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  • Category: Miscellaneous

    What can be done to improve the health care system in India to ensure better health for the citizens


    India does have an efficient Health Care system that branches out right from the Center to the Panchayat and even Village levels. But is something lacking? Is the administration able to maintain and manage the health care system in the way it has been intended? Has the rise in number of private sectors in the field complemented to the system or has it become a competitor to government machinery? What all need to be done to regulate and improve the system so that the citizens at all levels are benefited?



    Everyday newspaper, TV news segments, Whatsapp and other social media is filled with issues related to healthcare delivery in India. It is often related to funding, profit, lack of care, lack of supplies, rising costs and so many connected issues and finally and sadly, loss of too many lives.

    The private sector and the public sector healthcare delivery systems are often opposite of each other except in premier government institutions. I think what we need to improve the health care system in our country is to bridge the gap between the government and private sectors in the field. We need to ensure a strong monitoring system and have a dedicated coordinating team at the center level. The private sector should be strictly regulated and be made more affordable and at the same time, the public sector has to be made more reachable, efficient and safe. Can these two vital sectors along with number of NGOs and other organisations working in this sector compliment each other to deliver quality health care to the Indian population?

    Kindly share your thoughts or views. What do you think are the drawbacks of our healthcare system and do you have any suggestions?
  • #608582
    Good suggestion from author. Yes it is the fact that some government doctors are very good but the government hospitals are very bad maintenance wise. Like wise many private hospitals are very good hospitality wise but when it comes to doctors, some are very costly and some are moderate. If the authors suggestion has to be implemented, the government must em -panel all the government doctors as the consultant in private hospitals and the private wards should be opened to government patients. Though some private corporate hospitals are giving treatment to the poor, but very few cases are allowed based on emergency.
    K Mohan
    'Idhuvum Kadandhu Pogum "
    Even this challenging situation would ease

  • #608716
    A very thoughtful thread on how can we improve the health care system in India. A lot of improvements have been made in this section in our country but the situation is almost same. Private hospitals are very good in infrastructure and facilities towards the patient, providing proper care to the patient but the biggest problem arising here is money. Private hospitals demand accordingly for that for the best facilities they provide. And this becomes a slap for people belonging to middle class family or highly poor sections of our country. They end up going to government hospitals for treatments because they cannot afford to pay for private hospitals.

    While if we take an example of Government hospitals, the facilities are completely worse, unhygienic in all senses. And similarly the fee is less there. So, those poor sections or even some people from middle class family prefer to go there, because they can bear the costing.
    It is a very good idea that private and public sector should shake their hands and work in contribution to help those in need of treatments. If this is implemented, health care system could be improved in a much better way.

    A positive attitude will lead to positive results.

  • #608726
    In this regard I wish to make a important mention that every private employee or teacher who is working in big organization are covered with ESIC and they are issued a card. The card is supposed to be your entry to any hospital of ESIC dispensary for any emergency treatment. But invariably the card is not accepted in dispensaries and they seek on line registration forms. Whereas the ESIC policy says that every employee cannot be denied the medical treatment citing paper work. The government is spending huge money on health for the benefit of people but the staff in between are doing over action and denying the facilities.
    K Mohan
    'Idhuvum Kadandhu Pogum "
    Even this challenging situation would ease

  • #608761
    A good point for discussion. Indian Government and state governments are allocating a lot of money for the healthcare system. But the results are not at all in proportion to spendings. The main reason for this failure is sincerity in the service. Whatever money spent by government is not getting fruitful results. A Government doctor who is very efficient will have his own clinic outside and ask the patients to come there for treatment so that he will get some extra money. If a question is posed to him about this his answer is that there are no facilities in the hospital. It may be true also.
    As expressed by other members the corporate hospitals are charging very high charges which are not in the reach of the middle class forget about lower income class. Again government has taken an initiative to reimburse the expenses directly to the hospital if the patient is a lower-income group. This program is very nicely utilized by the private sector hospitals to encash a lot of money from the government. Some rich people also somehow obtained the required cards under this scheme and utilized the facility. That has led to very heavy expenditure for the government.
    If you deeply study the subject the problem is not actually with the funds, but with the correct usage of funds and creating facilities in proportion to expenses. For this sincerity and commitment from all the stake holders is the important issue. If these two qualities are imbibed by all the bridging of the gap between the government hospitals and corporate hospitals will not be difficult.

    drrao
    always confident

  • #608826
    I agree with the author that the time has come for us to have a re-look into our health care system. The government agencies responsible for healthcare need to introspect why more and more people are relying on the private hospitals and other agencies despite the high cost and non-affordability when the government is providing it for almost free. Steps should be taken by the government to ensure that facilities at par with the private sector is made available to the people so that they begin to choose the government health centers against private hospitals. I personally feel that what basically need to be changed is the attitude of the doctors and other paramedical staff employed in government sector. They need to realize that they are not mere government servants but have a bigger responsibility at hand. They need to be reminded of the ethics of the service they are in and the need to reach out to the public and give them the assurance that their health is in safe hands.
    'Real knowledge is to know the extent of one's ignorance'- Confucius

  • #608828
    This is a very important as well as burning topic today. Healthcare is a segment which has tremendous potential for growth and enormous opportunities for private sector.

