‘Government should aim to become a more proactive player in the healthcare sector’

In every major Indian city, corporate hospitals now seem to be on every corner. Modern air conditioned interiors, fancy reception areas, and lounges for foreign patients are a far cry from what the Indian hospital experience was like when the government released its last National Health Policy (2002) more than a decade ago. However, the prevalence of corporate hospitals is not an indication of the success of government intervention in the healthcare sector, but rather a symptom of its failures. Patients gravitate towards branded healthcare establishments because, unlike in the West, patient experience varies drastically based on which healthcare provider they use. In the West, health outcomes are relatively similar if a patient is treated by their local doctor or a premier hospital. India suffers from extremely limited government-mandated quality standards in healthcare and huge variability in the capabilities of accredited individuals and institutions. As the new government considers its next National Health Policy, it should weigh becoming more proactive in ensuring quality standards as well as working to create a larger supply of high quality healthcare workers; if it is able to do this, patient trust in the healthcare system and health outcomes will improve drastically.

Becoming the arbiter of healthcare quality

Non-governmental bodies such as the Joint Commission International (JCI) and National Accreditation Board for Hospitals and Healthcare Providers (NABH) have done important work in establishing standards for healthcare organisations in India. These standards need to become mandatory for all healthcare organisations instead of volition-based; however, the real problem comes in creating and enforcing mandatory quality standards for individual practitioners: this is where the government must step in. The Government of India needs to create a minimum quality standard that all healthcare practitioners in India must meet in order to continue practicing. This requires a three-pronged approach:

Re-registration/ licensing: The current licensing standards in India need to be revamped. Medical knowledge and standards are changing more rapidly than ever. Clinicians should be required to periodically demonstrate to the government that they are up to date on the latest developments in their field. While some states have elements of an organised re-registration process already in place, a concerted national policy needs to be implemented.

Auditing: There is huge variability in the quality of medical practitioners, especially in rural areas where quacks often abound. The government needs to create proactive audit units that spot check clinical skills and prosecute quacks posing as medical professionals. 

Focus on continuing medical education (CME): CME is currently largely provided by the private sector in India. However, creating standard CME modules to be completed by all medical practitioners has never been easier. The government should study the models of hugely successful e-learning start ups in the US, such as Coursera and edX, which carry the content of leading global universities and allow students to take classes remotely. The government could easily leverage staff at its premier medical institutes such as AIIMS to teach these classes and make them a mandatory part of the registration process in India, ensuring that all doctors throughout the country have received the same knowledge base.

Improving the supply of healthcare workers

Creating quality standards is an important first step in improving health outcomes for the average Indian; however, if there is an insufficient supply of healthcare providers, improving quality will have a relatively limited impact. This is a real challenge in India where there are only six doctors per 10,000 patients; in the developed world this figure is closer to 30. By creating a larger supply of high-quality healthcare workers, individual patients will be able to find credible medical professionals outside of the corporate hospital ecosystem. The Government can do this by granting more degrees, using workers more efficiently and making healthcare a more desirable career path. 

Creating more supply: The Medical Council of India should be open to creating more seats for doctors and nurses in India as well as make it easier for foreign trained medical workers to practice in India. The government should work with the Council to help it achieve these goals.

Using doctors more efficiently: In the West, nurses (and nurse practitioners) have begun to do much of the work that has traditionally been done by doctors. The Indian government should consider creating the Nurse Practitioner/Physician’s Assistant category in India. At a minimum, the Government should invest in heightening the skill set of India’s nurses so that more tasks can be shifted to them, freeing up doctors’ time.

Creating more attractive career paths: A large number of doctors in India have stopped practising and work in more lucrative (and less stressful) non-clinical roles. Clearer and more lucrative career paths will make healthcare workers more likely to continue practicing.       

Non-licensed healthcare workers: India needs a large number of paramedical workers including emergency medical technicians, home health aides and ward staff. The government has taken good first steps in this effort with the establishment of the National Skills Development Corporation, however, more concerted work and investment between the government and private sector is needed.

In its next National Health Policy document, the government should aim to become a more proactive player in the healthcare sector to prepare the country for a burgeoning population, a rapidly graying population and increasing prevalence of chronic diseases.

– Zachary Jones, Senior Vice President, Portea Medical