Guest Blog: The Mess in Indian healthcare- Some Solutions
What is the solution to mess in Indian healthcare?
New Delhi: Bohr Committee advised for Indian Medical Services, in line of Indian Administrative services in the year 1948. After that many Committees were formed on the same subject but recommendations not implemented.
It is high time that the government should immediately nationalise healthcare services in India.
Till 1990 it was mainly government hospitals which were providing healthcare services to masses & there were very few private hospitals. In the city of Delhi in name of private care, we had only three-four trust run charitable hospitals like Moolchand Hospital, Saint Stephen Hospital, Holy Family Hospital & Sir Ganga Ram Hospital.In that era, everyone including politicians & bureaucrats used to go to government hospitals for healthcare needs.
Then something suddenly changed, Corporate hospitals entered into the scene. We became confused between socialism & capitalism. Our government started running away from its responsibility of providing quality free education & free healthcare to masses. It led to the growth of big Corporate hospitals.
Our governments encouraged the growth of private healthcare by neglecting government hospitals & our neighbourhood dispensaries & health centres. The government stopped investing in healthcare & our centres of excellence started coming under stress & deteriorating.
The population kept on growing but proportionate increase in government hospital beds were not made. Staffing was not increased, infrastructure was not upgraded. Government hospitals started being identified as poorly managed & equipped facilities, where even poorest is scared to go.
With the liberalisation of the Indian economy, we tilted towards becoming a capitalist society, everything is opened to the private sector. Here began the entry of Corporates in healthcare, which stepped in to fill the vacuum created by failing & falling standards of government healthcare infrastructure to fulfil the health need & aspirations of quality conscious new rich or affording class.
Till now as we were getting free or subsidised healthcare, we didn't realise that healthcare is an expensive affair. Our policymakers were aware that is why they had stopped investing in new technologies. New technologies were very expensive & most machines are imported & hence we started feeling the pinch.
Corporate hospitals brought the best technologies & expertise to India but it was very expensive and was affordable for only a very few. We became confused, we wanted those best treatments but they were beyond our affordability, it started creating frustration among us. We are in catch 22 situation, we are not ready to go to government hospitals but finding it difficult to afford private healthcare. We wanted five-star facilities in hospitals, while it was beyond our means.
Land for many charitable hospitals slowly & steadily was taken over by Corporate Hospitals & Hospitals like Moolchand, Jessa Ram, GM Modi also became Corporate. The Government allowed it in collusion & this option is also taken away from us. We were cornered, government hospitals were not up to standards & unwillingly we were forced to go to Corporate Hospitals.
Health insurance started growing with this new opportunity & we were forced to purchase healthcare policies & additional burden was added to our household budget. Now with cashless health care insurance, a cartel started forming, which resisted entry of new hospitals into cashless healthcare networks. This cartel is so strong that in the last few years, very few new hospitals have been empanelled by public sector health insurance companies for cashless healthcare services by forming a cartel called GIPSA. Insurance companies along with select hospitals started dictating, which hospitals to go, we started being deprived of free choice to select our hospital & insurance companies started forcing hospitals on us. Government is well aware of this.
Under the confidence of our cashless healthcare policies, we started visiting five-star hospitals, for each & every medical problem. Now in serious illnesses, our bills started exceeding our insurance limit & we were disturbed & became angry. Yes, that five-star hospital was beyond our means & capacity but sometime we were forced by our insurer or sometimes we selected them as we wanted the best medical services.
Now a very tricky situation has been created in this country. Government healthcare infrastructure is failing us but 5-star healthcare is not affordable.
To further deteriorate the situation, our government started giving panels for government schemes like CGHS & Delhi Health Scheme also, to Private & Corporate Hospitals. Now government officials & politicians also dejected government hospitals. Corporate Hospitals handled the whole load due to the efficiency of services & better management. These hospitals provided care to affording general public, government panels beneficiaries as well as foreign medical tourists. As our lawmakers & bureaucrats also started going to private hospitals on taxpayers money, government hospitals further deteriorated. Now even poorest among the poorest don't want to go to government hospitals.
The government played another smart trick, instead of strengthening government healthcare infrastructure, which was not cost-effective, asked private hospitals to reserve beds for EWS. The public didn't realise that the cost of those bed is also being added to the bill of affording patients.
Now the situation is, the government is running away from its responsibility of providing free healthcare of quality to masses. On surface, it shows that it is concerned about the public but on the other hand, actually responsible for the mess. Small healthcare establishments are being destroyed to create monopoly & hegemony of Corporates. Such rules & conditions are being put, which will lead to the closure of all small clinics & nursing homes. There is a big conspiracy & we all need to understand. Tomorrow there will be very few hospitals, which will be providing you cashless healthcare as IRDA in collusion with big Corporates, is making NABH accreditation compulsory for hospital empanelment for cashless insurance. Quality is a facade as there are already Hospitals & NH Registration Acts & CEA, this NABH gimmick is to further marginalise small healthcare establishments & increases their cost of running.
Now I request everyone to understand this whole game, come on the streets, before it becomes too late. Demand from the government to own up responsibility & immediately implement Indian Medical Services on a line of IAS.
Nationalise Indian healthcare & stop running away from its responsibility of providing quality healthcare to masses, free of cost. The government should stop playing a double game of encouraging Corporates & also blaming Private providers, while actually promoting them from behind.
Dear friends, like public, doctors are also at receiving end. The profession is under stress. Corporates are turning doctors into slaves, taking away their autonomy. Healthcare is expensive that is why the government is not spending on it. Doctors pay commercial property tax, water & electricity. Huge tax on equipments. Running private practices, fulfilling cost aspirations of the public is becoming almost impossible, in the current scenario.
The country needs good doctors & excellent health services also. Doctors can't provide it at a cheap rate because it doesn't come cheap. Like every product, services also have cost but it looks that cost is unaffordable for most of us.
Insurance companies have also failed us.
We need nationalisation of Health Care Services so that the public continues to get world-class healthcare & good doctors. The current environment is not very encouraging to select medicine as a career because of very few government jobs, exploitation by Corporates, difficult laws creating hindrance in starting small establishments & non-affordability by masses of private healthcare.
Indian Medical Services, will create a proper environment for the growth of the medical profession as well as the Indian healthcare sector.
Please make it a revolution & demand that the government should nationalise Indian healthcare & guarantee free, quality healthcare to all citizens of India. This environment of distrust between general public & Medical profession should end. The nation needs its doctors, they're the best lot.
Hope everyone will introspect & will force the government to own up its responsibility towards the public, regarding free healthcare.
Dr Chander Prakash Khandelwal is an Ophthalmologist by profession. He is MS ( Ophthalmology) from Maulana Azad Medical College of Delhi University & passed his MBBS from University College of Medical Sciences, Delhi University in the year 1989. He is currently elected executive member of Delhi Ophthalmological Society & he is also Joint Secretary of Alumni association of University College of Medical Sciences & GTB Hospital, Delhi.