Healthcare in India
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AIIMS' students educating
slum dwellers in
Delhiabout water-borne diseases.
[edit]Healthcare Issues
[edit]Malnutrition
47% of India's children below the age of three are malnourished, almost twice the statistics of sub-Saharan African region of 28%.
[1] World Bank estimates this figure to be 60 million children out of a global estimated total of 146 million.
[2] Although India's economy grew 50% from 2001–2006, its child-malnutrition rate only dropped 1%, lagging behind countries of similar growth rate.
[3] Malnutrition impedes the social and cognitive development of a child, reducing his educational attainment and income as an adult.
[3] These irreversible damages result in lower productivity.
[3] [edit]High infant mortality rate
Approximately 1.72 million children die each year before turning one.
[4] The under five mortality rate and infant mortality rate indicators have been declining comparing years 1970 and 2002 (202 to 90 & 192 to 68 per thousand live births respectively).
[4] However, this rate of decline is slowing. Reduced funding for immunization leaves only 43.5% of the young fully immunized.
[3] Infrastructures like hospitals, roads, water and sanitation are lacking in rural areas.
[5] Shortages of healthcare providers, poor intra-partum and newborn care, diarrheal diseases and acute respiratory infections, also contribute to the high infant mortality rate.
[4] [edit]Diseases
Diseases such as dengue fever, hepatitis, tuberculosis, malaria and pneumonia continue to plague India due to increased resistance to drugs.
[6] And in 2011, India finally developed a
Totally drug-resistant form of tuberculosis.
[7] India is ranked 3rd among the countries with the most number of HIV-infected.
[8] Diarrheal diseases are the primary causes of early childhood mortality.
[9] These diseases can be attributed to poor sanitation and inadequate safe drinking water in India.
[10] However in 2012, India was polio free for the first time in its history.
[11] [edit]Poor sanitation
As more than 122 million households have no toilets and 33% lack access to latrines, over 50% of the population (638 million) defecates in the open.
[12] This is relatively higher than Bangladesh and Brazil (7%) and China (4%).
[12] Although 211 million people gained access to improved sanitation from 1990–2008, only 31% uses them.
[12] 11% of the Indian rural families dispose of child stools safely whereas 80% of the population leave their stools in the open or throw them into the garbage.
[12] Open air defecation leads to the spreading of diseases and malnutrition through parasitic and bacterial infections.
[13] [edit]Inadequate safe drinking water
Access to protected sources of drinking water has improved from 68% of the population in 1990 to 88% in 2008.
[12] However, only 26% of the slum population has access to safe drinking water
[13] and 25% of the total population has drinking water on their premises.
[12] This problem is exacerbated by falling levels of groundwater, caused mainly by increasing extraction for irrigation.
[12] Insufficient maintenance of the environment around water sources, groundwater pollution, excessive arsenic and fluoride in drinking water pose a major threat to India's health.
[12] [edit]Healthcare infrastructure
The Indian healthcare industry is seen to be growing at a rapid pace and is expected to become a US$280 billion industry by 2020.
[14] Rising income levels and a growing elderly population are all factors that are driving this growth. In addition, changing demographics, disease profiles and the shift from chronic to lifestyle diseases in the country has led to increased spending on healthcare delivery.
[15] In order to meet manpower shortages and reach world standards India would require investments of up to $20 billion over the next 5 years.
[16] [edit]See also
[edit]References
[edit]External links
India Today - 13 hours ago Four more children died at Malda hospital taking the total number of crib deaths in the last three days to 15. Doctors at the hospital mentioned that the babies were mostly referred from village health centres and couple of them from neighbouring ... Hindustan Times - 20 hours ago The Malda Medical College (MMC) has hit the headlines yet again, and for the same reason. The hospital saw seven more children dying between Wednesday night and Thursday morning. In the past 48 hours alone, 15 babies have died. ... Times of India - 20 hours ago MALDA: Four more babies died in Malda district hospital since Wednesday night, taking the toll in the last three days to 15. The members of a task force that went to visit the hospital on Thursday faced the ire of the patients' relatives.... Business Standard - Jan 19, 2012 As Mamata Banerjee treads on her populist track, the West Bengal finance department under Amit Mitra has raised an alarm over a huge outgo on account of new jobs created by the government. The 2,75000 new jobs would cost a monthly Rs 300 crore, ... India Today - Jan 19, 2012 The number of crib deaths in West Bengal's Malda district hospital shot up to 14 after seven more babies were reported dead on Thursday, a health official said. "In last 24 hours, (since last night) seven babies have died in Malda district hospital. ... -
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- answer three pertinent questions related to healthcare in India. .... of advanced medical equipments and technologies easier and promoting privatization and ...
