If you had been a student at IIT Kharagpur and been to the state subsidized BC Roy Hospital,you would know it as a rule that an antibiotic,an expensive cough syrup or an expensive injection would be referred irrespective of your illness ,just to ensure that the doctor has his cut from next door chemist shop.At the beginning of this new decade, while our GDP continues to grow at more than 9% per annum,a large majority of Indian middle and lower class do not have access to quality health care.
When I refer to poor quality healthcare,I am not only referring to government hospitals where "no treatment" is guaranteed but also the new age private hospitals with their marble floored receptions and air conditioned wards that have taken the medical and healthcare industry to ridiculously low moral and ethical standards
If you are not a high powered politicians ,or do not have the right network to pull the necessary strings ,chances are your doctor will recommend you the tests ,medicines and treatment which might not cure you but would definitely inflate your bill to the size of your wallet.Horror stories going in air range from the speculative ones like targets given to cardiologists for monthly by pass surgeries to the confirmed ones like doctors recommending diagnostic tests just to pocket heft commissions.The situation has become so bad that the average Indian prays that he does not have to pay visit to the doctor "GOD" or his holy temple-the "hospital".
One of the most basic reasons of the current horror situation is the rising input costs for doctors and hospitals.The average cost of medical education at a private college in India runs to about Rs 20 lakhs over a 7 year period ,starting with 5 years of medical graduation (Rs 2 lakhs pa) and another 2 years of post graduation (Rs 4.5 lpa).Add to it the usual cost a student spends on preparing for medical entrance exams (Rs 2 lpa) and we are looking at a business with a long pay back period.While before liberalization ,medical education was mostly a state affairs and fees kept low and affordable,after education reforms ,private institutes mushroomed in across the country.Their was always ample demand for doctors in a country of 1 billions people and seeing the skewed demand supply ratio just helped increase the fees to astronomical levels.Besides,the healthcare education industry being unimaginative rely on student fees as a major source of revenue.The solution to all these problems is of course multi faceted.Colleges should look at tapping alternate sources of revenue ranging from consultancy fees to setting up sustainable rural health programme.Also more reforms need to be introduced to encourage private players to invest in medical education.Further ,the government can provide a fixed cash subsidy to all medical students in country
A second and most important factor that has led to the corruption of the noble profession in the country is the growing nexus between doctors ,pharmaceutical companies and diagnostic centres.Many multinational drug companies are known to provide commissions to doctors directly from their balance sheets and register them as marketing expenses.The laws like always are there to be broken by the rich and powerful medical and pharma lobby.The average cutthat a doctor can make by recommending patients to a particular diagnostic center can vary from 20-50% depending on test and no. of patients referred by the doctor.While nobody should deny medicine is business but at same time we need to form a framework which allows profits and real patient care to co exist before its too late.
Many social thinkers have contended creating stricter laws to ban such profit sharing arrangements..A pragmatic view would further help us realize any law so erected would be circumvented and made mockery of by the corrupt system.Moreover,if numerous other professions like law,travel and even business consultancy can benefit from the comission system,why not healthcare?A better solution would be to intoduce a new Prevention of Patient abuse act and make following inclusions in that:
- Establishment of separate fast track courts for medical legal judges to assure faster and time bound trials
- Treatment of medical negligence as a criminal act,when some person trusts you with his life being negligent is being criminal.Any doctor who can be negligent must be filtered out of the system
- Impose harsh punishment on doctors recommending unnecesary treatment or tests to their patients including but not limited to licence cancellation
- Establishing rating agencies ,that rate various hospitals and doctors in the country.This would help self regulation by industry
- Increase compensation to be awarded to patients in case of negligence by treating any negligent activity as a criminal act
The current legal system is clearly inadequate.Currently ,the courts rule only 28-40% cases in favor of patients at a speed which is characteristic of Indian judiciary.As a result,most doctors have never even felt the fear of litigation and licence cancellation is an act no doctor even thinks of even in his worse fear
While the world over ,politicians and legal thinkers are focusing on reducing healthcare costs what seems to have become more important now is to bring back the ethics of noble profession before its too late and the society forgets the difference between goons and doctors
I hope at least one doctor reads this article and understands and spreads the message intended.