The Indian public health system that falls within the domain of the State and the Private sector. The government health care system including its hospitals, that are run by the State are, largely in a state of shambles. The health care system has progressively degenerated to shocking levels of neglect and un-care. It displays all of the malaise of the Indian government and State functioning in all its glory demonstrated on yet another front; the Government hospital’s dismal and shocking state of disregard and dysfunction.
They are understaffed with doctors and nurses, unhygienic, underequipped, and are often dens of corruption to boot. Budgets that are allotted by the government for the public health sector including for medicines and equipment, are largely gobbled up. Often the medicines meant for patients for free distribution, end up selling in chemist shops mostly located on the periphery of the government hospitals.
Many government doctors who are in service, run private practices or nursing homes in a variety of guises while delivering the minimum service and time possible to the public-sector duty. There are a number of reasons for this, including the general condition of State corruption that has gotten embedded in the Indian socio-economic-political-governance story; and the relative low salaries paid to qualified professionals relative to their private sector counterparts also play their part.
Government hospitals are overflowing into corridors and verandahs with patients often lying on the floors with all beds taken and doctors, nurses and medical care staff run off their feet.
Though there has been remarkable progress in private sector health care in India over the past twenty years or so where various business groups have set up state-of-the-art hospitals, with latest equipment, highly qualified doctors, and medical treatment to the extent that medical tourism has been growing over the years as comparative costs are far lower than in the West; for Indians, the private sector health care is for the well-heeled and is creaming money all the way to the Bank.
Often in the quest of making money, unethical practices, including unnecessary prescription of tests, and even operations, has been reported on many occasions in the press, and anecdotally by patients. As lucrative businesses, these are perceived by the population as money grabbing, heartless set-ups where you should be prepared for huge inflated bills, hang the altruistic motive expected from the medical profession.
A major contributory factor to all these stories is the fact that for it population and geographic size, there just aren’t enough doctors, nurses and health care workers in India. An India Today story reports that a recent parliamentary committee report on the functioning of the MCI pointed out that ". The total number of doctors in India is much smaller than the official figure and we may have one doctor per 2,000 or 5 per 10,000 population, if not more." The US has 40 per 10,000 population as per http://chartsbin.com/view/gcu web report.
For the poor, life is hell anyway, and becomes an unlivable inferno if someone falls seriously ill in the family. While the governments roll out mile long statistics to showcase how much they have done, on the ground, the situation remains hopeless. Walk into any government hospital and it is clear where India stands in caring for its citizens, from whom every party draws its strength.
The Rising India Party takes the position that it is the responsibility of the nation, through its government, to provide for a safety umbrella for the poor and disadvantaged to obtain the best health care possible such that citizens are not left uncared for under any circumstances.
The Rising India Party takes the position that the entire governance paradigm has to shift from a us-versus-them set in those-governed versus those-governing, perspective to a co-op effort that entwines the public of India in its own governance within pre-defined laws and rules based order. Within this model, the State is not seen as separate from the public and functioning as its rulers; rather, the State acts as facilitators with the full involvement of the citizens and public of India.
However, the State would ensure that the laws and rules that are set and agreed by the public, are met and enforced; and the system functions for the larger benefit of all and not as a largess dispensing “mai-baap” patronage driven story as hitherto; thus, leading to more of self-governance in a rules based order, and less of up-down governance model as set by a foreign power.
All solutions lie within this model that is in line, and consistent with the civilizational narrative of the nation. In fact, Gandhi ji, envisaged and advocated such a system. Unfortunately, his advice was neither understood nor implemented and Indian Governance simply carried on with the British model of up-down governance leading to the sorry state of affairs that exists today; one full of “Tanav, Tana-Shahi” and corruption, even as it developed but did so way below its potential. The Indian Public must decide its future. Does it want more of the same? Or does it want to switch to a fresh system that works to the good of all, and one that the citizens themselves oversee and participate in?
The health system must switch to such a system of functioning as suggested below.
The Rising India party takes the position that the entire system, including in the manner the Ministry of Health, and bodies such as the Medical Council of India are run, need a complete overhaul, reset and wholesale change in the way the nation treats its medical and health care narrative.
On winning elections, The Rising India Party would carry out the following actions which are detailed below for the Indian citizen to evaluate and approve:
- The government will set up Health Audit Boards (HABs) to undertake to examine the functioning of the country’s Ministry of Health and various Bodies including the Medical Council of India (MCI) with the view to eliminating the blockages built into the system while designing a new system of functioning that frees the logjams with citizen involvement and oversight.
- (HABs) will audit and evaluate the budgets that are set, and the process of allotting budgets, how they are deployed, as well as the rule books and laws that govern the health industry.