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- 1 Feb 2011 – Online edition of India's National Newspaper ... Neoliberal globalisation and privatisation of health care delivery systems across the world rests ...
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- 5 Oct 2001 – "india is one the only country where 82.3 per cent of total health careexpenditure is borne out by private agencies and a mere 16 per cent ...
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- 27 Dec 2011 – Therefore Commercialization of Health care is not suitable in India. ....Well, according to me commercialization/privatization of health sector is ...
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- India's health care system is characterized by a pattern of mixed ownership and with... The two major aspects of the SAP are privatisation and liberalisation.
Just see this report: Only a quarter of the population can afford Western medicine, with the rest relying on traditional remedies or alternative treatments, such as acupuncture and Ayurvedic medicine (which can at least boast fewer adverse reactions). Eighty-one per cent of health care across India is paid from private funds, mainly individual pockets. To compound the problem, the booming economy has attracted millions into the cities and away from the country's rural network of hospitals. According to the Organisation for Economic Co-operation and Development, in 2009 lower-income groups in India had less access to health care than 15 Asian countries surveyed, where, on average, only 55 per cent of health care is paid from private funds. Infants at riskIndia has come under criticism for not doing more to tackle the problem of infant deaths, the chief marker of the efficacy of a country's health care system. Unicef, the children's charity, pointed out that of all deaths of children aged under one across the globe in 2008, a quarter occurred in India. At 47 deaths per 1,000 live births, on the latest figures, infant mortality is 10 times that in the UK. However, only three years ago, the toll was 57 deaths per 1,000 live births. So progress is being made. It's not as if funds are tight. According to PricewaterhouseCoopers, Indian health care has grown recently at a compound annual rate of 16 per cent. The accountants put the total value of the sector in 2009 at $34 billion. This translates as $34 per head, or roughly 6 per cent of GDP. The estimate for the current value of India's health care sector is thought to be $40 billion. For comparison, the annual budget enjoyed by the NHS is £110 billion (taking some 9 per cent of GDP) and serving a very small population relative to India. Outstripping ChinaThere is no questioning the need for a hugely expanded health care sector. By 2050, India's population is projected to hit 1.6 billion, overtaking China as the world's most populous nation. The growth projection is not just based on fertility in India's population. Life expectancy is fast moving to Western levels. Government drives against hepatitis and polio in the young will give another twist to the population spiral. The number of inhabitants aged 60-plus is estimated to reach 189 million by 2025 – three times the 2004 total. Alongside the population spurt, India's economy can be expected to grow by at least 5 per cent a year for the next 40 years, according toGoldman Sachs, the bank. Factors behind the forecast include urbanisation, an expanding middle class, and a rapid increase in the number of well-educated women entering the labour market. But India has much to do. A quarter of the population is below the national poverty line. Some 300 million live on less than $1 a day. What's the government doing? A drive to increase rural health care provision began in 2005. The rural health mission is aimed at improving primary care in the countryside so that fewer patients overwhelm specialist services in the cities. To that end, general practitioners have been trained in basic surgery. Another Indian initiative is the government-run health insurance plan. The Government Insurance Company has the greatest slice of a market that in total attracts only some 11 per cent of the population. Premiums exceed $120 a year. Policyholders do not benefit from direct settlement, as in many Western schemes. Instead, customers pay from their pocket and apply for reimbursement. That can take months. Health tourismIf the medical tourist wants to go "cheap", few countries beat India. Reports from various sources point to huge price differences: - Heart surgery is typically priced at $50,000 in America, $14,200 in Thailand and $4,000 in India.
- For liver transplants, it's $500,00 (America), $75,000 (Thailand) and $45,000 in India.
- For bone marrow transplants, prices are closer – $62,500 in both America and Thailand. In India, the bill is roughly halved.
