Is it worthwhile to visit a government hospital at all?

Karnataka boasts of Medical Tourism as one of its most ambitious tourism attractions.  It is catering for the novea rich and local 'haves'.  But 'have nots' and government employees themselves have no faith in their own health care systems that are lacking in money, man power, infrastructure, life saving drugs, corruption, exchange of babies for gains, the list is long.

- What people want is minimum possible health care and emergency services during that 'golden hour' and when the sirens are blaring and rushing madly to save the life of the sole bread earner of a family.  These simple needs of aam aadmi are not available even after he reaches government hospitals.  To carry the sick person inside on a stretcher needs greasing of palms.

-  Administrators wake up and start rubbing their *eyes* for identifying some means to combat an incurable disease only after it has hit the BPL/Slum areas, some dead bodies are lying around etc. 

- Instead of letting the people die unnatural deaths due to medical negligence or lack of infrastructure by the service providers in government maintained hospitals, despite collection of taxes from people, it will be better to close down these 'Narakas', allow private hospitals to treat  people with qualified doctors and para medical staff with a sense of service, regulate fees and operation charges for identified sections of the society, open more and more peripheral/ essential services from government funds like, diagnostic, scanning, x-ray, drug stores at subsidised rates, elders homes, creches, orphanages, etc.

- Prevention is better than cure does not exist in Govt's dictionery.

Medical tourism for ordinary people in Bengaluru/anywhere, is like "ootakke illada uppinakaayi..."

- Anybody listening?

- Vasanthkumar Mysoremath

There is no simple answer to the title of this thread. Even today, the best of Indian doctors (like our engineers) come from public funded teaching hospitals. If you were knocked unconscious, your best bet of surviving may not be in the adjacent private hospital that refuses to accept unknown patients but the local public hospital that offers emergency services.

Many sectors in India are ailing, some could (as some believe) thrive if they were privatised. Not every sector can or should be privatised, health is one of them. As a doctor, my prime responsibility is to treat the patient as per clinical needs and not based on their ability to pay. Private healthcare thus in itself creates an ethical conflict. Ethics aside, no developed country has a satisfactory private healthcare model - US healthcare is in shambles despite a 15% of GDP worth money spent on health.

I can write reams on NHS and EU models, especailly the purchaser-provider model, but will not do so for want of time. It would be academic anyway, as if our health ministers were keen they would have snapped it up long ago after repeated jaunts to West on study tours.

Rather we can simply focus on how much we spend on health in India. On paper we spend a healthy 6% of our GDP (UK spends about 8). So what is the problem? Less than 1% comes from Govt funds and 5% is out of pocket spot purchase of expensive services provided for a significantly small minority of Indians who work all their lives saving for the bypass surgery (or the like when they hit 60).

The first step if we hope to reform our health and social welfare is to start a mandatory National Health Insurance scheme (no, not private - those interested may study US failings in their own time). Let every one pay 10% of their salary and employer pay 10% in addition in to this fund (over and above usual tax).

When I say the above will actually fetch year on year a large pot of money, the bog standard answer is - but a very small proportion of Indians are earning money enough to hit tax brackets. Well, on average only 30% of EU population pays taxes!!

Last year IR collected Rs 1,47,197 crore in taxes. India's budget for health is Rs. 16,534 crores in 2008-2009 (yes, the states contribute similar such petty amounts). One can imagine that very easily a massive corpus can become available for reforming the ailing health sector through a mandatory national insurance scheme.

Sadly, one needs to only compare these figures with amounts spent on less than 100 million people in 6 metro cities. Compare the above budget with the estimated loss of revenue through tax sops to SEZs (companies that do not need tax sops are milking the system - India needed to get rid of license Raj, investment flows where there is a market, tax sops or not). 

Again, I must end as an insider who informs, privatisation is not the answer - one needs to be a doctor to know how corrupt the private health sector is (it beats public sector hospitals in this regard many times over). As for Medical Council of India, the less said the better.

