the best UHC in the world and which was also the backbone of our medicare system when we became independent, has virtually disappeared. Till recently, no medical college provided an MD course in family medicine. After I gave the convocation address at the West Bengal University of Health Sciences a few years ago, the government of West Bengal, with the support of Gopal Gandhi, then Governor of the State, his Health Minister, and the university Vice-Chancellor, decided to introduce an MD course in family medicine. This may, however, be the only one of its kind.
Consequently, today, it is the (often ignorant) patient who decides which specialist to go to, even for the most trivial of problems. The specialist — in most cases, in the private, commercial sector — finds a disease of his speciality, even when it does not exist. Moreover, he is generally too busy to ask his patient if he has any other problem or is taking any other drug besides that prescribed by the specialist. We thus had a case in Hyderabad when a person chose to go to seven specialists, each one of whom prescribed him a course of antibiotics; he returned to the hospital as a victim of antibiotic toxicity. The fact is, unlike a specialist, a family physician (a GP) cannot recover the astronomical amount spent on getting admission to a medical college.
• Many private commercial health care establishments have touts in villages who bring them patients against a commission. This was once recorded in a sting operation in Hyderabad and reported by us to the State Medical Council that did nothing about it.
• Unnecessary diagnostic tests (for prescribing which a doctor gets commission from the diagnostic laboratory), surgical procedures and stay in the hospital, are common practices resorted to by commercial hospitals.
• Payoffs to doctors for recommending a particular test to be done in a particular diagnostic centre, or for recommending another doctor or hospital, are rampant.
• There are also payoffs today to doctors in private hospitals. For example, in a private hospital in Bhopal that was ostensibly set up to take care of the gas disaster victims, Rs. 2.81 crore was paid to 30 doctors in the hospital over and above their salary which was substantial, between 24.07.2010 and 31.01.2012, out of the money received from private patients, according to the data provided by the hospital itself under the RTI Act.
Neither fair nor transparent
• The billing of patients in private hospitals is often neither fair nor transparent. I had the personal experience of having a bill presented to me at the time of getting my wife discharged from a corporate hospital in Hyderabad, in which the charges for anaesthesia (couched in a language that did not make sense) were included even though my wife was not administered any anaesthesia.
• The right of the patient to have a copy of his medical record is often not respected.
• There is no legal imperative today for a hospital, diagnostic centre, or infertility clinic, to be registered and accredited. Through the efforts of The MARCH (The Medically Aware and Responsible Citizens of Hyderabad, an organisation which has met every month in Hyderabad since September 1995), our country has a system of voluntary accreditation of clinical laboratories; this must be made mandatory. Similarly, through another initiative taken by The MARCH nearly a decade ago, we today have a bill for accreditation and supervision of infertility clinics ready to be placed before Parliament. None of the problems, for example, relating to surrogacy, that we have been reading in the press recently, would have arisen if the provisions of the bill had been followed. And very few hospitals in the country are accredited under the National Accreditation Board for Hospitals as such accreditation is voluntary.
• It appears that 10-25 per cent of the drugs in the market are spurious or of low quality. The sources of such drugs are often known but nothing is done about them.
• There is a nexus between drug companies and doctors who benefit substantially in cash or kind for prescribing a drug made by a particular company, even when cheaper or better alternatives are available.
• There is no obligatory requirement for all registered medical practitioners to go through continuing medical education courses (CMEs), to keep themselves updated in their area of expertise.
• The course we used to have on medical ethics in our medical colleges has been abandoned. Therefore, ethics is not a word in the dictionary of most of our doctors.
• We need an appropriate code for medical shops which, for example, should not be allowed to act as general stores or sell scheduled drugs without a prescription.
• Terminally ill patients should be allowed to die in peace with as much comfort as possible. There are very few establishments in the country for palliative care of such patients.
• Many of the clinical trials in this country ignore the ethical code — even the legal requirements — for clinical trials for which India is a key destination world-wide.
• There is virtually no impartial market surveillance after the release of a new drug.
The consequence is that India is the world capital of malnutrition, stunted growth, infant and child mortality, burden of disease, and indebtedness on account of (often futile) out-of-pocket expenses on health care. A fair proportion of farmer suicides in the country out of over 250,000 during the last decade or so, have been on account of inability to pay money borrowed at exorbitant rates of interest for health care.