Clearly, with some of the treatment costs a fraction of the American rates, flights and a week or two staying in a top hotel are minor factors. India has quickly developed a lively trade, despite the known hazards of medical tourism – variable infectious-disease rates, different medical-accreditation standards for staff, and exposure to organisms against which the patient has no built-in resistance. This last point is a particular hazard for people in fragile health. Dysentery and mosquito-borne diseases such as malaria, dengue and chikungunya fever are widespread and could derail recovery. Long flights in cramped airliners are a known risk for circulatory problems. Most of the possible risks do not apply to established expats, who have a range of Western-level hospitals to pick from. Staff speak English, have the most modern equipment and direct links with Western hospital chains. One such, Wockhardt Hospitals Group, is partnered by Harvard Medical International. Hospitals in this group, based in Mumbai and Bangalore, are among the best. The 400-bed Bangalore unit specialises in cardiology, orthopaedics, neurosciences and women/child care. Wockhardt Mumbai claims very high diagnostic facilities among the usual range of services, including orthopaedics. It advertises total hip replacement at $6,500 (compared with about £12,000 in a private hospital in UK). A total knee replacement also costs $6,500. Dr Sneh Khemka, medical director of Bupa International, knows the country well. "There are medical centres in the cities that really are truly excellent, especially Mumbai, Chennai and New Delhi." Other cities with top-class hospitals include Hyderabad and Bangalore. But there are not enough new facilities outside the urban centres. One exception is the Rajiv Gandhi Super Specialty Hospital, a public-private partnership, opened in 2000. It involved the Apollo Hospitals Group and the government of Karnataka, with support from the Opec fund for international development. Dr Khemka said: "The tier-one cities are world class, with international patient clientele, and the tier-two – the Hyderabads and so on – are certainly able to cope with their metropolitan communities. But clinics and hospitals are still underinvested by government and are a massive problem. "Sometimes the uninformed perception is that India is a dirty place and there is a higher rate of infection. But if you look at outcome data – and we've done quite a few inspections of hospitals in India – you'll see they have much better outcome records than many places in Western Europe. They have meticulous attention on quality and safety." Bupa International has close ties with the Max hospital chain in India. Newly qualified consultant surgeons in such hospitals were about a third more experienced than their European counterparts because they were not hampered by the EU's working time directive, Dr Khemka said. And "hotel" services in leading hospitals were outstanding. Medical insuranceThe Foreign & Commonwealth Office urges Britons going to India to buy holiday or international medical cover. It states: "You should take out comprehensive travel and medical insurance before travelling. Check exclusions, and that your policy covers you for all the activities." The FCO adds: "Local medical facilities are not comparable to those in the UK, especially in more remote areas. In major cities private medical care is available, but expensive. For psychiatric illness, specialised treatment may not be available outside major cities. " International premiumsThe insurer Aviva comes out well in a list of insurers recommended by brokers Medical Insurance Services of Brighton. Aviva International Solutions, a comprehensive plan but with reduced outpatient cover, costs £715 a year for a 25 year-old in India (£643 budget). AxaPPP comprehensive with a £100 excess costs £866 for the same person (£670 budget), while Medicare International is £1,203 (£912 budget). For a couple (aged 34 and 31), the Aviva scheme is again cheapest at £1,615 (£1,450 budget). Again, outpatient caps apply – but no two schemes are fully comparable, as with all medical insurance plans. HazardsUsual hygiene advice applies strongly. The FCO says: "Take care with your water and food hygiene. Drink or use only boiled or bottled water and avoid ice in drinks. If you suffer from diarrhoea seek immediate medical attention." Bird flu outbreaks have occurred most recently in the north-eastern states of West Bengal and Assam. "As a precaution avoid visiting live animal markets, poultry farms and other places where you may come into close contact with domestic, caged or wild birds," says the FCO. "Ensure poultry and egg dishes are thoroughly cooked." Prevalence of HIV/Aids is greater in India than in the UK: 0.3 per cent of the adult population as opposed to 0.2 per cent in Britain. PatchworkEuropeans in rural India are unlikely to find health care to Western standards. But Indian cities are very different. As Bupa's medical director puts it: "If you are going for elective or emergency treatment, it is absolutely fine to go to the centres in the big cities." http://www.telegraph.co.uk/health/expathealth/9017878/Expat-guide-to-India-health-care.html 'If farmers are the backbone of the economy, then it is fractured'
