Rising above the chaos


Self- governance and holding each other accountable for good medical care is the need of the hour

By Dr Garima Singh

Everyday you hear of doctors being roughed up, hospitals being vandalised. Fundamentally, it’s the mistrust manifesting itself and a belief that society at large does not protect individual interest, and its ok for things to be taken in their own hands as lawlessness abounds. When this helplessness sets in it’s but natural that extreme behaviour will manifest itself.
In recent times, medicine as a profession has been singled out by the Government, media and public at large. Underlying notion is that doctors and healthcare providers are only interested in filling up their pockets. No profession particularly as noble as medicine needs to bear the blemish of such disparaging comments. A profession comprises scores of individuals with their own ethics and values. To say that doctors and hospitals in private are out to mint money (implying malpractise) is like saying all lawyers except public prosecutors are liars. Every profession requires individuals to take informed decision in line with codes and ethics listed by their professional bodies. Individual greed cannot be assumed to be practised at large. There are many sides to a situation. Have we or the people who report one sided stories pertaining to private healthcare taken time to evaluate what the current healthcare scenario in India is like?
 To serve a population of 132.42 crores, we need 4,97,189 doctors more.
 We need 2.6million beds over the course of next decade,
 India’s current health expenditure per capita (CHE) as a percentage of GDP is 3.9%, much lower than world average of 6.78% (according to WHO’s statistics for 2018).
 India’s CHE per capita is also low at $63; in countries with low CHE, proportion of spend in health to total expenditure is higher among households.
 Most developed nations like France, the UK, the US, Canada spend about 8% of their GDP on health.
 India allocates less than 6% of Govt resources to health, less than many African countries.
 Govt spending in healthcare as a percentage of GDP has fallen over the years and led to consequent rise in private healthcare.
 Private health sector: It consists of 58% of the hospitals in the country, 29% of beds in hospitals and 81% doctors. As per the National Family Health Survey-3, private medical sector remains the primary source of healthcare for 70% urban households and 30% rural households.
 Majority of population living below the poverty line (ability to spend Rs 47 per day in urban areas and Rs 32 per day in rural areas) rely on under financed and short staffed pubic sector for its healthcare needs.
 Growth in Indian healthcare sector is attributed to the private equity and foreign investments in the sector. These boost innovation and advanced healthcare delivery. However, these are largely focused on private healthcare, making public health system largely underfunded.

Most developed nations like France, UK, US, Canada spend about 8% of their GDP on health.

Now visualise the heavily burdened infrastructure (both Government and private). Is this problem even in focus? As a citizen of this great country we are stuck since, on one hand, public hospitals have long queue, apathetic staff and poor compliance to standards and protocols and, on the other hand, private hospitals are prohibitively expensive on account of their high costs and to meet obligations to their funding sources.
Let’s also reflect on medical fraternity- as a fraternity, physicians have abhorred peer governance, data sharing, reporting outcome measurements in India leaving the door wide open for fingers to be raised against our good doctors. Self- governance and holding each other accountable for good medical care is the need of the hour.
Now that we have understood different facets of our healthcare environment let’s try to understand some of the recent events which have hogged media attention; and sometimes it’s best to refer to age old wisdom when grappling with unexpected situations. Evident mistrust between doctor and patients and amongst the fraternity in India can probably be addressed by referring to Hippocrates oath which came about in 500 BC. Hippocrates remains the most famous figure in Greek philosophical medicine. The oath represents a prevailing ethos rather than professional edict but it still regarded as the fundamental governance of the medical profession. It mostly talks of the following:
1. Coordinated instruction and registration of doctors – intention being that the public has to be protected as far as possible from charlatan (try and apply the bridge courses for AYUSH doctors recently being suggested to this principle).
2. Doctor is there for the benefit of his patients and to the best of his ability he must do them good and he must do nothing that will cause harm (principle of beneficence and non-maleficence).
3. Limitation of one’s practice to that in which one has expertise (it may be interpreted as self and peer governance in today’s world).
4. Doctor cannot take advantage of doctor patient relationship.
5. Patient confidentiality.
Modern medicine is expensive in countries where health is mostly provided by private sector which are mostly funded by PE firms and usually tend to have high costs with little or no subsidies. In the western world, philanthropy and religious orders sustain neighbourhood hospitals and hospices which are vastly different from the current scenario in India.
Questions that I leave you with are: Is the bulk of today’s discontent against private healthcare arising out of failure to meet the financial obligations when receiving medical attention? Who is responsible for making heath accessible to the citizens of India? Can access to healthcare be improved if appropriate funding can be deployed in public sector and subsidies in costs are provided to private healthcare?