The solutions to the problems mentioned above are obvious and well within our capabilities and resources if we have the political will. For example, the implementation of the excellent report (The Hindu, April 14, 2012) of the High Level Expert Group set up by the Planning Commission for working out modalities of UHC, under the Chairmanship of Dr K. Srinath Reddy, will take care of several major problems mentioned above. Dr. K.K. Talwar, present Chairman of the MCI and president of the National Academy of Medical Sciences, recently set up a high-power committee under the chairmanship of Dr. Nirmal Ganguly (former Director-General of ICMR) to work out a code of ethics for medicare establishments and related organisations. We hope that the report of this committee will give us a framework for solving many other problems that have an ethical angle to them.
(Pushpa M. Bhargava is former Vice-Chairman, National Knowledge Commission.)
Keywords: universal health coverage, government health care, healthcare policy, India health sector, medical education, medical ethics, drugs companies, medical service, access to healthcare, private hospitals
My experience of Universal health care in an urban slum of delhi is
that most of it is provided by the traditional medicine practitioners
who fall under the bracket of "quacks". For a slum of about 50,000
which is right in the backyard of a national apex institute this is
the condition. A MBBS doctor is out of reach...There is no concept of
a general practitioner in India . Right after MBBS or rather before it
(the skill based internship training is a farce for many of the
students as that time is to be utilised for PG entrance preparation
!!!)they feel inadequate to face the challenges of patient treatment.
This system has to change.
Everybody knows what the problems is greed of corporations to take the maximum benefit out of the needs and weaknesses of people, but what are we doing to correct the problem. Governments’ are complicit and people are helpless. It is better we sleep over the problem and allow it to solve by default than waste our time in spreading an awakening without results
Government has inrtoduced PHARM.D course in india.It appreciatable but there should be rule every hosipal should have pharmasist so that we can reduce the no.of anibiotics intake because a pharmacist knows more how it effects body.there are so many skilled people in phrama sector.we are not utilizing them and they have problem of jobs scarcity.If we provide this rule we can solve the two problems and the no of people who study life sciences also increases.
The poor have no option but to drink water and pray to God. Mal-nutrition, poor quality of air - lack of drinking water supply - sanitation ! And yet we talk of "super-power status" ! It is all a bluff.
Pushpa Bhargava has touched the raw nerve. But our Political Class will NOT do anything. Procastrination and Fence Sitting are part of Indian DNA. Quality will not come immediately ! It will take years and decades to nurture quality.
I think MCI must approve another 700 Private Medical Colleges (give one each to the MP, who has the money). Let us have poor quality 70000 doctors every year. From these 70000, we will have 700 who are quality stuff. This is the way to build capacity, gradually.
If it were possible, we need to nationalise Hospitals. Medicare and Commerce must be divorced. There are no soft options. A firm decision is needed. Healthcare must be simple and clean. The British provided superb health care system upto 1947 !
"Medical profession" noblest profession as it empowers a doctor to be the saivour of ones life,relive patients from there pain and sorrow and for all those patients doctors are the other form of god.But now days the moral fiber of the doctors are corroded.Have they forgotten the moral obligations being a human.With the commercialization of this profession,a medical student needs to pay a hefty amount prior to his admission and tries to get it back consequently exploiting the vulnerable citizens.The supreme body i.e MCI(medical council of India) is corrupt.The grave need of the hour is to have a government regulatory body,putting a vigil on clinical trials being conducted,put a check on nexus between touts,pathologies and doctors.Approval of Bachelor of Rural Medicine and Surgery(BRMS) course so that rural health care could be improved.And above all teaching doctors moral science during there mbbs course.
Aping the west took us to ICU . Still it is not too late . Let us find out the specific solutions to India specific problems and there will never be a need of ICU .
First the government should implement abolition of Capitation fee as
advocated by Hon. Supreme court and have a Fair, Free, Merit based
admissions to Health Education Institutions. Councils are bribed to get
Permission and recognition etc, This is going to be a big diaster for
the country in time to come.
The author has not provided any new earthshaking information. This
state of affairs has been in existence for more than three decades.
And the answer again is, you guessed it, more committees. Headed by
big names, they will in time produce voluminous reports which will
gather dust, just the like the dreams of the poor have over the last
sixty years. Surely, this is not the "India of my dreams"?
Universal health Insurance is the only solution. Empower the consumer. Let him select Hospital.Treatment should be Cashless.Similar on the lines of RSBY.
Empanelment for only accreditated hospitals.
