The document discusses the detrimental effects of free medical care and economic dependence on government funding within India's public health services, leading to overcrowding, corruption, and poor working conditions. It advocates for a system of accountability through charging fees and making hospitals self-sufficient via income-generating projects. Additionally, it calls for a shift from sectarian medical care to a holistic approach to enhance the overall effectiveness of health care delivery.

1. STRESS
AND
THE AILING
HEALTH CARE
DR.
SHRINIWAS
KASHALIKAR

2. Since the public services and especially public health
services, affect most of us, it is essential to find out the
root causes and remedies for their AILING that causes
STRESS to most of us. This kind of exploration; is part
of Total Stress Management i.e. SUPERLIVING; i.e.
blossoming of one and all.
The main cause of the diseases and degeneration of the
public health services and in the public hospitals in
India; is the prevalence of the two concepts on which
these institutions work.
These two concepts are:
1. Free medical care
2. Economic dependence of these institutions on the
government revenue (public money) and donations.
3. Sectarian medical care such as allopathy, homeopathy,
Ayurveda etc.
FREE MEDICAL CARE
The ill effects of free medical care are:

3. A. The free medical care gives rise to unnecessary visits
to hospital out patient departments, excessive crowding,
parasitism, beggarly tendency, meekness and
irresponsibility towards personal and public health.
B. The free medical care creates a special and extremely
favorable situation and golden opportunity for the
powerful, rich and famous individuals to exploit the
government revenue and tax payers’ money. The
chances; of misusing the FREE services through
irregular and illegitimate means; increase.
C. The free medical care leads to zero returns and
subsequent deterioration in the infrastructure,
maintenance, renovation, state of the art technology and
facilities such as food and recreation given to the patients
and their relatives.
D. The free medical care associated with perpetual
absence of returns; leads to unjustifiably low salaries,
delay in filling the vacancies, delay and/lack of
promotions, excessive working hours and duties,
substandard working conditions (such as inadequate
toilets) etc.

4. E. This state of affairs demoralizes the sincere and
dedicated employees and implicitly and often explicitly
promotes irresponsibility, lethargy, absenteeism,
corruption etc.
ECONOMIC DEPENDENCE OF THESE
INSTITUTIONS ON THE GOVERNMENT REVENUE
AND DONATIONS
The ill effects of economic dependence are:
A. The public hospitals are not self-sufficient and do not
have any projects to support them. Naturally since there
are no legitimate returns from patients or from any other
source; for what is spent; the public hospitals are always
in loss and the problems resulting from the FREE
medical care; multiply.
B. Thus inadequate progress in terms of inadequate
facilities, inadequate salaries, and inadequate
employment in terms of number of employees in almost
every category, protracted duty hours, worsening
working conditions, worsening of staying conditions for
the employees and crowding of patients due to huge
patients/employee ratio; worsen even further!

5. C. The dependence of the public hospitals on government
through sanctioning of funds; leads to colossal corruption
while attracting funds and while undertaking any
developmental activity. In fact; many individuals and
institutions concerned with hospital; get obsessed by the
thought of “how they can be “richer” rather than the
development and improvement in services.
D. The corruption of the individuals in the public
hospitals drives them to seek money in every possible
way. Thus they may deliberately spoil the equipments so
that newer can be purchased (and kick backs can be
amassed), they may manifest other tactics; such as
misbehavior, insulting behavior, delay or denial of
services and thereby compel the patients to go to the
private practitioners and consultants and get
“commission” from them.
E. Large number of lower middle class and even poor
patients turn to private practitioners, consultants and
hospitals; out of helplessness; rendering the public
hospital investment wasteful and counterproductive!
“Health Restoration” of “Health Care”:

6. This deterioration can be overcome by:
1. Abandoning the concept FREE services and charging
fees and
2. Making the public hospitals self sufficient through
other appropriate productive projects.
1. The concept of free medical care has to be replaced
by more just system of payment. This would make
everyone involved; less casual, more sincere, more
accountable, more responsible and more dignified, in
seeking health care and providing health care. The
arrogance and condescending attitude of the health
care providers and meek and irresponsible attitude
of the health care seekers would be transformed.
This would bring adequate revenue to ensure progress in
terms of adequate facilities, adequate salaries,
appropriate employment, which could ensure normal
duty hours, improvement in working conditions,
improvement in staying conditions for the employees and
preventing excessive and many times [because the
services are free] unnecessary crowding of patients.

7. One may raise the objection that this is difficult to
implement in case of very poor, helpless, unsupported
patients.
It is very true that no sensitive and sensible individual
would think of doing it as well. These patients who are in
agonies, in emergencies or helpless; should be made
exception and a separate arrangement be made for them.
But in most other cases the problem can be overcome by
making provision for payment through “services” or soft
loans.
2. Making public hospitals self sufficient by buttressing
them with some productive income generating
projects; such as plantation of medicinal herbs.
We can recapitulate and list the benefits of the “Health
Restoration of Health Care” as follows:
A] It would inculcate a sense of responsibility towards
one’s own health, towards public funds, towards public
services, amongst everyone including the patients.
B] It would generate the sense of accountability,
satisfaction and fulfillment amongst the employees
C] It would ensure optimal progress in medical care
especially in terms of holistic approach and making

8. health far more convenient, reachable, inexpensive and
effective than ever before!
D] It would improve the lives of patients as well as
employees
E] It would make the revenue hitherto squandered on
free medical care available for other developmental and
research work thereby facilitating national progress.
F] It would reduce the corruption born of out of injustice
G] It would reduce the crowding and degeneration of
private medical care.
3. SECTARIN MEDICAL CARE
The sectarian medical care involving sectarian training,
practice and research has to be evolved into holistic
medical training, practice and research.
Gita calls such body of knowledge, practice and research
SATVIK.
Can NAMASMARAN empower us to comprehend and
practice Total Stress Management (SUPERLIVING) a
part of which is; HEALING THE STRESSFULLY
DISEASED HEALTH CARE?