M. J. PRABUSHARE · PRINT · T+ R. Subbaian. Photo: M.J. Prabu "All human toil is for the mouth, yet the appetite is not satisfied" says the Bible. "This is true in agriculture too. Our politicians shout, preach from platforms that farmers are the backbone of the country's economy, but in reality, the backbone lies fractured and our politicians are just not bothered. Their attitude is to throw the produce from the broken bone in the garbage dump and import from the U.S. or Australia," says Mr. R. Subbaian, of Kanakkan Thottam in Coimbatore district. PollutedBoth the soil and water in Mr. Subbaian's field became polluted due to the chemical waste seepage from nearby dyeing factories into the Noyyal river which runs across his village. Several farmers in the area started selling their lands and moved into the cities as the Government failed to check the pollution or clean up the river. "Petitions, demonstrations, nothing seemed to work and the dyeing factories continue their pollution unabated," says the farmer. But unlike others, Mr. Subbaian did not sell his lands. "The fields are my extended family and the birds and insects here are my relations, I wanted to stay on and do something. "During the course of my search for some information on what crops can be grown in these soils I came to know that Alfalfa (called Kudhirai masal in Tamil) grows well and I decided to cultivate it," he says. The farmer also took to multiple cropping to increase his income. "Multiple cropping system is ideal for farmers as it is an effective method of avoiding risk of loss for the farmers. In case one crop fails, the farmers need not worry but can easily tide over the financial crunch through income from the other crops," explains Mr. Subbaian. "In fact, much of the crop loss and farmers suicides happen only in areas where there is monocropping. Can you ever show me an instance of failure in multi-cropping?" he asks. Mainly organicThe crops are mainly grown organically as chemical farming proved to be a failure for him. "Though I did chemical based agriculture nearly a decade back, all that it left was debts, which accumulated to nearly Rs. 30 lakh. One thing I realised in all my life as a farmer is that no government is really interested in helping farmers. The centre is willing to import anything from the West and these countries are ready to dump us with their produce. Our Ministers are only too willing to accept it with open hands at the cost of destroying the lives of crores of farmers' livelihoods," he says. Becoming a debtor"How did farmers become debtors and suffer this wretched condition? Is it their own doing? Don't people in other professions take loans and default? But it is only when a farmer fails to make one or two payments that it becomes news," he fumes. He adds, "the bank goes in search of him as though he is a terrorist. What happened to the people who swindled crores? That money could have been used to improve agriculture and production for many years. Is anybody bothering about this?" The much trumpeted green revolution in reality turned out to be a farce and was not able to either sustain production or improve farmers' lives, according to him. "What is the use of only fields turning green? The lives of farmers must also turn green with money. Only then can we accept it as a revolution," says his son Kulandaivel. "A sugarcane farmer goes through much hardship and it is the sugarcane mill owner who prospers. A paddy farmer remains poor throughout his life but the rice mill owner expands his mill or even buys two or three additional rice mills. Similarly it is not a cotton farmer but the buyer who flourishes. "This is the ground reality. Even a 10-acre farmer is driven to sell his lands for getting money to finance his daughter's wedding," he emphasises. Eye washAccording to the Mr. Kulandaivel the Government's campaign that rural India is shining and that too brightly, is just an eye wash. India no longer lives in villages; it lives in cities and cramped towns. "The barren fields and almost empty streets in many villages with dilapidated homes are living proof of this," he concludes. Contact Mr. R. Subbaian at 4/5-A, Kanakkan thottam, A.G. Pudur (P.O), Irugur (via), Coimbatore, Tamil Nadu: 641-103, mobile: 0936-3228039, phone:0422-2627072 Keywords: Indian farmer, Indian economy, chemical waste, Multiple cropping system http://www.thehindu.com/sci-tech/agriculture/article2811593.ece Trial, error and regulation
