Monday, November 21, 2011

Corporatization of health

Indian government seems to have washed its hands off of providing health care to its citizens. Going by the evidence of measly allocation of funds in the budget for health and its acceptance of corporate hospitals to provide health care to its employees, the trend is firmly set that we are going the American way. What then is going to happen to the existing health infrastructure, the vast network of primary health care centers and secondary and tertiary care hospitals? If the present trend of encouraging corporatization of medicine continues it is inevitable that these institutions will gradually go to seed and one day will altogether disappear. Imagine the situation where in excellent institutions like AIMS [Delhi] PGI [Chandigarh] NIMHANS and Jayadeva at Bangalore deteriorating and becoming places where only destitute go!

Nations are spending a considerable percentage of their GDP on providing health care. As the population ages health care costs are going to go up and India is no exception. But neglecting government run institutions and encouraging private clinics and hospitals run by corporate and health management funds is the right way of providing health care?

Far from it, it is the worst way, especially for a poor country like India. Some you who are not Indians may wonder when I use the word poor to describe India. What you read or hear about India in the news and electronic media is all about the doings of the 5% of Indians who have done well for themselves.

This 5% is what the corporates are interested in. This 5% consist of the upper middle and the rich. Our politicians [even the grass root ones], beurocrats belong to this class. These are supposed to use the health facilities of the government. Hardly anyone does this and all of them with rare exceptions make a beeline to corporate hospitals when they fall sick or even for their routine health checks. If the top echelons of the government have no confidence in their own institutions how can one expect the ordinary citizens to have any confidence? They too will and have to go to these privately run institutions.

With increasing play by the private sector, falling ill has become a risky proposition. Let me explain. As the private players are mostly businessmen/venture capitalists/health management funds, the end point of their venture is to make money. They are not doctors who are supposed to think of patients welfare first and money next [many doctors too are becoming money first and health next thinkers]. They think of maximum and quickest return on their investment. If the investment is on building they will look at how much a square foot of the building will earn, if it is bed how much a bed will earn, or if it is human in the form of a doctor how much this doctor will earn for them. That is how they look at each item as money earners. Let us say the expected return on a bed is x amount in a year and the year end sees that bed earning is less, then the hospital administrator is pulled up and he in turn will pull up the doctor. The doctor who is so pulled up for not providing the hospital with enough business will either has to quit or adopt methods which his famous Hippocratic oath forbids him to. Most doctors are not in the real sense businessmen to begin with but they become one due to this kind of pressure. So what happens is this. When a patient goes to a corporate hospital and sees the doctor the first likely thought that comes to the doctor is how much I can get out of this patient and not what might be wrong with the patient. This attitude I am sorry to say is widespread and leads to lots of unnecessary investigations and procedures and needless hospitalization.

The sucker is the hapless patient. If he belongs to middle or lower income group, these institutions will make them feel that death would be preferable than the torment of raising sufficient resources to meet the expenditure that a hospital stay brings on.

This fear has led to the mushrooming of health insurance industry. This is another sordid story. Between corporate hospitals and insurance companies there appears to be a cozy relationship. It is not uncommon to hear the hospital reception asking the victim whether he is insured or not. If he is uninsured the smile of the receptionist is likely to be replaced with a frown. This is because you are likely to opt for less paying bed and at the time of discharge haggle, ask for concession, create a scene or as it happens occasionally, simply abscond!

So what is the solution? May be in the next write up.

1 comment:

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