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சுவர் இருந்தால் தான் சித்திரம்


It was not an easy Sunday - I never imagined that I am going to collapse one day holding my stomach. With a hard deadline ahead of me I was twisting like an unborn baby. The thought worsened the pain even more. I might've heard this blog's title atleast a 1000 times in the month of august. An explanation of what happened after that will be a mere lament, so lets get past it fast. Learn that things are much better now. For some reasons, My mom fell ill soon after I got up - her plight was much worse than me. "August maasam" has become "Aaspital maasam" for the entire family. The experience gave me some serious questions about the state of health care in India.

There is absolutely no doubt that the age has come when we are able to receive the best Healthcare services in the world (I am talking only about the Allopathy). Modern medicine has developed very good diagnostic techniques, which even though are forbiddingly costly, are accelerating the treatment cycles. But the kind of cost a person is required to pay for such health care services is what scaring me. Today approximately 63 % of the population is middle class (based on the percapita income). if you ask Rama Bijapurkar, she might say middle class figures are always debatable, I am quoting the figure that CRIS quotes as middle class. Not all of them in that 63 % bracket can definitely afford today's health care services.

As per PWC's data, The % of the population that had affordability for western medicines and modern health care is approximately 4 % (approx 50 million). In coming years, this situation could improve with increasing percapita income, increasing average salary of the indian household (if more women participate in job market), increasing urbanization and strengthening of service sectors. These situations are anyway guaranteed to happen - but these situations come with a price, and that price is your body. As of today, India is the diabetic heaven for the world - especially Type 2 diabetics seem to be very prevalent in India.

This health care Industry is guaranteed to contribute more to the nation's GDP in the coming years. But, With the kind of booming demands for quality health care, are we really having good infrastructure and affordable health care services ? The answer is a disappointing "NO". Lets look in to the state of the plight little in detail. We are encountering several problems in this area - the chief among them is listed below:

1) Lack of adequate Healthcare Infrastructure:When it comes to Infrastructure, India is divided - any city in India is divided. Rural and urban infrastructure are not the same, while the people live in these regions and their anatomy are no different. The kind of diseases that these people will get is same while kind of infrastructure rural and urban india has is grossly different. While some of the urban cities (especially metros) are drumming up the hysteria of modern diagnostic techniques, proactive health check ups, sophisticated surgical procedures, the rural India is still decades behind for access to medical facilities. Even in cities all these medical sophistication are available only for a choicest small percentage of people.
Rural India is atleast 2 decades behind. Some of the states in eastern India are even worse. At one end, In order to attract foreign investment we are propogating the idea of medical tourism, and presenting statistics about how cost effective treatments are. On the other end we are having the natives who cannot afford even the basic medical care.
I am quoting a block of statistics mentioned in one of the documents I have referred in the bottom of this post. Take a look at that yourself.
The total number of doctors (all kinds included) per thousand persons stood at only 1.27 in 2006 and 0.5 physicians per thousand persons in India, compared to a world average of 1.5. The number of nurses per thousand persons stood at 0.9 in 2006 compared to a world average of 1.2. Added to this deficiency is the mal-distribution between rural and urban areas and shortages of specialized personnel. These ratios are projected to remain below the existing world averages even in 2016. The current ratio of beds per thousand persons is a mere 1.03 (well below the WHO norms) compared to an average ratio of 4.3 for developing countries like China, Korea, and Thailand, and in the best of circumstances is projected to reach 1.85 per thousand persons by 2012. It is estimated that over a million beds have to be added to attain this 1.85 ratio, which translates into a total investment of $78 billion (Rs. 350,830 crores) in health infrastructure. An additional 800,000 physicians are required over the next 10 years, which in turn translates into huge investments in training facilities and equipment. In order to reach even 50-75 percent of the present levels of other
developing countries, the sector will require an estimated investment of $20-30 billion.2 Thus, India’s healthcare sector needs to scale up considerably in terms of the availability and quality of its physical infrastructure as well as human resources so as to meet the growing demand and to compare favourably with international standards.
2) Lack of awareness among people for personal Hygiene: I think India is probably the only (or one of the very few) country in the world that urges its citizen to build toilets for houses. Nowhere else but in India, you will see a pani poori stall on road where a bus will be emitting its own share of smoke and where two of great indians dispose their liquid excreta (one of that will be your pani poori vendor). We are yet to learn to sneeze and cough with in our palms and wash the hand immediately after that. Unless its Swine flu of Sars, we are the group that is predominantly insensitive to the microbes. For several of Indian households, a liquid handwash or a cistern block is still a luxury item. Usage of common toilets in India is definitely a unpleasant experience - but that can be avoided with little planning.