A good number of issues has been mentioned in a patient’s eye-view. Without going into the details, I like to repeat that ‘universal health coverage is a primary responsibility of the State and in India, the solutions are within our capabilities if we have the political will’. Perhaps what could be added is that this responsibility is more imperative for democracies, irrespective of developing or developed countries. Truly the situation is one among the many failures of our democracy. All the core areas of human life, in addition to education and health care, like drinking water, pollution-free air, housing and old-age care need to be State’s responsibility. But none of our so-called democratic governments in the States and at the Centre ever cared to assume their duty.
Very useful article which shows the real distorted face of Indian medical system. But in my opinion the main problem which arising in India is degradation of moral values in aspect of human life. Each person excepting few is busy in making money by any means also they don't fear to put a human life on risk in this process. In my opinion these type of doctors are doing more crimes a day than a criminal.They exploit patients as customers at each step.
But as I have said earlier this is more moral problem in India.This is not only case with medical sector but in each field humans in market became like parasite who just want to suck blood of others.
But this situation is about 'Sapekshvaad' or about relativity , who is more culprit, a farmer who uses to colour his vegetables to get more money for his product to fullfil his daily needs or a doctor, to whom these poor respect like God but they never leave a second to write them expensive medicine to live life lavishly.
Too much of doctor bashing! As Ajay says there are institutions which
run family medicine course. Mushrooming of private medical institutions,
many of which do not have any set standards is leading to deterioration
of the health care system. Why blame doctors alone? If a doctor does not
administer a drug by injection, or if he/she does not prescribe
antibiotics, he will not be considered a good one by many patients! I am
sure majority of doctors are not as portrayed by the author.
superb article wonderful comments but all these for whom and for
what!!!i know of a corporate hospital where an engineeringstudent boy
(the only child who had never had an injection in life asking
innocently his mother before going in for the scan 'mother, will the
injection pain and her replying no son')died, the mother did not know
for hours and they demanded money to hand over the body!!!another
experience in the same hospital by my uncle who underwent bypass
surgery not seeing the surgeon at all and when he went for check up
physician asked for a lot of tests and when referred to surgeon
again, he asked for the same tests to be repeated from the same lab.
again!!!!!!Racketeering is the only word if not looting poor!!!
everyone says we are totaaly failed in this area but i think we just need to fine tune the sytem by making the cheap generic dreugs freely available to the needy.if iam right i think the recent decison by the rajastan is similar to this idea & itshould be a great learning experience to be followed by the other states.we must not get under the pressure of some states & not to issue compulsory licence to the life saving drugs & we must continue our position as the top supplier of the generic medicines.
The training in the discipline of General Practice/ Family Medicine
does exist in India. The National Board of Examinations has been
offering the 3 year Diplomate of the National Board in Family
Medicine for more than 25 years and there are about 700 seats
available in the country. The Medical Council of India also sent
notifications few months ago to all the states asking them to start MD
in Family Medicine. However, for the best and brightest to take up
Family Medicine as a career choice, steps have to be taken by the
Health ministry to make the specialty attractive to medical graduates.
The disparity in remuneration for the Family Physicians and the lack
of a clear career path even in the government health system are
factors which will prevent many from taking up a specialty that is
crucial for the health of the nation.
The topic is commendable but could have been written- any most scathingly critical articles are! But there seem to be several inaccuracies in this article- one of them most obvious to me is related to the issue of MD Course in Family Medicine: Many institutions like CMC-Vellore, SRMC-Chennai have run these or similar courses for years to decades. The author being of person of official standing & authority, ought to be far more careful & accurate in doing her own homework before putting out an article like this.
HEALTH is WEALTH.i UNDERSTAND the plight of patients.I worked in remote construction sites.I feel working in villages will help to face adversities of life in a better way.Doctors may be sent on a rotation basis or fixed terms with suitable backup from district HEADQUARTERS,(emergency transpotrtation, medicines)with well laidout roads (two lane bitumen bound macadam)and reliable communications.i hope the doctors rise to the occassion!
I can talk from personal experience and knowledge. I quit chennai because I just couldn't
take it anymore. The whole system stinks from top to bottom. The seats for ug and pg are
openly sold and corporate houses and politicians are in it together. I made the very difficult
decision to leave India with a very heavy heart. I belong to the so called forward community
and was driven out from chennai by mr mks policies. I have done fantastically well and am
an opinion maker in my field at a univ hosp in the west. I still long for a meritocratic India.
