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For a healthier nation

Healthcare delivery system in India needs a significant overhaul.

For a healthier nation

That a family had to pay 16 lakh rupees to the Fortis Hospital, Gurgaon, for the treatment of dengue fever, that too when their child did not survive, and a similar case from Medanta Hospital Gurgaon is a matter of shame for the nation which is aspiring to be world leader. This is a pathetic situation and total failure of the healthcare delivery system. In our country 30 per cent of the population lives below poverty line with a per capita earning of Rs.32 in rural and Rs.47 in urban areas and another 50 per cent population is marginally above the poverty line. It is beyond comprehension that how these people can afford even basic healthcare what to talk of tertiary advanced care like the one being provided by Forits hospital and the like. Even the middle-class population, which is nearly 26 crores and who, by accepted definition, earn Rs.60,000 approximately per month, find it difficult to bear such huge expenditure. That is why 6.3 crore people are pushed below poverty line because of out of pocket health expenditure.

No doubt we boast of a highly advanced medical care system in our country, but forget that the system of healthcare delivery which we have developed makes advanced healthcare unthinkable for 80 per cent of the population. Many of the corporate hospitals have been given land on lease at throw-away prices. They are under obligation to give free healthcare to the poor strata of the society. But in actual practice this is not happening. Last year the Dayanand Medical College and Hospital in Ludhiana, a private concern, had issued a circular that unless an advance deposit of Rs. 20,000 for ICU and Rs. 30,000 for ventilator is made, a patient will not be admitted. This is completely in contravention to the Supreme Court directions, which say that no one can be denied medical care on the consideration of money. It was only after lot of agitation by the people and intervention by the Punjab Medical Council on complaints by the people of the area that the hospital withdrew the notice.
The incidence of Fortis hospital has thoroughly exposed the utter failure of the government to provide healthcare to the citizens. What else can be expected when the Central government's spending on health is a meager 0.26 per cent of the GDP as against a minimum of 5 per cent required to meet the basic health needs. The current policy proposes a financial investment of 2.5 per cent of the GDP—not now but in 2025. In contrast, the high level expert group of the Planning Commission (2012) had made a financial estimate of at least 2.5 per cent of the GDP by the end of the 12th Plan and 3 per cent by 2022 (Imrana Quadeer).
Disease is not by choice. There are several factors beyond the control of an individual that become the cause of illness. Therefore, all these have to be addressed to make a healthy society. In the present scenario, the onus of illness is being put on the individuals. Therefore, instead of tackling the causes as a whole, the focus is being laid only on healthy diets, regular exercise, avoidance of stress etc. by the individual. The social determinants of health, such as access to balanced food, sufficient wages, proper living conditions, education, conditions in workplace are being down-played. Major attention is towards non-communicable diseases. Even though they form an important component of the disease pattern, the infectious diseases like resistant tuberculosis, sepsis, malaria, dengue and chikungunya still form a major part of the disease pattern in our country. There is an attempt for complete distortion of the concept of health care, as is evident from the statement of the Health Minister of Assam, who links the disease to Karma and says "God makes us suffer when we sin. Sometimes we come across young men getting inflicted with cancer or young men meeting with accidents. If you observe their background you will come to know that it's divine justice. Nothing else. We have to suffer that divine justice." He also said, "In this lifetime or in our previous life, or perhaps my father or mother... perhaps that young man did not do anything, but his father has done something wrong... no one can escape divine justice."
The healthcare system has to be revamped. It is high time the medical profession as a whole plays a proactive role on these issues and joins hands with social groups to change the health scenario; otherwise, we will be having a sick society devoid of healthcare facilities in time to come. IPA
(Dr. Arun Mitra writer is senior vice President Indian Doctors for Peace and Development, Former Chairman Ethical Committee Punjab Medical Council & Member core committee ADEH.The views expressed are strictly personal.)

Arun Mitra

Arun Mitra

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