    Unfortunately in Govt sector due to lack of governance the healthcare system is in shambles and the situation inspite of availability of sufficient funds is really pitiable.

    Under this situation one solution which comes to mind is total privatisation of these services. The only problem or fear in that is probably the poor class will not be able to avail those services due to financial constraints and the main purpose and objective of Govt in today's perspective to serve people in interior areas through Govt dispensaries will be defeated.

    So theoritically there are or may exist multiple solutions but in present scenario due to poor governance it does not appear that any such method will be successful.

    Some radical changes are required which the present Govt is also trying very hard and we can hope a suitable outcome in this sector.

    Thoughts exchanged is knowledge gained.

  • #608834
    The basic health care system programmes in India operate under two sub scheme of National health mission namely National rural health mission and National urban health mission. These schemes are basically integrated with government to eradicate diseases which are curable by vaccination like polio, tuberculosis, measles, chicken box etc. and reduce MMR, IMR rates. Health care system starts with primary health centre, district hospitals, city super speciality hospitals to research institutes in Government sector. The problem in government sector it is overloaded with responsibilities. We must understand that Government institutions are not only involved in health care but also aid government in crime , investigation.
    Further any disease outbreak like cholera, MERS, Zika virus, is exclusively under government hospital control. Government doctors find it hectic during these outbreaks with tracking the disease, quarantining the affected and treatment. Private presence during disease outbreak is minimal.
    The creamy layer among government doctors are in premier institutes like JIPMER, AIIMS, AFMC, State medical colleges and so on. They mostly concentrate on research, teaching and are also part of hospitals attached to these hospitals. No doubt they are one of the finest doctors in world indeed.
    There is a popular misconception that treatment in government hospitals is pathetic with several newspaper reports on them. But in reality the resources in government hospitals both human and infrastructure are extremely strained.
    And also cost in government institutes is very less . For eg, a kidney transplant in JIPMER costs 1/10 th of what it is in a private hospital.
    Even private hospitals in cities are only better and in rural areas private clinics are not functioning well.
    We can also find that most cases of not judging the disease correctly are from private hospitals only despite expensive lab reports. Private hospitals refer certain cases where they find too critical to government hospitals. Government hospitals which treat at the extreme stage of disease fail obviously with less resources.
    Of course some private hospitals have excellent infrastructure but are too expensive. They utilise the cheap human resource available in India like paramedic staffs, doctors etc and increase their investment.
    In government hospitals the main problem is time in diagnosing. This is due to burden over doctors and people must also understand that though government doctors diagnose by taking time they diagnose correctly with fewer tests.
    And also health policy of government is outdated with government must take steps to come to new realities of society. Government must realise that diseases like diabetics mellites, heart problems, phsycological problems are new challenges and must have dedicated schemes for them like polio, tuberculosis,etc.
    It is encouraging that the new government is encouraging traditional medicine by establishing ministry of AYUSH and have established new AYUSH hospitals as part of allopathic system and also as dedicated centres. The treatment is good and cost is a fraction with less diagnosis. For common fever, cold, diabeties, these centres are really good.
    The next big problem in India is trauma resulting from accidents. For these ministry of road transport and highways have to play a major role. Avoidable accidents must be reduced with a better motor vehicle policy the discussion of which goes beyond the mandate of the debate.
    Next health is a holistic policy in India. We must have better NFSM, education policy and even intellectual policy to have better health system. But discussing them specifically would be beyond the mandate of the thread. We must discuss them in future threads.
    Finally the concept of community managements of atleast at the level of all primary health centres must be established with grams Sabha given administrative control over them. This will increase the transperancy and also help by increasing awarness about hospital procedures to people. The next important issue government must consider giving some income slab for free treatment in government. People above the slab must pay normal far for government services. This will improve the finance of government hospitals. Also legal provisions must be strictened to utilise these funds purely for infrastructure development of government hospitals and not for other government expenses.
    Recently Niti ayog is considering contracting government facilities to private for specified period to improve efficicincy. But this will only further put pressure on government resources. Surely Government must consider increasing health care spending.
    During disease outbreaks , natural calamity private hospitals must also be encouraged to aid government by including them on board and making it mandatory for them to lessen the cost atleast during those difficulct times. Private doctors must be sensitised on c section delivery mechanism because it is responsible for rampant exploitation. Private doctors must also be sensitised in disease diagnosis and outbreaks.
    Government must consider implementing the non practising allowance policy in premier institution to all other government hospitals.
    Next medical education regulation is seriously needed in India. The need for crores of rupees on medical seats must be justified in private institutions. The recent neet controversy has clearly brought out the issue. I completely agree that private institutions need enormous amount to the time of hundreds of crores in establishing medical facilities. But government colleges have the largest patients giving more scope for study.
    Also government must consider establishing AIIMS like IIT drive of UPA government in 2010 by establishing one. IIT/ NIT in every state or union territory. Central government must seriously consider something like that.
    The concept of tribal hospitals by NGOs is very innovative. These tribal hospitals use tribal medical knowledge in addition to common medicine in tribal areas thereby enabling research, inclusivity. Even logistics need improvement. And also there needs to be better drug pricing policy.
    Finally I congratulate the author of thread for bringing a relevant and least discussed issue into forum. Members have given excellent suggestions in above responses.

