22 June 2012
As i write this piece, there's talk of a nationwide strike by the medical fraternity. On June 25, doctors, affiliated to the Indian Medical Association, plan to strike work, protesting the central government's policies, including the setting up of a national commission for health. Any agitation is an index of popular mood and people's hunger for change. Given the huge demand–supply gap in India's healthcare, reforms are inevitable in this critical sector.
In recent times, we have come to witness one more disturbing trend and that is of doctors coming under close scrutiny from various quarters. What is being overlooked is there's certainly more good than bad in this world. For every negative story about doctors and hospitals, there are far more positive stories that remain untold.
Take, for instance, Ashish Sabharwal of the Smile Train campaign, Prakash Amte, son of Baba Amte and his wife Mandakini Amte, who have reformed the lives of tribals, or the inspiring story of the Jaipur foot which helped thousands of people. Hospitals like Shankar Nethralaya and L V Prasad are regarded as global benchmarks. Every doctor i know devotes considerable time and resources to treating and taking care of the poor. What is ailing our medical system is its demand-supply deficit. At the core of the problem lie systemic flaws that require an urgent redressal.
Here are some key medical concerns that beg immediate attention. First, the ratio of our number of doctors and beds per 1,000 population is even more abysmal than in Africa. India is still producing far fewer doctors than it needs.
The debate on medical ethics, hinging on errant doctors and hospitals is only a reflection of the general societal norms. It's not a problem afflicting the entire medical profession. There are black sheep in every profession, among the representatives of post–Independence generations that have grown up in an environment of scarcity, income disparities and corruption. In future, this will change.
There's also an important concern about reducing the cost of medical education. Many middle–class families are forced to mortgage or sell a lifetime's hard–gained assets to pay for their children's medical education. By severely restricting the number of postgraduate medical seats, especially when there's such a huge demand for doctors, we have created an artificial demand–supply imbalance.
The cost of one postgraduate seat often goes up to Rs 1 crore to Rs 2 crore, depending on the specialisation. Let's look at what happens to doctors. After putting in more than a decade of hard work, doctors begin to earn when they are well into their 30s. Their peers in other professions usually start earning a full decade earlier!
Let's also not forget that India's healthcare spending as a percentage of GDP is among the lowest in the world. The government needs to spend more – especially in primary, secondary healthcare and preventive programmes, along with rural healthcare programmes. There is an equal need for long–term care for senior citizens.
Now that i've highlighted the problems, what are the solutions?
The important thing is to make medical education less expensive. Public investment in new medical colleges and liberalising infrastructure norms for setting new medical colleges will certainly help in this regard. A better pay package will enhance the quality of teaching faculty.
Postgraduate medical education needs to be liberalised and the number of seats increased by allowing large public and private hospitals to impart postgraduate education. This will help lower the cost of medical education. There's an imperative need to eliminate the practice of making undercover payments for postgraduate medical seats. The healthcare industry needs to be granted infrastructure status, with tax incentives at par with other infrastructure service sectors, with parallel subsidies on power, water and other utilities to reduce the overall costs.
There has to be universal healthcare insurance especially designed to cover serious and fatal illnesses as is customary in many countries abroad. All hospitals must have an accredi–tation process and scrupulously publish their audited patient care results. We have to create conditions to achieve medical excellence, and not just pillory doctors for their lapses. All doctors must update their knowledge and secure a mandated re–certification every five years. This is already being followed in some states of India.
Developing a public–private partnership model to cover the demand–supply gap is an important aspect of toning up the fragile healthcare system. Private sector expertise, coupled with efficiencies in operation and maintenance would lead to improved healthcare services delivery.
This model can act as a catalyst in the creation of new capacity and improvement of efficiency in the existing infrastructure. This, of course, will need political commitment and requisite regulations, policy and legal frameworks. Lastly, provide incentives to the industry to set up infrastructure in rural areas. This would improve the overall economic and social status, making it attractive for medical professionals to work there.
In conclusion, i want to say something important to all Indians: put aside your fears. The experience, quality and commitment of Indian doctors is a guarantee that you and your loved ones are in good hands.
The writer is vice–chairman and managing director, Asian Heart Institute, Mumbai.