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‘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

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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

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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.

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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

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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

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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.

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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