India’s healthcare system needs a tweak in ethics instead of policy change

The National Health Policy has been cleared and the view persists that it falls short of the 2015 draft. The Indian Express says, while marshalling the fine details, that it “fails to make health a justiciable right in the way the Right to Education 2005 did for school education.” There would be justified debate which is healthy, for in India, the healthcare is nowhere even near the halfway mark to where it ought to be.

Aim is to raise public health expenditure to 2.5 percent of the GDP, but here is the catch – “in time-bound manner” as the Minister (Health), JP Nadda put it. Also, it “advocates” two-thirds or more of resources to primary care, ensure a ratio of two beds per 1,000 population spaced in a manner to reach them within the golden hour, proposes “free drugs, free diagnostics and free emergency and essential health care services in all public hospitals.”

Sounds nice right? But the healthcare activists will have quite a lot to say for now a poor, ramshackle healthcare system has to be brought to vibrant life. To assume that it was good earlier even to an extent would be a false belief. The target of 2.5 percent spends of the GDP was set earlier too and had to be met by now. But according to Nadda, now this would happen by 2025. Which means, we have to wait like one does in a doctor’s waiting room. Till then, be happy with palliatives – promises.

The policy promises a system which sets and ensures standards in both government and private healthcare arrangements. National Healthcare Standards Organisation (NHSO)-set standards would be the measure against which the patient can complain and an empowered tribunal will deal with grievances. Sounds good but does not inspire confidence because so far, the system comprising of both public and private healthcare have taken the patients not to good health but on a ride.

Anyone using the public healthcare system has serious complaints about the quality of care, diagnosis made, absence of hygiene within hospital premises, or the profiteering by the private sector. Even hospitals which are set up by trusts and style themselves as research institutions to secure concessional land allocation and beat the taxman are no better than the corporate hospitals. Both set increasingly higher targets of revenue per quarter. And there sits the devil.

If a hospital does not increase the bed strength, or the number of operating theatres or expand its outpatient, it can achieve higher revenues (which it requires), only by extracting more from the patients. There is a variety of ways to achieve these targets and hospital managements will usually deny it, but one of the ways to achieve it is by performing procedures on patients which are perhaps not needed. Way back in the 1970, in Guntur, the women without uteruses (female reproductive organ) outnumbered with it for it had become a practice to recommend that surgery.

Of late, we have seen a racket of sorts getting exposed. One such exposure has come from the government, which showed how stent prices were increasing — up to 10 times — at every step (starting with the manufacturer) before it reached the patient. The biggest jump came at the hospital end, and the National Pharmaceutical Pricing Authority got wise to it and put ceilings on their prices, as it has on many drugs used for treatment of cancer. Not only does cancer kill, but often enough it also kills the economic well-being of the family of the cancer victim.

Several questions remain unanswered with regard to healthcare (one of them is the bill amount patients are asked to pay).  It is common practice for in-patients to be visited by ‘another specialist’ and billed for that. In certain hospitals, an appendectomy would cost Rs 1 lakh or more, but some other hospital would console the patient that the surgery would cost a third of that. But all this while no one reveals that the patient didn’t even need that surgery.

Why for instance do some doctors order non-requisite tests (which are out of the scope of the diagnostic assessment)? Is there a system of cutbacks between the laboratories and the doctors? Why is it that a surgery cost a particular sum in a general ward, as opposed to private wards? Does the quality of surgery differ from shared to single-bedded rooms?

These issues could be dealt with on priority basis, by making private healthcare affordable even if not as cheap as in the public hospitals. And public hospitals could be made more healthcare-friendly by upping the standards at every level, including reducing the level of neglect which comes by poor staffing at most levels, contrived non-availability of drugs which force patients to go and buy it from doctor-friendly pharmacists. Or, simply put, make both sectors caring.

These relate to ethics. To honesty. And it does not need a new health policy to attend to.

The author of this article is Mahesh Vijapurkar.

Source: Firstpost

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