Healthcare policies for progress an indian healthcare perspective by Mahboob ali khan,MHA,CPHQ

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Can India have absolute Affordable and Quality Healthcare in every City and Town?
Healthcare in India is heading towards a major makeover, thanks to the liberalisation and globalisation of the economy. Like every other field, such a change starts from the class room. Involvement of private players in education has set the bar high; now it has to be followed by government institutions as well. Health education in India is comparable to anywhere in the world. Policy change from MCI had ensured relaxation of stringent criteria required for operating medical colleges. Currently there are around 300 medical colleges all over India; around 30,000 to 35,000 students graduate every year. Yet there is room for improvement.

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Healthcare policies for progress an indian healthcare perspective by Mahboob ali khan,MHA,CPHQ

  1. 1. 1 Healthcare Policies for Progress An Indian Healthcare Perspective By Mahboob Ali Khan,MHA,CPHQ. The Indian healthcare industry is undergoing a transformation, be it on the delivery front or on the policy front. In its 12th five year plan, the Government of India has planned some significant policy changes and intends to introduce new regulations to make healthcare not only more accessible and affordable but also more transparent and ethical. How far will these regulations and policies help better healthcare access and improve healthcare delivery within our country? Express Healthcare talks to industry players on how policies can play a role in improving healthcare delivery Excerpts… ‘The healthcare delivery model of India in its current form is an excellent idea about how a system should be’ Healthcare in India is heading towards a major makeover, thanks to the liberalization and globalisation of the economy. Like every other field, such a change starts from the class room. Involvement of private players in education has set the bar high; now it has to be followed by government institutions as well. Health education in India is comparable to anywhere in the world. Policy change from MCI had ensured relaxation of stringent criteria required for operating medical colleges. Currently there are around 300 medical colleges all over India; around 30,000 to 35,000 students graduate every year. Yet there is room for improvement. Insurance in healthcare has a bright future, as an industry it is expected to touch Rs 32,000 crores by 2016-17, public-private partnership is making it happen. Welfare schemes for employees by ESI, CGHS, ECHS etc, have made world class tertiary level healthcare accessible to poorest of patients. But there are discrepancies in the financial compensation offered by government and that of private sectors, which put pressure on patients. The healthcare delivery model of India in its current form is an excellent idea about how a system should be. The biggest challenge is translating it into providing basic healthcare to rural areas. Talent migration due to poor working conditions is at best stopped or reversed only by allowing private players to enter the arena of primary healthcare. But then who will go to rural areas without expecting good return? Political and bureaucratic hurdles make the process more painful. One solution to this problem is public private partnership creating competition which ultimately leads to improved healthcare delivery at primary care level.
  2. 2. 2 No doubt that the healthcare facilities in urban areas of India are not less than anywhere in the world. We have hospitals providing best facilities, performing advanced procedures, with world class equipments. India has one of the largest clusters of Joint Commission International (JCI) approved hospitals. This enormous concentration of tertiary or quaternary care centers in the urban area makes us to ignore basic healthcare, leading to pressure on urban centers to handle high patient load. The Government of India had recognized this problem and taken initiatives to address it through National Rural Health Mission launched in 2005 to extend healthcare to all. The Rashtriya Swasthya Bima Yojana works towards providing health insurance to the lower strata of community. However, the problem lies in implementing these policies at the grass root level. Improving the GDP allotment to healthcare by 4-5 per cent would help in providing basic facilities and better pay grades to health workers would attract more employees. Need to translate the phenomenon of globalisation of healthcare at the level of villages would require involvement of both private and public sectors. ‘The biggest obstacle in the healthcare sector today is lack of access to medicines’ Government policies and regulations play an important role in developing efficient and sustainable healthcare delivery model in any country. Especially in India, where medical sector is still unorganized, regulations play an important role in achieving standardization in processes and healthcare delivery. However, the key to success of any regulations and schemes run by the government is implementation. In India, where there are several states and diverse health schemes for each state, efficacy of any scheme depends on how successfully it is implemented by different states’ authorities. For example, Rashtriya Swasthya Bima Yojna (RSBY) may have been exceptionally successful in other states but it seems to have fallen flat on its face in Maharashtra. The ministry of labor is contemplating whether to continue the national health insurance scheme in its present form in the state. Thus, implementation plays an important role in the success of any scheme. To ensure maximum outcome, policies and regulations should be developed on the basis of the learning of all available systems, the strengths as well as lacunae in existing schemes and needs of individual states. Also, people need to be properly directed towards taking benefit of health schemes.
  3. 3. 3 The best example of stringent implementation of regulations is Dubai where we are present since the last four and a half years. There the emphasis is on quality of services and safety of patients based on the local and federal laws in addition to international accreditation standards. There are strict regulations governing licensing of any healthcare facility in Dubai. Audits are done at regular basis to ensure the quality of service in healthcare facilities. For example, it took us one year to get a license for our clinic in Jumeirah. Moreover, the license needs to be renewed regularly for ensuring proper implementation of guidelines. India should follow such discipline in implementing the guidelines set for quality in healthcare delivery. The biggest obstacle in the healthcare sector today is lack of access to medicines. It is the common denominator in all the nations of the world, regardless of whether their healthcare systems are public or private. Healthcare regulations must begin with reform in the way in which medicines are created and, accordingly priced, which requires a series of improvements at Research & Development (R&D) level. They further need to focus on availability of these medicines to people even in remote areas. Indian healthcare today is urban centric. It needs to be reformed through regulations that emphasise on providing good medical facilities in rural areas. They must provide impetus to lift the population, which is at the bottom of the pyramid. Conclusively, at the core of every regulation should be the safety of patient. Everyone should have access to quality healthcare at affordable rate. Moreover, the state authorities should take the responsibility of implementing regulatory guidelines for success of policies and health schemes. India needs increased penetration of insurance throughout the country’ Where the Indian healthcare sector is concerned, there are a couple of things that are needed to be put in place in terms of bringing new policies. Firstly, we will have to create more access to healthcare without compromising on quality of care. We need to see to it that we provide good standards of healthcare facilities to more people, especially in the Tier II and III cities and towns of India. Secondly, we need to make healthcare affordable. This can be made possible by way of partnerships between the government and the private players; where the government plays the role of a payer and the private players provides the service. We have initiatives like the Rajiv Gandhi Arogya Yojana in this sphere which is indeed a good scheme but needs to improve its mechanism. The systems followed
