Emerging Opportunities in India


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Emerging Opportunities in India

  1. 1. ‘EMERGING OPPORTUNITIES AVAILABLE TO INDIA AND STRATEGIES TO MATERIALIZE THEM’ India is a developing country, where a large section of population is below poverty and health and hygiene as such is not up to the mark. It is reported that in India about 20 lacs infants and children die from preventable illnesses, one lac mothers die during the childbirth and five lacs people die from tuberculosis. Also around 5 million peoples die from HIV Aids and numerous others die by diarrhea and malaria. The plight of the least advantaged is increased because of the poor public health systems. The Government Hospitals and health care centers do not completely address the needs of the poor people. On the other hand the private health care institutions charge exorbitant money, which automatically renders them beyond the reach of many. However, it needs to be realized that private health care sector in India is definitely flourishing at the cost of public one. However, according to some critics the national policy of the country lacks specific measures to achieve the stated goals. For instance, there is no integration of the health services with the wider socio-economic and social development, there is a lack of nutrition support and sanitation and there is poor participation of the people and government officials at the local level. The central government adopts the strategy of improving the health systems through Five-year plans. It cooperates with the State Government for the purpose and for sponsoring major health programmes. The Central and State -1-
  2. 2. Governments share the expenditure they need on providing healthcare to the people. In mid 1990’s the Government spent 6% of the GDP on health, which is one of the highest levels of the expenditure in the developing nations. According to the World Bank Study the per capita spending on health in India is around Rs. 320/- per year, with a significant input of 75% from private households. The State Government contribute 15.2%, Central Government 5.2%, third party employers 3.3% and the Municipal Government and Foreign donors provide 1.3% of the total spending of which 58.7% goes to primary healthcare and 38.8% is spent on the secondary and tertiary ones. However, despite of the State and the Central Government efforts, the health care in India is in a bad condition because of several factors, of which the important ones are : 1. The rapidly increasing population of the country 2. High level of indifference in Government and Non-Government health care organizations. 3. Lack of awareness amongst the people. However in the context of globalization there are certain developments, which have a far reaching consequence. As a result of this a paradigm shift is taking place because of the certain inevitable socio economic considerations. With the developed countries finding themselves over-burdened with the task of providing cost effective healthcare, India has emerged as a popular global health care tourism destination. Medical institutions in India are providing for an estimated 20,000 to 30,000 doctors and nurses each year complimented -2-
  3. 3. with medical facilities driven by advanced technology and high-quality procedures at par with hospitals in developed nations such as USA or European Union and at a price that could be a fraction of what they would spend in their country. Interestingly apart from the specific health care issues Indian approach is a holistic approach. India is well known for alternative therapies and post treatment travel destinations. Medical Tourism in India as such is growing by 30 per cent each year. The health care sector in India resultantly has witnessed a phenomenal growth in infrastructure in the private and voluntary sector. The private sector is a flourishing industry and it is equipped with the most modern state-of-the-art technology at its disposal. An added plus had been that India has one of the largest pharmaceutical industries in the world. It is self sufficient in drug production and exports drugs to more than 180 countries. As one of the key players in medical tourism there is a growing need for accredited hospitals, to ensure best practices in a safe environment. It therefore is imperative that for the purposes of ensuring quality assurance and the quality standards incorporated therein, the statutory enactment to that effect is necessary. This will not only entail incorporation of quality assurances, which will augment quality services but will also re-assure patients who otherwise intend to seek treatment abroad. -3-
  4. 4. With the advent of globalization increased numbers of people are traveling to other countries to get treated abroad. In this context quality is the primary factor. However cost involved in procuring quality health care that could be surgical and non-surgical in nature is yet another most important determining factor. Constraints such as high costs and long waiting lists for treatment or surgery are prompting people to look at the effective options. Developing countries in which India turns out to be a key players is resultantly has turned out to be a key health treatment destination amongst people in developed countries like USA, UK etc. as India offers high quality treatment at minimal costs with minimal waiting period. Frankly speaking, health care and tourism may seem prima-facie contradictory to each other but realistically people have been traveling to distant lands for re-juvenation packages. The efforts therefore should be to institutionalize medical treatment for all kind of health care areas including the super speciality fields in the medical sciences. In this context it is imperative that we take into consideration the influences under which the health care arrangements are required to evolve, primarily they are : 1) population health status 2) health infrastructure and its management 3) fairness in financing costs and care 4) defining health perceptions of people, professionals and planners -4-