PREETI MEHRASHARE · PRINT · T+ Norms for clinical trials tightened There were 22 cases of deaths reported in clinical trials in the year 2010. Global pharma major Bayer, Lilly, Sanofi and Pfizer were sponsors of 14 of these cases. Information on the background of these people who lost their lives during clinical trials by the pharma firms, especially with regard to their socio-economic profiles, is sketchy. Now, waking up to the need to beef up regulations relating to clinical trials by pharmaceutical firms in the country, especially with the view to check possible exploitation of people from the lower strata of society, the Government has come up with a draft notification for amendments in the Drugs and Cosmetics Rules. The notification — GSR 821 (E) dated November 18, 2011) — attempts to change the current procedure for filling out the 'Informed Consent' that is taken at the time of the enrolment of trial subjects, effectively ensuring that the socio-economic profiles of the subjects is duly filled in. According to the new notification, the details to be take note of from now on in the 'Informed Consent' form include the details of address, occupation, annual income of the subject, so as to have information regarding the socio-economic status of the trial subjects. The notification also provides for incorporation of provisions for providing financial compensation to the trial subjects in case of trial-related injury or death. Also, an enhancement of the responsibilities of the Ethics Committees, the sponsors and investigator to ensure that financial compensation as well as medical care is provided to the trial subjects who suffer trial-related injury or deaths, has been provided for in the notification. The Ethics Committee, which reviews and accords its approval to a trial procedure, is essentially entrusted with the task of safeguarding the rights and well-being of all trial subjects. "Strengthening the role of the Committee is a positive," a health sector expert said. According to the Ministry of Health and Family Welfare, deaths may occur during clinical trails due to various reasons. "These could be disease-related deaths as in case of cancer or administration of the drug to critically ill patients or side-effects or unrelated causes. Such deaths are investigated for causal relationship by the investigator and by the medical experts of the sponsor… So far, the socio-economic profiles of the trial subjects have not been included in the format for Informed Consent taken at the time of their enrolment." Keywords: clinical trials, Health Ministry http://www.thehindu.com/health/policy-and-issues/article2801522.ece Healthcare sector takes a leap in city
M. SAI GOPALSHARE · PRINT · T+ K_RAMESH BABUHYDERABAD, 17-01-2012--- A patient being treated at Yashodha Hospital in Hyderabad on January 17, 2012. PHOTO: K_RAMESH BABU At least 12-15 super-specialty hospitals to come up along Shamshabad-Hi-tech city stretch Walk into any corporate hospital in the State capital, and the first thing that one confronts is non-availability of beds for a patient. If the patient's condition is serious, then hospital authorities shift him/her to the emergency wing and wait till a bed is empty. This is all-pervading, despite the fact that in the last two years, there has been huge growth in healthcare industry. Lucrative sectorPromoters have realised that the sector has become lucrative in Hyderabad and more hospital beds are being added everyday. Small and budget hospitals (50 beds) are opening by the day in big numbers. Several middle and large sized hospitals (200 beds and above) have either come up or are setting up their facilities. Existing top corporate hospitals have expanded to other parts of the city and added beds. And yet, despite the leap in hospital beds, more or less, all corporate hospitals are running full. By the last count, industry observers assert that 12 to 15 super-speciality hospitals (200 beds and above) are coming up along the Shamshabad-Hi-tech city stretch. The total investment that is expected to pour in through these projects is between Rs.1,000 to Rs.1,200 crore, in the next few years. Among many factors, two major reasons that have fuelled the growth of private healthcare here is the manifold increase in population between Shamshabad and Hi-tech city and medical tourism. The government has given up on tertiary care and hence the private sector has led the growth. In this decade, Hyderabad has witnessed a steep growth in population by almost five million. And, apparently, the metropolitan area alone has a population close to 6.5 million. "To be able to service this population, Hyderabad requires about 25,000 hospital beds and at present, estimates suggest that there are 10,000 to 12,000 hospital beds and that too majority may not be in the higher secondary or tertiary care," says Medical Director, Care Group of Hospitals, Dr. Rampapa Rao. Other factors driving this 'boom' in the private health sector includes increase in the number of 'insured' population, Arogyasree and traditional government sponsored re-imbursement schemes like CGHS, ESI and large pool of patients from nearby States like Orissa, West Bengal, border towns of Maharashtra, Karnataka and Andhra