My family was a central govt employed middle class with very strong principles which I still
follow but what will happen to my children? I cannot see any great future for India in this
generation. The only way out of this mess - help for poor and vulnerable only, free judiciary,
non paid free media, law and order. I feel personally let down by the TN system I was the
very best and hope things change for the better
Universal health care will be a disaster in our country.We want the
patients to be in control of the cost as well as the doctor they
choose for their medical problems.Only competition will bring down the
costs of health care and improve the quality as well.The affordable
health care for the poor is possible when we will have more
doctors.The problem in our country for higher cost of healthcare is
there are only few doctors.So don't blame the evil doctors for this.
What we need is more medical schools and that is going to happen when
we less regulation on them.So don't blame the evil doctor for higher
costs when we don't have enough doctors.But you can always blame the
inflation for higher costs in health care just like the reason for
higher costs in other goods and services.
Enlightening essay, I now realize why it took me more than 6 months to get my mother to a neurologist to be treated for Cerebral Atropy, all the while I had been taking her to ENT's who kept saying "old age" was the reason for her "slurred speech". One of them even proposed to operate her nose. The neurologist chided me for not being alert enough, I had no answer... By my own experience, the way we are going, I dont think we are even useful to those who can pay.... Ultimaely, as there is formal treatment for Cerebral Atropy, the neurologist encouraged me to approach me an Ayurvedic Physician whose treatment is giving some good results - not a cure although. So we use both Allopathy and Ayurved, the latter is far cheaper and more effective (in this case). Hope the said bill also encourages and proposes an inter-disciplinary approach, which individual practitioners (senior ones) are quite aware of, but would not make public for business reasons.
Unfortunately not everything can be painted as black or white. There
are always intermittent shades. The author is off course using the
same colour to paint all the doctors as bad. It is factually incorrect
to suggest that private hospitals try to gain maximum from patient by
providing the least. While there are ills like kick backs in various
forms not everyone solicits/takes it. The chairman of my hospital has
put his foot down and refused to entertain any such demands from
referring doctors and rather hopes that patients will turn up based on
the services provided.Regarding the government hospitals, i know for a
fact that half the time is spent by doctors in Directorate of medical
education to ensure that they do not get transferred. Training is
slowly losing its priority. The fact that private trusts and corporate
hospitals are churning out research papers(which is not equivalent to
clinical trials) while hardly anything happens in government hospitals
explains the current scenario
While many of the points in the article pointed out are true. The
maladies are not limited to the medical profession alone. As a
physician I do not deny most of them. But truthfully guys every
profession suffers from these maladies due to lack of a
accountability. It is impractical to say that a guy who has payed
capitation will not recover his money. Why capitation in the first
place? As far as lab cuts, drug reps go it is true but that is a
problem of the Indian system, doctors are not the only villans. CME
which profesional in india does it? Archaic laws need to be modified
if you cannot get specialists to work full time in govt hospitals than
atleast employ them part time. As a physician I do not deny most of
these but the maladies are not unique to the medical profession. it is
a trend of changing times where only money is important.
the points expressed in this article are valid ..the author forgot to mention the free
safari trips to Africa in return for prescribing unnecessary drugs. Doctors have to get
back the money (in lakhs) paid for their education and plus require huge amounts to
keep up their fancy lifestyles. This is why education is important and being internet
savvy. One can treat oneself as per one's symptoms by just asking the net. If you
type in natural cure for whatever ailment you have all kinds of benign alternatives
that don't harm your body show up on the screen and have myself availed of the net
free services and have been very happy with the result. Naturopaths should be sent
by the Govt. to all the villages to educate people, how to care for themselves in case
of cold and fevers etc.. simple fasting or just having congi (rice in rice water) and
lemon juice with honey in case of fevers. Rest is the most important with quiet and
lots of sleep. No need for doctors except if there is an accident
Although author was addressed all most all the crux to reach out to
solution and to stand by other nation who are already on the driver
sit but the argument that stated “lack of political will “ omits some
important concerns such as 1.ACCOUNTIBILITY 2.REFORM in Medical Policy
that must be addressed to substantiate the argument. Furthermore, the
argument assumes that political will only solution to make improved
our medical system. Furthermore, the argument never addresses
reformation in medical Law. Most importantly, generic medicine store
are the most anticipated interim solution to hoi polloi while to reach
out to U.H.C standard.
