Are we on the right path ?

Corporate healthcare for money has rapidly entrenched itself in India spreading its roots to tier II & Tier III cities. Confronted by the deep pockets of the corporates, small and medium healthcare establishments have already ceded defeat. That this is not in interest of the masses is a moot point which is ignored in corridors of power because the corporates bring world class infrastructure to India. Quality is the buzzword which is used to flatten all opposition to the growing corporate culture. It is presumed that the Government healthcare services are competent to handle all healthcare needs not met by these glitzy palaces of glass and steel. Those still not catered to always have Baba Ramdev and other Government sponsored quacks to heal themselves. Government is now pushing for corporatization even of medical education which is fraught with further dangers.

What however is sorely lacking is the audit of the bang for buck as it is commonly called. We need a unbiased audit of the factual cost of procedures done in corporate hospitals, Government Institutes, small and medium health care establishments. This audit should include 1) cost borne by taxpayer in form of land given at concessional rates, various taxation benefits given to various categories of hospitals, 2) cost borne actually by the consumer of services, and 3) cost of ancillary needs like transport , and loss of daily earning of the individual and other incidental expenses. If by various laws we want SMHCEs to conform to so called "standards" then this cost benefit ratio which I expect is very much in their favour will also change.

A simple question needs answer "Are small and medium private healthcare establishments really bad". Before confining them to the dustbin should not a proper unbiased study be conducted into the role they play in delivering inpatient and outpatient healthcare to masses. If they are criminals ,incarcerate them all. Using them to fulfill the duties which essentially are of the state and denigrating them in public seems fashionable to the political class. Many a politicians have made their political debut by leading mobs and vandalizing Small medical establishments. Many a news paper is sold with catchy, provocative headlines making murderer out of a senior surgeon in private practice. What needs answered is whether OT deaths occurred more in Small and medium health care establishments which charged a fraction or in the Government Institutions or now in the Corporate hospitals. Since no data is available every voice has its opinion depending on their own experience or agenda.

Each country has to develop systems to provide essential services to its citizens based on its resources and needs. We cannot and should not import a system from USA and implant it in a developing country. It is only my gut feeling but this over rapid corporatization of healthcare will reflect poorly in our health statistics and parameters. Again this is my personal opinion as is that this dictatorial course change that the country has been ordered to make towards plastic economy will cost us heavily. A gradual promotion of Small and medium health care establishments with incentives to improve their services, bring in quality conciousness while simultaneously promoting tertiary (maybe) corporate hospitals would have given better results. The corollary for the plastic economy similarly holds true. But then in absence of data these are only my personal views.

We need data on quantity and quality with cost analysis of healthcare provided by various categories of healthcare establishments and we at MLAG would like to start and fund such a study.

Dr Neeraj Nagpal 
Convenor,Medicos Legal Action Group, Managing Director MLAG Indemnity, 
Ex President IMA Chandigarh
Director Hope Gastrointestinal Diagnostic Clinic,
1184, Sector 21 B Chandigarh 
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