Pradesh. Another reason for the growth of the healthcare sector is the entrepreneurship of doctors, which has spawned mini-hospitals. "Large number of medical graduates from Andhra Pradesh (between the 60's and 90's) had gone to UK and US for specialisations. Few faculty positions at teaching hospitals forced these doctors to take up private practice. They later turned entrepreneurs and set up mini-hospitals. That's why the capital has large number of facilities with 50 bed capacity or less," analyses Dr. Rampapa Rao. Number of hospitalsThe estimated number of mini-hospitals (with 50 beds) in Hyderabad is between 120 and 150 and the number of clinics and nursing homes (10 to 20 beds) will be anywhere between 3,000 to 4,000. The medium to large sized hospitals (200 beds capacity and above) will be a little more than 15 in number. "The demography of doctors is cosmopolitan. Nearly 40 per cent of the doctors here are from other States and they, in turn, attract a large number of patients from other States. Hyderabad, compared to Delhi and Mumbai, still provides affordable options in medical care and even lifestyle. In the end, it is the goodwill of the doctor that attracts patients," asserts Chairman, Asian Institute of Gastroenterology, Dr. D. Nageshwar Reddy. Observers, however, caution that the growth in medical infrastructure should be commensurate with availability of talent. "The present ratio of 0.6 medical professionals per 1,000 population in the country reflects the big gap between infrastructure and expertise. The situation is even worse in relation to other key human resource areas like clinical nurses, technicians, paramedical healthcare givers and healthcare managers," they surmise. Keywords: Healthcare sector, Hi-tech city http://www.thehindu.com/news/cities/Hyderabad/article2809193.ece Health insurance for more unorganised segments
SPECIAL CORRESPONDENTSHARE · PRINT · T+ The HinduA beneficiary showing his smart card which allow health services under Rashtriya Swasthya Bima Yojana in Bangalore. A file photo: V. Sreenivasa Murthy. The Rashtriya Swasthya Bima Yojana to provide health insurance cover is likely to be extended to more people among the vulnerable sections. This was decided at a Union Cabinet meeting, which reviewed the scheme on Thursday. The scheme has already been extended to MGNREGS beneficiaries, street vendors, domestic workers, beedi workers and those working at building and construction sites. "The scheme has been extended to a few segments of unorganised workers. In future, it is likely to be expanded to other segments of such workers," a release said. The scheme has got wide appreciation from the International Labour Organisation and the World Bank. It was launched on October 1, 2007 as the health insurance scheme for families living below the poverty line and came into operation in April 2008. Beneficiaries are entitled to a smart card-based, cashless health insurance cover of Rs. 30,000 per family per annum on a family floater basis. The Centre contributes 75 per cent of the annual premium, while the States' share is 25 per cent. For the northeast and Jammu and Kashmir, the Centre's share is 90 per cent. The beneficiary family has to pay only Rs. 30 a year as registration and renewal fee. The administrative cost is borne by the States. Keywords: Rashtriya Swasthya Bima Yojana http://www.thehindu.com/news/national/article2795899.ece Privatisation of health care: new ethical dilemmas
Surinder Jindal
Surinder Jindal discusses some of the complexities arising from new trends in health care
Increasing economic liberalisation and privatisation have affected health care as much as they have affected many other social and administrative systems, perhaps even more so. Though the changes are global, in India, the shift seems to have happened overnight, and public health services have been overwhelmed all of a sudden.
This was inevitable. How can one expect proper health care from a state which is unable to guarantee its people clean water, food and housing? Infact, very few countries can afford to provide their citizens comprehensive health care. Wherever state-managed care is free it is nominal – or there are "hidden" costs to the user. Today the majority of us must take care of our own food, clothing, shelter and health needs.
State responsibility in health care
There are three main elements of health care: prevention, treatment and rehabilitation. Prevention of disease is both a personal and a state obligation. In fact, the state has enormous stakes in the maintenance of healthy and relatively disease-free society. It is committed to providing a good and clean environment, water supply, family and social welfare services, vaccination and health advice.
Individuals, on the other hand, may choose to abide by the state's laws and follow general health guidelines, in their own interests. Private and voluntary organistaions have an important role to play, depending on their specific aims and objectives.