It is indeed a wretched state of affairs. I wonder if the word "ethics" actually exists in the minds of most Indians, whether it be the doctors or the patients, or anybody else for that matter. For I have no doubt that if the roles were reversed and the patient today is the doctor tomorrow, he too would tend to unflinchingly attempt daylight robbery. The malaise is in society, not in individuals. It cuts across the various strata of our citizens, educated or not, rich or poor, and is not restricted to any one profession. Ultimately it is a reflection of ruthlessness in attempting to achieve an optimal material outcome for the individual and his/her immediate family when scarce resources are divided amongst over a billion people.
This is an exquisite analysis of entire medical system in India. But
the truth is that a nation without commitment and culture with no
vision has to pay penalty whether its mine or others. But i totally
agree with Mr. Sriram's opinion on this. To add, whether its corporate
or government service, delivering medical services, and for that
matter any service can never go impeccable. It will depend on the
local culture and social barriers. We have to realize, building a
hospital is no longer just having few doctors available. The
infrastructure is getting bigger, and our politicians and
administrators who are imminently busy in building their own familial
infrastructure, are not competent enough to, frame the guidelines. The
authors speaks of billing for services which were never provided and
in fact medical billing it self is a different accounts and how many
hospitals are giving training in this.Focus on giving the best
possible training to medical graduates, and hope they will change it.
Many studies have shown that the more a health-care system relies on primary care the better the outcomes and at lower costs. Unfortunately medicine is heavy on specialists who depend on technology pushing up the costs of health-care.The vast majority in India does not have medical insurance and many of the hospitals run by the government and city municipalities are closed down leaving the citizens to depend on their private savings for their healthcare needs.Anybody who thinks Big Pharma's largess was limited to pens is misinformed.
Countless free meals, holidays, resort stays including airfares for seminars both in India and exotic destinations abroad, CME’s and the list is endless. The advertising and marketing budgets are overwhelmingly higher than their R & D costs though the industry is always fond of proclaiming how much they spend on research and why drugs has to be expensive!
It is a question of right policies by persons who know the ground realities of the health needs of the country as a whole, keeping global agenda in mind ,but concentating on health needs of you own communities. Intitutions working in this direction ,may be even with limited resources are the ones who need to be supported. Of course teaching training and evaluation has to be for same So all rules regulations by any managing body must ensure the minimum must.
Let us be honest and straight in the health matter. We a highly immoral and corrupted Indians should not expect the professionals coming from that society to be a saint. So there is no way you are going to get doctors who are ethical until and than we recruit the doctors from United Kingdom directly which is not possible for our poor country. I am really puzzled when someone thinks the govt. can solve the healthproblem. Govt. sector in India in any field is just a wasteful , corrupted and highly inefficient.Any amount of money investe in govt. will be a drain. It will only benefit peole like authors who enjoy the govt. slary and does nothing for the nation. The solution is more private involvement, international firms should be allowed to compete, so that healthcare will be more cost effective and high quality. For poor let the govt. pay the insurance premium so that they can get treatment in corporate hospitals in par with the fat cats like the author of this article.
This is the comprehensive layout of those points in the current Indian health care market which are going to spoil our aspirations for being super power. Already we are nowhere near the developed country in terms of health care and poverty. It covers both poor regulations and educational apathy in medical field. Malpractices of doctors, hospitals, nexus between prescribers and labs, between hospitals and drug companies are some issues to be urgently targeted. I have been the victim of opaque billing of corporate hospitals like Medanta Medicity where I had to pay 60 RS per sugar test around 25 times a day. On objection they told that they had done more than 25 such tests in a day but charged for lesser. Poor are unable to bear the real cost in india and if such extra cost they need to pay they will fall in a deep hunger and poverty. Our government should take care of each bullet of lucidly written article.
Two examples from personal experience:, one from a government hospital
in the middle eighties and another the experience at a branded
hospital ten years back in the same city. In the government hsoopital, the senior doctor would attend the in patients first in the day before atending to the out patients. The branded hospital there is no specific time the senir doctor’s visit to in patients. Their priority was to attend the outpatients and when it is over visit the in patients. On being asked why this practice, the explanation of the branded hospital was just matter of fact. They had more out-patients and hence the priority for them. After all money speaks and we patients and their relatives listen in utter helplessness.