ASJ 

We spend 1% of our GDP on public health. Yesterday it was in news that 50% of us are BPL. WHO norms for health spend in developing world is 3.5% of GDP. Most downtroden economies in developing world do better.

I have no evidence of there being enough money. How does one define enough money in the context of 50 years of under spending (Bhor Committee immediate post independence had recommended close to 9% spend).

In 07, I visited a WHO center of excellence de-addiction ward in Mumbai to lecture. Damp, leaking walls, dim lights, pealing paint, rusted beds........what a way to rehabilitate - it felt as if everything on the ward resembled the country liquor shop.

90 minutes from Mumbai, in Thane tribal areas or western coastal villages - we went there as interns in mid 90's. There was PHC with no furniture. What more when it rained, it was expected that doctors waddle through knee deep sludge, there was no access road. Villagers said, they have no access to anti-snake venom, they put a victim on hand cart, take them to nearest local train station (30 minutes away) and then get the person to a hospital.

In 95/96 I and my colleagues toured a mental hospital, massive site, thousands of petients with severe psychiatric problems. Dress code - cement bags with 3 holes cut open to convert it in to a vest. Nurses said they have so many that no one is aware of patient names, they do a head count each evening. Shock treatment does work, but the method used here was without anesthesia (a la torture), something that happened 70 years ago. We were then taken to backwaters - dirty wards - the most ill patients, lying naked, not a shred of cloth, but that to surrounded in their own urine and stools. Ironically, the patient who is most well in the lot does the cleaning.

I spent 10 years, my mother retired as Prof and Head in a teaching hospital. After 35 years of her service, a graduate from poxy MBA institute earned more than her. A call center class XII student with fluent english got more than a lecturer's pay. This is still true in many states. Every pay commission gave small rises with retrospective dates, we never saw the money for up to 3 years on average.

In Mumbai, I have worked in Dharavi, Cheeta Camp, Shivaji Nagar Camp (transit camps with refugees from B'desh) - we saw patients, we dispensed medicine with our own hand. People were supposed to queue with their own unwashed bottles in which we would pour paracetamol or other medications for their kids. We used to make paper pudi - the kind of stuff that holds channa sold on streets - and dispense tablets in same. We would go house to house to immunise kids and did this standing on swamps and gutters under our feet.

When someone got admitted to public hospital, and we never said no to anyone, if need be, people were given floor beds on wards where every health norm was broken due to the demand (there is meant to be 10 feet between patients). Every patient who seemed to have some money, we asked them to buy syringes, needles, gloves.........in excess of what they would need..........why............because the really poor who had not a dime in their pocket, we used the extra stuff for them.

A relative last year with cancer, needs chemotherapy cycles, repeated visits to Tata Memorial - India's leading public sector cancer Institute, no private sector can match it but for shear workload these people deall with. I know this from personal experience of a close relative, people - well cancer patients and 1 relative, they queue up at the door of the ward, when doors open all hell breaks out, its like catching a Mumbai Local train, cancer patients have to run to get to a bed, those that do, get treatment first, others wait for round 2. Cancer patients playing musical chairs!! Some care we provide.

I can go one for ever with such examples. Where is the money?

Now lets come to accountability. This is a matter of ensuring structures of accountability exsist, it has nothing to do with money. Where is the evidence that private hospitals are any more accountable.

A bypass operation is done, a relative in Jaslok Hospital was given breakfast with a bread's face covered with butter!!

I have seen everything - from sham appendix removals, sham shock treatments, sham abortions, heaps of CT and MRI scans for no rhyme or reason...........what accountability is there is private sector?

An inner ear surgery goes wrong, patient is left with life long side effect - what are the chances of staff coming clean on whether they botched it or not?

It is not ethical to practice other that what one is trained in. Every private hospital - where do the ward doctors come from - they are not allopaths - they are people doing Ayurveda, Homeopathy, Unanni........cheap labour

Every posh private hospital is managed on paper by Trust.......why.......tax sops...........these paper charities charge lakhs of $$...........where is the price control, where is the quality control?

