India has the best minds in medicine. Many advanced hospitals have made India one of the most sought-after destinations for medical tourism, by making low-cost medicines and vaccines to patients from across the globe available.
Yet, affordable healthcare is still out of reach for most people in the country. As the public health delivery fails to meet the needs of a rapidly rising population and the costs at the burgeoning private sector goes through the roof, basic public health delivery needs a booster shot to maximise outreach and impact. The centre and states need to adopt necessary measures listed below, to improve affordable healthcare both in the short- and long-term.
Some states including Delhi provide free essential medicines, which are also available at nominal costs in Jan Aushadhi stores. State governments need to closely monitor medicines’ availability to ensure continuous supply. The popularity of the scheme is obvious from the increasing footfall in government-run hospitals in the states where these drugs are available. Add to this an effective price-control policy to bring down cost of drugs not included in the essential drugs list.
Access to affordable investigation facilities, including blood and imaging tests, is a must. Expensive high-end diagnostic tests such as ultrasound, X-rays and CT/MRI scan needed for clinical diagnosis, are often unavailable in public hospitals for unavailability of reagents for tests, breakdown of equipment or lack of skilled personnel. High costs make these tests out of reach for thousands, delaying treatment. To ensure that high-end facilities are available in district hospitals, state governments must consider effective public-private partnership models to provide the required services.
24X7 emergency services
A medical emergency is a frightening and stressful situation for patients and their families. Yet trauma, surgical, gynaecological and paediatric emergencies at most public hospitals are below the desired standards. Skilled specialists, technicians and investigation facilities are lacking in most, which, coupled with bed shortages, force patients to seek expensive treatment in private hospitals. The seasonal dengue outbreaks in Delhi reiterate the importance and need for adequate and affordable emergency facilities in government as well as private hospitals.
Apart from the emergency medical staff, specialists from medical/surgical disciplines should also be available 24/7. Ambulance services, including those in collaboration with the private sector, also need an upgrade.
Barring a few major government hospitals, public hospitals largely do not have the infrastructure and expertise for elective surgeries and highly specialised treatments, forcing patients to suffer or leave their homes to seek treatment in metros. Government hospitals need to be upgraded to provide secondary and tertiary care to low- and middle-income groups.
In addition to central welfare schemes, each state must also introduce and implement relevant welfare schemes. In Punjab, for instance, cancer patients are given financial help of Rs 1.50 lakh and the Bhagat Puran Singh Swasth Bima Yojna provides cashless treatment to blue ration card holders for up to Rs 30,000 in the state’s 214 government and 216 impanelled private hospitals. Integrating these schemes would reduce duplication and make treatment seamless across state borders.
Empower public hospitals, clinics
Medical colleges, district hospitals, community health centres (CHCs) and primary health centres (PHCs) must be empowered by states with financial and advisory support from the centre. Several innovative measures within the available resources can be adopted to improve services in government hospitals.
Regulation and monitoring:
Accrediting hospitals should enforce the same standards of care, and closely monitor services and programmes to ensure standard care and treatment protocols are followed across India.
District hospitals must be linked with adjoining medical colleges and PHCs and CHCs to improve quality of care. Treat referral cases locally to lower the load on district hospitals;
Post resident doctors at district hospitals:
As the workforce requirement for the healthcare sector is expected to grow, from 35.9 lakh in 2013 to 74 lakh in 2022, resident doctors, training for their master degree, must be posted, for two to three months, at a district hospital. This will give them the required clinical exposure and fill vacancies in understaffed facilities. Skill India Mission must focus on training medical professionals like nurses and paramedical staff to work with these doctors.
Raise funds to plough back into patient care:
Funds allocated to run a government hospital can be raised by introducing a minimal fee for the Out Patient Department (OPD) tests and investigations. This will ensure that patients get all services under one roof. The poor, of course, must be completely exempted. This approach has drawn flak and been labelled “semi privatisation of public hospitals” by its critics, but it is an effective way to supplement limited resources and provide services at an affordable price. Major tertiary institutes such as the All India Institute of Medical Sciences in New Delhi and Postgraduate Institute of Medical Education (PGI) and Research Centre Chandigarh follow this practice with a satisfactory outcome.
Raise private funding for district and community health centres: A district welfare committee under the chairmanship of the deputy commissioner should actively support the hospital and encourage donations from the local community. This will add to the available infrastructure and help offer more medical services.
The writer is an advisor to Government of Punjab, chairman of cardiology, Max Healthcare Institute and former director of Postgraduate Institute of Medical Education and Research, Chandigarh