Healthcare is central to economic, social, political and environmental prosperity of India and the country is moving towards providing accessible, available and equitable healthcare for all. Although health is a state subject, there has always been room for private providers who have matched the government’s enthusiasm for bringing world class healthcare to India.
The well-crafted National Health Policy document released by the present government is a step in the right direction for moving the health agenda forward. The real challenge lies in scaling up the proposed measures and its effective implementation which requires close coordination between the Centre and the states to channelise their efforts together to deliver on this vision.
Building institutional capacity by establishing AIIMS like institutions across India is laudable, but without policy changes in medical education these large institutes will struggle for workforce and students alike. There is a pressing need to bring down the cost of medical education so that the intake of students at the undergraduate level increases. In addition, the government needs to look at equalising post-graduation seats with undergraduate seats. Each year, 150,000 man years are lost as young MBBS graduates spend time preparing for a handful of PG seats available.
These MBBS graduates are not able to contribute to the society and are
desperately seeking PG seats as they are not allowed to do even simple procedures without a PG degree. Surgical procedures such as caesarean delivery, laparotomy and treatment of open fractures constitutes a large chunk of cases at any hospital. The government needs to focus on providing these surgical procedures at all CHC level hospitals as surgical conditions represent a significant proportion of the global burden of disease, and surgery is an essential component of health systems. There is a need for policy intervention to allow MBBS doctors to perform bellwether procedures.
The glaring shortage of specialists at government hospitals is a result of the above stated problem. One way to solve this is by creating intermediate-specialists. The College of Physicians and Surgeons, Mumbai offers two-year diploma courses in a number of specialities like anaesthesia, paediatrics, obstetrics and gynaecology, orthopaedics, radiology etc,. This CPS diploma has now been recognised by the MCI and will help bridge the specialist gap in India. There is a need for more such institutes.
And lastly, the government needs to look for ways to bring down the overall cost of providing healthcare without compromising on quality. The government needs to approach the issue of costing in a very systematic and scientific manner. Recently, a unique study was conducted to look at the cost of medical procedures in Karnataka by IIM Bangalore, Association of Healthcare Providers India (AHPI), NABH and the Government of Karnataka along with other stakeholders. The study looks at the actual cost of 20 common procedures carried out in private, non-profit and government hospitals.
The clinical pathway for each of the procedures/surgeries was defined by the respective societies, which are independent clinical bodies. This is a first-of-its-kind study and a pilot to understand the actual cost-incurred while using a standard treatment protocol. Hopefully, more such studies will be carried out in future to bring in transparency in healthcare delivery. The capping of price of stents and orthopaedic implants is a welcome step in this regard. However, this has affected the booming medical value travel industry as some of the products have been withdrawn from the Indian market and patient who can afford the cost are now seeking treatments abroad.