3) Lack of awareness among people for financial protection against diseases: Health insurance - that's the term getting popularized recently. Health insurance as a concept hasn't even reached the urban india fully. In rural India, I am sure the adoption levels will be much lower.

4) Unaffordable state of private health care: The healthcare infrastructure in India is chiefly private infrastructure. General public neither in Urban India nor in Rural India have much confidence on the public health care facilities. But private health care is unaffordably costly for a comman man in rural India. Due to the scarcity of the medical professionals, the stress and strain that creaps in to the system for existing professionals is significantly high. You can't get treatment in any private hospital that is run by a corporate group with out an insurance. The normal bill comes in six digits. More often than not, the private hospitals prescribe more than warranted diagnostic tests, prescribing stay inside the hospital a period that is more than needed, etc. There are several angles to it - defensive medical practices, unethical medical professionals who take the patients for a ride, commission based internal arrangements between some private hospitals and diagnostic centers etc. But the bottom line is today's health care demands a lot of money.

So, Whos to be blamed ? I will blame the government. It is getting more and more evident that efficient healthcare from the government is becoming a day dream. Public health and safety should be the primary focus of the government - atleast the government that has the full majority for five years should have taken this as part of their main stream transformational agenda. Central funding to improve the state of public health care centers and to set up new health care centers should be atleast doubled. I could hardly envision that the state of government hospitals is going to improve in the near term. According to me, Government has also bought in to this thought. So handed over the responsibility safely to the hands of FII. The government opened the gates for foreign investment - this mere act is a testimony for itself that government is not able to raise capital and significantly improve the situation to meet the demands. We should appreciate the government atleast here.

In today's scenario, there is 100% FDI allowed in Healthcare sector. But the appreciation stops here. While investments can import equipments, drugs and purchase lands, what happens to the human capital? For the capitalist who is going to invest in India, is there a conducive arrangement for getting assured returns?

While we realize that there is a great demand for health care services, what are we doing about the supply side ? How many doctors are we generating year after year ? Medical profession unlike engineering is not a mere 4 year program. How do we attract and retain top talent ? According to Wikipedia (which in turn refers to American Association of Physicians of Indian Origin), there is close to about 35000 Indian American doctors? What are we doing to attract these physicians back to India and retain them ? Where is our accelerated program to generate doctors, surgeons, nurses and professionals for allied business. It is not sufficient to announce discount in the import duty for life saving drugs year after year in the annual budget. Government should facilitate more medical colleges with the help of corporate sponsorships (such as Fortis, Apollo). But that alone is not sufficient - Our management institutes haven't yet seen Healthcare Industry as one of the Industries for which they need to create curriculum. They should atleast create executive programs (a 300 hr program) for Medical executives. We need more doctors open their minds for Management education for effective management of health care education in India.

How are we equipping our people to meet their ever increasing medical expenses? Unless every one's per-capita income sky rockets, an ordinary middle class person will never be able to meet the medical expenses from the private hospital. The government should come up with the package of medical insurance as part of their compensation for all its employees and make it mandatory for any registered company to provide medical insurance for its employees as part of the compensation package. While our leaders are urging this, there is no policy level change. What we need is a mandate from government.

How is the government planning to protect the people from unethical capitalists and unethical medical professionals if such a level of privatization is allowed? What kind of regulations are we going to bring on to the table to ensure that private hospitals treat the patients fairly. This situation will also lead to empowering the consumers and the consumer protection act will attract significant amendments in the years to come.

OK, all these statements are wishful thinking. What can one do in today's scenario instead dreaming about a Utopian world. I have these tips for you
1) First get into the concept of Family doctors. Believe me, that will work wonders for you. Family doctors don't charge registration fee for maintaining your case history - but they understand your body and the family's background. If one of your trust worthy friends is a doctor, nothing like it.
2) Get Medical Insurance for the whole family. If you have elders of age more than 60 year, minumum coverage recommended is 2.5 lakhs - Dont think about saving this money and repent later
3) Get a lifestyle and keep yourself in decent shape as much as possible - If you are obese, REDUCE
4) Get yourself checked up atleast once in 18 months. If you have elders in the family, get them checked up atleast once in a year

Recommended Reading:
http://planningcommission.gov.in/reports/genrep/bkpap2020/26_bg2020.doc
http://www.pwc.com/en_GX/gx/healthcare/pdf/emerging-market-report-hc-in-india.pdf
www.whoindia.org/LinkFiles/Trade_Agreement_FDI-1.pdf
www.ficci.com/press/428/EMPLOYEES.doc

PS: My diary's pages are filled not in mother tongue, but in inherited one. Needless, to say that this is one of the leaves out of it and for some inexplicable reasons, I am compelled to embellish this with data and make a post out of it.

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