The dissapperance of the fraternity of General Medical Practioners is
a sad turn. Worse still, the Indian Medical Council and the government
are not looking into this aspect at all. Having grown up in an era of
GMPs, where I have seen general medical practioners in our localities
seeing 40 patients in the forenoon and another 40 in the afternoon
for years on – the disappearance of GMPs is sad. Now people are seeing
specialists directly. A sitation has arisen that they would see one
specialist each for every one of their ailmetns. This issue is not
being tackled by the regulators and the government. In the legal
fraternity, you cannot go to a senior counsel directly. You have to go
through your advocate. In the medical fiedl it is otherwise. This
trend may not be good for the society and for the medical fraternity
alike. Will the authorities look into this?
An excellent article by a very intelligent , honorable man. Hope the Hindu publishes more such articles and keep track of this issue of Universal Medical Care.
I have read many articles by Pushpa M Bhargava and all of them are very informative.
Provision of healthcare is expensive: Medical investigations, drugs,
procedures, infrastructure increase in sophistication incessantly.
Patients' expectations rise continuously, while people live longer
(sometimes with no quality of life). Length of medical education and
training become ever longer, and areas of specialisation so fragmented
that even doctors can’t keep abreast of latest sub-speciality routing.
One can thus understand India's difficulties.
But what makes India a basket case, is the self-inflicted long-term
damage to every aspect of human life and activity in India, driven by
UNQUENHABLE PERSONAL GREED, get rich quick at any cost and at whatever
harm to the other party!
Since society is inexorably inter-connected, it is foolish to expect
that any one group, or any part of society, can be improved without
having improved standards applicable to all, without exception,
equally. WHY SHOULD A DOCTOR GIVE UP LOOTING WHEN POLITICIANS,
BUREAUCRATS, JUDGES, BUSINESSMEN DON’T?
In a country where the tax coverage, insurance coverage and literacy
levels are low but coupled with high levels of corruption and feudal
polity these things will happen. As a country we need to decide
whether we will follow a capitalist model where all are covered via
insurance or a socialist model where medical care is subsidized. We
cannot have both models co-exist and make it work. Right from daily
commuting, schools and hospitals to temples and even jails we
differentiate rich and poor and try to satisfy both. In the process
there is a collapse of system at the end where poor receive these
services and dilution of quality at the rich end due to limited supply
and excessive demand. Corruption cuts across the spectrum. We are
becoming a country that tries to find a sense of balance and we are
always in that mode. We can keep writing about the ills in each area
but need to find a common model of servicing citizens. VIP culture
needs to be removed. Is it possible ?
"...a 12-year school education and universal health coverage (UHC) are
the two primary responsibilities of the state. India has failed
miserably on both counts." and this will have some really adverse
consequences in the long run. Today we all have degenerated and sowing
the seeds to plant those great values for which our great nation was
once known for, right education imparted to every single child is our
only hope.
Its a shame that a noble profession like this has now become so corrupt. The morals, ethics have been washed out from the practice and are also fading away from the books. This article or the situation described by the writer should be taken seriously by all the people. After all no one will like to go under the knife of butcher who calls himself a Doctor!
The article is a thought-provoking one. The author has rightly analysed several maladies plaguing our medical system. However, there are some trust hospitals in India which make a difference in their treatment. K.G. Hospital, Coimbatore, which is run by K. Govindaswamy Naidu Medical Trust, is a centre of excellence. The hospital follows ethical principles at all levels. Doctors are very sympathetic, considerate, approachable and understanding. The nurses and managers are always accessible to patients. The Chairman of the hospital is always available to the patients. The hospital lays emphasis in diagnosing a disease in the first instance before instituting any treatment. In the process, appropriate treatment can be initiated on a patient and this will cure his ailment. The hospital also stresses the importance of PREVENTIVE MEDICINE, so that people do not have to visit hospitals. K.G. Hospital has introduced a revolutionary 128 slice heart CT scanner which has saved several lives.
I had extremely bad experience with treatment of my father and five other first degree relatives in India. I fully agree with authors observations as doctor. Everyone knows where and what the problems are but do not want a change because the present system is the best for establishment and not for people. People do not know what to do and politicians are still in dark.
"Medicare of reasonable quality is currently largely
commercialised and corporatised, the primary objective being to
get the maximum money from patients by giving them the minimum
possible in return."
That's just not fair. I find it very hard to believe that the people running private hospitals and the doctors serve there wake up everyday thinking about how much money they can make from their patients while providing them the cheapest care. That is just an insult to the many honest and humane doctors who are working in private hospitals and are motivated by a desire to do good.