  4. 4. 4 under the scheme are fairly ad hoc. A health insurance co-ops is a good alternative. Apart from this what India needs is increased penetration of insurance throughout the country. Well, speaking of the policies and regulations introduced by the government in recent times, I would like to point out a commendable move by the government of India- the PCPNDT Act. This is one act that will help us curb sex detection and abortion of girl child. Another good move is the CSR Act which makes all companies give two per cent of their net profit towards the society. This culminates to a significant amount of funds been ing raised for many social and healthcare causes. On one hand we have policies like PCPNDT and CSR Acts that have helped us bring in some transformation but on the other, we have the Clinical Trial Act which was brought with the right intent but has some adverse effects. Regulations brought under this Act for monitoring and compensation has made companies reluctant to conduct clinical trials in India. This serves as a drawback to India. Finally one area that the government needs to focus on is opening avenues for private players to enter into medical education space. This will also help in increasing the number of doctors, nurses and other healthcare professional within the country. ‘New regulations and policies introduced would be of much larger use if well organised, improvised and facilitated’ Improving public health for all is documented in the Constitution of India as one of the primary duties of the state. To achieve this, the planning process of the country provides a broad framework to the states to develop their health services infrastructure, as well as facilities for medical education and research. It is very difficult to ascertain whether the presence of private healthcare provision has made any impact on health outcomes and whether the states having higher availability of private healthcare provision do really exhibit significant differences. It would require observing health status and utilization patterns over a long period of time. The laws pertaining to healthcare in India are effective in protecting the interests of the patients; but the main area of concern is about their proper enforcement. Issues with regard to public and private health infrastructure are different and both of them need attention but in different ways. Rural public infrastructure must remain in mainstay for wider access to health care for all without imposing undue burden on them. Side by side the existing set of public hospitals at district and sub- district levels must be supported by good engagement and with adequate funding and user fees and out contracting services. This demands better routines, more accountable staff and attention to promote quality. These, attempts must persist without any wavering or policy changes or periodic denigration of their past working.
  5. 5. 5 New regulations and policies introduced would be of much larger use if well organised, improvised and facilitated. These regulations would surely be beneficial for the Indian healthcare industry but the concern still remains that whether the designated body or authority utilizes the opportunity justly. In a market economy, healthcare is subject to three links, none of which should become out of balance with the other - the link between state and citizens' entitlement for health, the link between the consumer and provider of health services and the link between the physician and patient. ‘Mere legislation doesn’t bring significant change’ Introduction of numerous healthcare bills in the cabinet in the last two years is in itself a testimony to the growing importance accorded to this sector by the Government of India. Recent regulations and amendments include almost all areas of healthcare ecosystem, from medical technology, medical education, insurance, to healthcare delivery and medical tourism. They are a critical and much needed steps in setting off on a path of long-term reforms in a country where healthcare services are still marred by issues of poor physical access, high cost, under- insurance, and unregulated quality of care. Amendments to the Medical Council of India Act will empower the central government to ensure proper development of medical education, and keep corrupt practices under check. The bill to regulate medical devices is a long-due initiative which is likely to strengthen the domestic manufacturing industry and make medical equipment more accessible and affordable to the masses. It will also benefit hospitals as they will have more high-quality indigenous products to choose from. With more than 80 per cent of the providers being in the unorganized space, there is barely any quality control over this segment at present. A regulation that can go a long way in improving quality of care delivery is the Clinical Establishments Act, which emphasizes on adherence to standard practices. The utility of this Act can be further enhanced if the registered facilities are mandated to periodically share critical operational and clinical data with the state and national councils. This database can be leveraged to design performance benchmarks for Indian healthcare providers and analyse their performance on a continuous basis. While these regulations have many positive features, it is important to not lose sight of the fact that mere legislation doesn’t bring significant change if it is not followed by effective enforcement and monitoring. We have a long history of drafting strong laws which remain mostly on paper.
  6. 6. 6 Therefore, the important aspect is the speed of enactment, management of stakeholders including doctors and healthcare administrators, and monitoring of adherence. This is a mammoth task which requires an army of officials, and continuous investment in financial and technological resources. It also requires serious commitment from private healthcare players, as self-regulation is the first step. ‘It is imperative to evolve a robust long term policy for healthcare’ It is imperative to evolve long term policies and regulations for healthcare, as the developed world witnesses the perils of galloping healthcare costs. While the intent is visible, the way these are approached and framed, there is a growing concern among various stakeholders in healthcare. There is not enough research data on various issues to frame these policies and thus there is an inherent risk of framing wrong policies. The core issues that need to be addressed together are:  Who pays for the costs?  Who provides care?  Who regulates safety and quality of medical services?  How do we meet the human resource need?  How do we design medical education for future?  How do we address the rising costs in terms drugs, devices and diagnostics? Is there a national policy to support indigenous industry to contain costs? Hence, in conclusion, it is imperative to evolve a robust long term policy for healthcare. However, it needs to be addressed professionally taking all stakeholders into confidence and should be based on robust national data. ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------

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