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.