Of course I acknowledge that sometimes the doctor's aims, to provide the best treatment to their patients no matter that the costs, might conflict with owner's aims, to provide the most cost-effective treatments, and there is a legitimate debate to be had there. But to say that private hospitals are just blind heart-less profit-maximizers is a grotesque caricature and does gross injustice to them.
As evident from the above article an important issue which was not highlighted before is that, many of the doctors are engaged in recovering the money they have spent in their education... in terms of fees, they have to! but in terms of recovering donation? this is not something which we expect from our doctors. The motto of a professional medical practitioner is going to shifting from 'serving the people' towards 'making money'! As stated by the author, teaching ethics during the medical education itself is very important. otherwise public health will be merely a game for 'some' people (I'm trying to point out the huge number of 'mafia's involved in medicinal drug dealing) in the society for making money.
It is the responsibility of a doctor to see the patient as a human being and understand him as a person who comes to doctor with many hopes...
The future doctors have the potential to make this system and the life of our fellow Indians better....
A very apt article describing the current situation of the medical
healthcare and services in the country which has been crying tirelessly
for UHC. It seems that "Rich" are the only human beings in the country
and only they deserve medical attention. The most important thing that
caught my attention in this article was the mentioning of "Ethics",
which are very much absent in the young breed of medical practitioners.
All they care about is their business and focus on thinking of new ways
of making more money out of the pain and misery of the patients.
Here I also would like to share one of my experience. Few days back I went to one of the govt. hospital in Delhi with my uncle. Actually my aunt had her delivery & my uncle can't afford the hefty bills of private hospital. So he took her to govt. hospital.
when I went to saw my aunt, the scene which i had seen there was yelling to revamp of whole structure. As compare to infrastructure of this hospital the patient load here is enormous, one patient had to share bed with other patient, no matter how critical he was. Sanitation was something which I hadn't seen in any part of hospital, neither in wards nor even in operation theater. Corridors were painted with red colour, but that was not the actual colour of walls but the result of spitting by visitors. Condition was so pathetic that i felt if I would have stayed there for long i also need to be hospitalized. Patients attendants were lying throughout the corridors, as there was no facility for sitting there.
Hospital- DDU Hosp.,Delhi
in a Guna hospital even as a womn came hurried in an auto and had
delivered a baby soon in the hopsopital even as the papers were being
prepared, the pigs roaming in the vicinity began making a feast of
the new born and the mother were in the verandah and it was only a
passer by who drove the pig away and saved the child! The Daily
Telegraph, London shaming us pointing out that even as the capital
has slick flyovers and state of the art hospitals disadvantaged women
deliver babies unattended beneath those very flyovers! It shocks the
national conscience and puts us all to shame. A researched article in
The EPW in January 2012 talks of the way medical facilities are
unaccountable and how statutes and regulations go merrily uncomplied
with. That article is an eye openeer for all of us.What is the DG for?
Why can’t the government just sack the doctors concerned instead of
pussyfooting. If wardboys do operations in UP,where have the doctors
gone, perhaps for private practice or at home
The issue needs a wider and intense public debate calling for
political acocuntability and official responsibility not only for the
public domain but also for the private medical care which has become
unaccountable. Even as we produce medical graduates from the
prolfierating colleges, we need to examine the qualititive part. Can
you from your memory just tell how many times you have noticed the
local legislature debating the condition of medical faciltiies in the
state and how much is the media coverage thereof, except on occasions
when grotesque things occur. A few immediate action areas: Why can’t
we ensure cleaner sourroundings in the hosiptals: negligence begets
fire accidents like the one at Kolkatta; negligence in santiary
standards in labour rooms witnessed series of infant deaths on
delivery in Jodhpur because labour rooms were not santiised after each
delivery.
The article is self explanatory and lists all ills and proclaims they can be eliminated if the powers that be have political will.
Which agency can bring about this will? This state of affairs is true not only in medical field but in all areas that concern the common man. We know the ills and we know where the solutions lie, but we cannot do much about that in the present scenerio. Knowledge of the problem coupled with inability to practically solve it will breed revolt.
Better India wakes up fast.
The bureaucrats will support the universal health care because it will
give them more power.but be aware,there is no Santa claus out there
whenever the govt comes and promises you something for free you better
watch out it will cost you more than what you think. There are no
solutions which involve more govt the only solution is which involves
free markets.The best option for getting any goods or services is to
get them at the market place because that is where they are avialble
at a minimum possible price.We need the patients to be in control of
the things not the govt bureaucrats.