It is largely curative and rehabilitative medicine which is getting privatised, and rightly so. Such services are not only costly but highly individualised and time-consuming as well. Recent advances have expanded vistas in health care, raising people's expectations. They can not only stay healthier but also live longer. Body imaging and scanning procedures, endoscopic surgery and screening examinations have helped diagnose diseases earlier and with greater precision. New drugs and interventions have modified the natural histories of most diseases. Both morbidity and mortality have decreased.
Newer methodologies have also helped rehabilitate even the most severely disabled, including those with chronic and systemic diseases. People with gross respiratory, cardiac, renal or cerebral insufficiencies are now able to live more meaningful, useful and enjoyable lives.
Better services, more choices
People are no longer satisfied with general panaceas for their ills. Some patients may want a quick fix if possible, but a large number prefer to have their condition diagnosed and treated with the help of all available technology. Moreover, this is both scientifically and legally required.
Individualised care is obviously easier in private than in government institutions. One can choose both the treating doctor and the time and place of treatment. In certain conditions the patient may want to choose the method of treatment as well. This is especially true for surgery where more than onc eoption is available, such as between endoscopic and open removal of a gall bladder. It can be even more critical when there could be a choice of a life support device such as a pace maker.
A privatised system can also provide better nursing and allied services. It can provide better facilities for attendants and other care-givers. Patients and their relatives are not pushed around, neglected and ignored. Such care may also provide patients with a choice of convenient timings, treatments and costs, though these factors can be limited in both private and public sector settings.
Thus, privatisation has helped improve health services – their type, scope, quality and consequences.
The price of privatisation
Privatisation leads to steep hike in health expenditures, attributable to the increased costs of medical consultations, drugs and devices, medical tests and hospitalisation. Everybody involved has to earn; private medical practice is a profession, not just a public service.
Because of the pressure to make a profit, many private doctors, hospitals and diagnostic centres promote uncalled-for investigations and treatment in order to recover their initial investment. So services with limited value will be popularised and promoted to many people – whether or not they need it.
This is true for the simple ultrasound scanner, endoscopy centre and test laboratory as well as the more costly and sophisticated lithotripsy, CT and MR imaging, balloon angioplasty and transplant. Every test and treatment must be marketed like a commercial consumer product. This is done y individuals as well as big commercial organisations. Newly developed drugs, test kits or instruments are promoted aggressively. All kinds of methods are used to prove that the product at hand is superior to other, and almost indispensable in itself. The strategy succeeds at the cost of rational, ethical practice and patient care.
Points of concern
I will not make value judgements, only raise certain points that concern all of us. The most important is the availability of health care. The economically deprived are bound to suffer in a private health system.
The public sector provides limited services and charity encourages inefficiency and dependency. But knowing this does not help one overcome a feeling of helplessness and guilt when seeing a needy patient with a curable illness suffering because of the absence of a sincere social welfare system.
Privatisation has also encouraged unhealthy competition among the groups involved, since the objective is not only to earn, but to earn more than others.
Privatisation leads to the relative neglect of problems from which there is little to earn. Everyone including the state is interested in setting up commercially viable units. National preventive programmes get neglected.
There is also an undue stress on procedure-oriented medicine. Well-considered, comprehensive advice is bypassed for a computerised laboratory test, resulting in the loss of the human touch.
Effect on medical education
The general decline in standards of medical education and research in most Indian medical colleges can be partly attributed to privatisation. Busy clinicians and hospitals see little reason to invest their time and money in education.
Running private medical colleges is lucrative, but the standards of education have fallen, especially at the undergraduate level since the primary motive is to make money. The basic MBBS diploma is devalued today. An MBBS doctors is reduced to doing the work of a village level health worker or being a postgraduate-in-waiting.
I believe this is at least partly due to privatisation, because private practitioners and institutions almost always prefer practice to teaching and training.
Research, a high-cost investment with poor or uncertain returns, is largely the domain of a few institutions and pharmaceutical companies. Most medical research in India is unoriginal, rarely resulting in improved techniques or therapies.
Privatisation has undoubtedly improved the quality of health care, and widened its scope and availability. And private health services will continue to flourish, since they provide curative and rehabilitative services that the state does not provide. But privatisation has resulted in a number of problems hitherto alien to Indian society. Promoting health care as a consumer service and product is both unhealthy and risky.
It is high time we ponder this worsening situation and take remedial steps.
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