- The government would simultaneously, set up Health Care Plans Boards(HCPBs), to come up with innovative practical solutions to permanently sort out the nation’s health care system issues. Some of these are suggested hereunder.
- The government would move to rapidly change the manner in which the public health system functions.
- A viable option would be to move all public sectors hospitals into public-private partnership models in different configurations; models built for metros, tier 1,2,3 cities and rural clusters.
- Opportunities would be offered to Investors, including to medical professionals within the State and Private sectors to invest, participate and expand the existing built-capacity within the State or Government sector, by adding wards and beds on existing land and / or on top of existing buildings
- They would invest alongside and on top of the State allotted funds, to upgrade the equipment and infrastructure in return for permission to run a preset, financially viable, private section / sector full-charge-service within the public hospital land, and infrastructure, while providing free care for the poor.
- The provision of health care in the public sector would move to a “means tested” model where people who are at family income levels below set thresholds, say 5 lakhs per annum would gain free health care and those above would pay fees scaled from low to modest based their income levels.
- The Private section embedded within the public-sector hospitals would charge full fees and where possible, would also pitch for medical-tourism income wherein the entire public-private and private sector system would market and pitch for foreign income.
- Such a strategy would mean the entire system would aim to build world class facilities, expertise and research capability within the entire health care industry and system.
- The government budgets passed for the public health sector could be redeployed such that the government would assign part of the health-budget to health insurance funds that would be run in public-private models or domains with citizen oversight committees forming part of the audit mechanism to ensure that there is no misappropriation of these public funds or corruption of any kind.
- These insurance funds receiving public health premiums would form large pools of deployable money that are invested to earn and grow while they pay out for poor patients within actuarial calculations of viability that would be used by the government to arrive at each annual budget.
- This would provide a viable water-tight health care umbrella to the entire population, from the poorest, who would be subsidized to the richest who would be paying, as they normally already are, for world-class healthcare.
- Such a model would also create huge opportunities for health care professional including to medical doctors to function within a entrepreneur environment of benefit and win-win for the nation as well as the individual.
- Within these models, entrepreneur opportunities could be created for the medical staff already employed by the government who can be offered entrepreneur shares in the managing of the hospitals in exchange for going off the salary model or to a reduced base salary plus incentive models.
- Larger urban hospitals could be offered to private investors to upgrade and part use for full private fees beds while providing free or subsidized care to the lower socio-economic segments of the population.
- India has a large number of doctors who have settled overseas and have accumulated huge experience and often gained immense reputation, wealth, connections and knowledge whether in high paid jobs or in their own private practices.
- The government would examine possibilities of offering incentives to these to return home based around investment opportunities in the public-private model of upgrading and running the current public-sector hospital system as investors or lead managers at packages designed to better the life-styles they enjoy overseas even as they form the core thrust for medical tourism within upgraded and enhanced facilities.
- All larger public-private sector hospitals would be converted into high end teaching and research hospitals immediately allowing the nation to spring-board to the forefront of global medical research in a very short period of time.
- These moves would get the entire system reset and moving involving the entire health care human resource and investors, by providing huge opportunities to the country’s doctors and medical professionals for personal and national growth.
- The would help develop the public health system hospitals into institutions of excellence by up grading them in terms of equipment and facilities to the best standards in the world while expanding and upgrading the Indian public health system in financial models that would become profitable and self-sustaining.
- Medical graduates passing out of the Indian system who have moved overseas for post-graduate study and eventually settled there would be Incentivized to return and set up base at enhanced life-style packages including investment opportunities within the public-private model.
- Overseas domiciled companies who are in the fore-front of medical research and inventions would be encouraged to either move their operations to India at attractive terms or to set up parallel research facilities wherein they would function in a less restrictive environment.
- All inventions or patents developed under such system would be either fully Indian owned or would be under joint ownership models as decided with due thought and discussion.
- India would declare itself as a research destination of the world through attractive schemes and incentive offered to both its citizens, global India citizens as well as leading overseas talent who would be offered dual citizenship.
- Indian doctors settled and practicing overseas would be invited to return to India under special schemes wherein they would be offered to take up investment stakes in the public hospital system in public-private partnership models.
- Alternatively, offer them compensation packages better than the ones they have in the countries they are settled in through a cost to nation calculation in a mix of life style enhancement, homes, house help, bonus packages, and other means available. This would rapidly fill the gaps in staffing the Indian health system.
- These moves would quickly remove shortages and blockages within the nation’s health system and drive world class health care and efficiencies.
TO BE ADDED AS APPROPRIATE