  5. 5. Other than these four important influences, yet another influence, which has significant impact, is the foreign aid from the developed world. As a open democratic society India had always been influenced by the dominant international paradigm on health care be it WHO, UNICEF, UNDP, World Bank etc. This has resulted in re-direction of the public health priorities in a substantial way. As a result of this one direct consequence is that the burden of treatment has become disproportionately regressive for the poor- and a tendency exaggerated by both compression of public expenditure and unregulated private factors including the blatant commercialization. It is therefore imperative that a crystallized policy frame is evolved towards regulation of the private sector in medicine. As a result of which the quality would be blended with accountability and fairness in care through strict adherence to the criteria for accreditation, transparency in fee, medical audit, accountable record keeping and credible grievance procedures. As a matter of fact such accreditation, standard setting and licensure systems are best done under self regulation, but self regulation system in India in Indian medical practice have been deficient in many respects creating problems in credibility. ‘Acute care’ has become the key priority and continues to attract manpower and investment into related speciality education and facilities for technological improvement. Common treatments, any expensive diagnostic procedures and family medicine stand replaced. Tertiary hospitals had been given concessional land, customs exemption and liberal tax rates against the -5-
  6. 6. commitment for reserve beds for poor patients for the treatment. However, no effective procedures exist to monitor this and the disclosure systems are far from transparent. Redressal of patient grievances is poor and allegations of cuts and commissions to promote needless procedures are common. The bulk of corporate private entities such as nursing homes are run by Doctors and Doctor entrepreneurs have remained unregulated either in terms of facilities for competent standards for quality accountability of practice and sometime operate without systematic medical records and audits. Medical education has become more expensive and with a rapid technological advances in medicine, specialization has more attractive rewards. The responsibility of private sector in clinical and preventive public health services have not yet been specified. As a result of which, their roles in this domain even till date remain questionable. Situations and circumstances blended with technological advancement has resulted in growth of telemedicine with treatment from distance and rapid second experts opinion becoming a matter of routinity. Therefore in order to have a full potential growth in the context of globalization for articulating and effective health care delivery system, it is necessary that following strategies are given diligent thoughts : a) A sensible mixture of external regulation and professional self regulation can be devised in consultation with the professionals to ensure competence, quality and accountability. -6-
  7. 7. b) Role and relevance of Indian systems of Medicine need to be specifically articulated in the context of need basis and also the cost effectivity. c) The desirable level of public expenditure towards health services need to be deciphered with clarity and augmentation of the same should be worked out through a strong political will to actualize the real concept of ‘welfare state’. d) Evolve accreditation standards for all health care agencies to build up the concept of quality assurance as a genuine modality towards fulfillment of legitimate expectations of the all relevant stakeholders. e) The qualitative incorporation in medical institutions in terms of infrastructure, teaching and training personnel, relevant curricula, matcheable training and technological availment should be worked out, whereby effective trained health manpower is generated not only for the national but also for the global requirements and interest. f) The planned efforts need to be undertaken for the purposes of institutionalization of medical tourism in India, which is a testimony of the quality of health care services and also the generated competitiveness therein. g) The role and relevance of the private capital in the health care services needs to be crystallized and also to be regulated so as to ensure that they play a decisive role in subsidized public health care systems, so that the needs and interests of the marginalized sections of the society are also catered to. By Dr. Vedprakash Mishra Member Executive Committee, Medical Council of India & Former Chairman Postgraduate Medical Education Committee, Medical Council of India -7-