Healthcare in India is an industry in want of good management. The onus of providing this precious service has been divided between the private and public institutions. The public institutions are overburdened, under-financed, and notoriously mismanaged. The private institutions cannot claim to be any better. Although they provide a better work culture, they are famous for over pricing and over-investigating.
The poorest of the poor are always the worse affected by these policies. Disregarded by the government hospitals and drained of all savings by the private hospitals they are at the receiving end at all times.
The government in some states, has taken steps to fund the expenses of healthcare for BPL families by providing health packages. Although well intentioned, this is like most government policies is bereft of forethought for possible repercussions. An old adage summarizes this policy- "give a man a fish, and you feed him for a day; teach a man to fish, and you have feed him for a lifetime". Anything handed out on a platter, for grabs, is always ignored for value. Anything worked for or fought for is valued beyond its true price.
These schemes are also exploited by many- some who use it to obtain free healthcare not appropriate for their income, some who pocket money meant for medicines/services rendered and others who take kickbacks for referring the poor souls to an institution that would ultimately benefit from the ingress of money to its coffers.
No scheme involving large amounts of money can be adequately insulated in India from corruption. Unless we incorporate good work ethos and eliminate poverty- which cannot ever happen overnight- we are slaves to corruption!
How then, can we hope to implement better health care to our masses?
Instead of putting lump sums of money into schemes that concentrate on referral and private/public tertiary care setups, we must build around a three-tier system of healthcare with most of the finances and maximum emphasis on the base of the pyramid- the rural health care centres and district healthcare centers. A large chunk of problems can be tackled by these setups itself- if adequately staffed and equipped. Private setups in the rural areas must be encouraged- with incentives such as tax-free holidays (on the lines of IT companies); these centers must be monitored for quality of care by independent responsible observers. Medical colleges must be ordered to adopt a district level hospital and dispense the required heath care to all subjects in that district. Tele-conferencing between district level physicians and those at the tertiary care center must be offered for counselling regarding difficult to treat cases. Unless this kind of infrastructure is in place, it would be meaningless to deploy fresh medical graduates in the grass root centers by compulsion.
Private and public hospitals in two-tier and three-tier cities must be the next target of the government health policies. Only by reducing the burden (by diverting simple-to-treat case to the district level) on these institutions first, can we begin their reconstruction. Strict monitoring of health services dispensed must be undertaken to ensure quality care.
The final priority of the government must be the public institutions in the metros. These must focus primarily on specialized services and advanced training. Soaps and services must parallel the private healthcare setups to be able to survive the economics of the times.
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