  • #608913
    Glad to see the responses and suggestions coming in. Look at any western country. Anyone paying their taxes has access to a decent healthcare delivery system. Only in India, the taxpayer does not have access to a good government health care services (barring a few). If one looks around or gathers information from the media about the public sector hospitals, its easy to find a common set of factors emerge as key to the underperformance - corruption, lack of realistic policies, lack of funding, lack of infrastructure, lack of access, lack of benchmark indicators to assess the quality of public health care services and lack of commitment of from the supplier and the end user. On the other hand, if one looks at the privative health care units the common factors that stand out are expensive,

  • #608929
    Response to #608913
    But sir the the problem of corruption is in western countries also. And people are phsycologically thinking mostly government institutions are corrupt. But majority government workers are not corrupt. It is true and I admit that corruption is there. But it is there in private instituions too.
    There seems to be a thinking in this discussion that everything is fine in private sector except expensive. But this is not true. Disease wrong diagnosis is mostly from private sector. Particularly even simple procedures are complicated just to increase cost of medicines. Most of us would know that many normal delivery are wantedly changed to c section delivery of birth just to increase the cost of treatment. This has great effect on the health of our women.
    The problem of super bug in India is created by private clinics. Not everything is rosy in private sector as few members are pointing out. And during disease outbreaks private hospital research and studies are not enough to even identify the disease. That time the only hope is Government hospitals.
    In India major health problem can be classified as these:
    1. Vaccinated diseases like polio, tuberculosis, measles, chickenpox,
    2. Life style diseases like diabetics, heart problems and phsycological problems,
    3. Trauma.
    4. Organ transplant needs.
    In each of these government hospitals outperform private clinics in treatment. The problem is people need immediate solution to diseases and this is exploited by private instituions. This is responsible for many side effects and anti biotic resistence in India. It is true the more the time a person is unhealthy it is economic loss to his family but government hospitals mostly suggest the right amount of medicines and treatment to cure the disease with a little time delay so the person doesn't generate any unnecessary complications.
    I may seem to support government sector. But to reduce out of pocket expenditure of poor people on medicine improving institutional mechanism of government hospital is the only solution and not gradual privatisation.

  • #608954
    I was thinking about the role being played by Health Insurance Companies. Don't you think they have started playing a major role in our health care system? Where should we go and what all should we do is almost decided by these insurance agents. What do you say?
    'Real knowledge is to know the extent of one's ignorance'- Confucius

  • #608958
    The Health Insurance Companies are all business houses at the end of the day. They need clients who in turn need clients big or small and these clients are we the people. Due to increasing competition and various factors influencing the supply and demand, it would be very difficult to ensure transparency. Everyone wants to safe guard his or her slice of the pie ( profits), so questionable alliances would have to be formed, favouritism creeps in and to satisfy the core aim of a business (being profitable).

    Stringent guidelines have to be laid down right from the quality of care, the capability of the hospital, remuneration for all involved on both side and hence the premium paid by the people buying the health insurance. Unless there are regulators with the highest integrity doing this work, sadly the end users shell out more and more, the service providers & companies pocket more and more.

    A section of veterans in the health care profession feel that we lost the battle, the day commercial aspects of health care took the upper hand over the so called noble cause of helping one the heal.

  • #608980
    This is a very important subject and requires serious deliberations. Today healthcare industry is multi million rupees industry and growing at a tremendous rate. There are many private hospitals in addition to a lot of government dispensaries.

    Unfortunately the real benefits of healthcare system are not going to the poor and downtrodden class. Government has many schemes in urban and rular areas and it is spending a lot of money through annual budgets in these schemes.

    There are some top class private hospitals which provide very good health care in India but they are very expensive or even beyond the capacity of middle class people. Only rich people and those who are having health Insurance plans can take advantage of these hospitals.

    Our health care system is full of many deficiencies and requires a thorough overall. Poor governance in the system is adding fuel to the fire.

    We have to create an integrated healthcare system which can take care of all levels of society. It may look today like an utopian scheme but the dream may come true if the present Govt is successful in this direction.

    Knowledge is power.


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