It is not the state's responsibility to provide healthcare to its
citizens. The state responsibility is to enforce the law of the land
i.e, constitution. This idea that govt is the solution for our
problems should be shed away.The govt is not our solution to our
problem but govt is the problem.Authorizing any govt agency to certify
for quality purpose will create more corruption rather than anything
else.Instead the patient should be empowered to decide which hospital
he/she should go for his healthcare needs.This will create competition
and will bring down costs and increase the quality of the care.Just
like in telecom sector, where the companies work for profit incentive
yet the customer benefits from the competition.We want the same thing
to be happening in the healthcare sector. No universal health care
will increase our problems.It will cost us more money at less
efficiency and less quality.
The NRHM must focus on building tertiary care superspeciality hospitals at the taluka level and remote areas to decentralise health care delivery in the country. A good example is CMC Vellore. All district hospitals must start medical colleges in the public sector. Healthcare infrastructure like hospitals are cost effective and practical ways to utilise the increased budget on healthcare amounting to 3-5 percent of GDP in future.
Though many facts are already in the public domain, the article is very much hitting the nail on the nail. But who cares. We, everyone, just save our one rupee at the cost of 10rupees of the other who is economically much below us.
Indian government should learn from the health policies of foreign
countries where a pharmacist plays a vital role in health care sector,
where a prescription written by doctor is first passed through a pharmacist who check the prescription for the possible drug interaction, incompatibilities and side effect, if such problems is recognized by pharmacist then an alternative medicine is recommended by him or physician is asked for the suitable changes. in India there is no such policies, although Pharmacy and Therapeutic Committee(PTC)
is appointed in large hospital but its role is not significant in
India.The government should realize the role of pharmacist in health
care sector, and should not be focused on a single aspects.
Hospitals are very dense in urban areas and vice-versa in rural,
hence government should also made a policy where the "number of
hospital per area" should be defined, such steps will helpful to
achieve the goal of health care service to every citizen.
Dr. Pushpa M. Bhargava has listed the ills plagueing the patients while under medical care and the reasons for it. True, but the concept of family doctor which was in vogue even in 1960&70s has been given a go-bye for 2 reasons. 1. Then there were many LMPs in allopathy and LIMs in Indian system of Medicine in small towns and villages. They knew patient's family as much as the patient. There was a relationship built on confidence and unless essential they will not refer patients for so many diagnostic tests. They had confidence. To study for these diploma courses fee was nominal but faculty was from a pool of experienced Medical Personnel who took pride in their profession, not in the earnings. When these diploma courses were abolished soon after independence, may be with ideals high, medical education began to cost more. When it became a Corporate Enterprise, India has become a Medical Tourism destination. But the bulk of Indians, cannot afford it. What a Pity?.
A major factor, often ignored in discussions on healthcare access is the quantum of corruption in the overcrowded "free public healthcare facilities." Several surveys have highlighted the extent to which this malady, fueled by avarice has taken roots in Government hospitals. So people end up spending a lot on bribes to get the "free care" they need. It is not surprising that many prefer to get treated in private hospitals than pay bribes. Any plans to strengthen universal healthcare should also devise effective deterrent against corrupt practices.
"Medical Bankruptcy" is a new social malady, worse than even the evil of Dowry because currently, about two-thirds of rural debt is due to the former. If we are to be considered a civil society, we need to usher in universal healthcare globally.
The article raises very valid points but still misses the real picture.
For instance, it omits the problems of government hospitals, primary and
secondary health centres, corrupt bureaucracy that results in scams like
the one in NRHM. These are the main reasons why our health care system
is a failure and not the problems with private hospitals.
I have had a horrendous experience of witnessing the plight of a
patient (in labour pain) and her mother a week back. She was refused
admission in a state-run hospital on grounds of complexity of her case.
Elder women around confidently said that she would have a normal
delivery in 10-15 mins. In that state of excruciating pain, this 24
year-old would-be, ignorant,illiterate mother was piled inside a cab
(the cab-owner was reluctant but gave in to the public outcry) and
rushed to the referred hospital, apparently equipped to handle her
'critical' delivery.
Are these insensitive, belligerent beings (would not say human)
doctors? Where are we living? The plight of ignorant people with dearth
of money is in an unimaginable state. This is NOT a hyperbole.
From West Bengal
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