Mumbai Corporation last year spent less money on health than Worli-Bandra Sea link which is to be inaugurated today. 1.5K crores in service of 75k cars per day (Mumbai has 1 million vehicles). But less than 1k crore last year was meant to serve population of 10 million or more (note, I have treated patients from Nepal to Sri Lanka in Mumbai Corporation hospitals meant to be run on corporations tax collections) - 50% of Mumbai lives in its slums - work out the per capita spent.

MCI - the only job done is recognising and de-recognising private medical colleges.......its a scam....it was in news not too long ago........I once taught in a private medical college, there were students, but not a single patient.............what kind of doctors are coming out of these Institutes (only a small handful of private medical colleges have actually done justice).

The logic is that we need sea link to drive economy. Don't we need a healthy population to drive an economy? Better education is directly associated with better health - look at the uselss education budget, it dwarfs in comparison to what is planned to be spent on metro rail projects in 6 cities with population of less than 100 million.

Lets get real - do visit a public hospital or better still a primary health centre in a village.

ASJ

ASJ - you post is damn depressing. I have been to govt hospitals in Bangalore and the plight of the under priviliged people is as bad as else where and sometimes even worse.

Doctors salary or infact the salary of all govt servants is a major issue. It is ridiculous to expect them not to make money (aka bribes) when their compensations are so low - and as long as we dont solve this problem - corruption will never end. 

MCI - they have made this noble profession into one money making business. What else can we expect from doctors who have paid multi millions as donations and bribes to get seats - dont they have to recover their investments.

Rhetoric apart - whats the solution? To a great extend we know whats the problems are. Manivannan sir points the lack of management skills and may be NRHM will address it to some extent. But what about accountability?

We all understand civic issues and hence we constantly query the govt for updates and classifications (atleast thats what a few of us have been trying to do). Can we do the same thing with the hospitals - obviously not many of us understand how govt hospitals work. But i am sure there will be doctors who are more ethical than the rest of the lot - can these people act as independent auditors of govt hospitals - the RTIs is always there to help them?

ASJ has written from personal experience and it shows. I have a problem with the approach of western medicine today (thankfully things are changing).  They are more post problem approach and the whole damn thing is so commercialised. What I mean is they are so focussed on the latest and greatest drugs, thats what brings money. There is comparatively insignifcant research on root causing and prevention through non drug based treatments (and they can work)

Good hygiene, healthy lifestyes, simple cures for common ailments will prevent a lot of the hostpital visists to start with. Part of the budget should be focussed on prevention and education as well. The ideal scenario is where we have all the best of facilities but dont need to really use them.

On the management side, really really true. Does not apply to doctors only - applies across the country, whether it is our administrators, politicains, BMTC, and even our METRO gets delayed for poor management. Its not rocket science and the basic concepts should be part of our school/college education. (I am not talking big theories, just simple things like planning, ablitliy to see big picture, structuring the tasks involved, taking care of all details etc).

If apathy and neglect are issues with govt. hospitals, excessive energy and focus are problems in (some)private hospitals. The excess energy and focus is only on one thing, how to extract the maximum off the patient. At least in the private space, we should not wait for the govt. to do but start with some form of consumer redressal/feedback . Like a website where there patients can put in their feedback, put in stats on hospitals (like success rate etc). That will bring in some kind of pressure on them to improve, they know they are being watched.

Quick reflection on some issues that have come up. Yes, the cat needs to be belled, but this cat is running amok, first it needs to be bolted. A better anology is that of a wild horse with no reins that needs to be tamed.

I will start with accountability - even a cobbler has to be held accountable - this is more to do with principles of governance. The corporate world uses the jargon of corporate governance. In health sector, the phrase is tweaked and called clinical governance. I have spent dozen years in this profession in India before getting to UK, not once was this phrase ever heard or mentioned. One can imagine thus that actually there is no structure, no policy in place on such matters - its no different from our road traffic which is informed by a rudimentry Motor Vehicles Act rather than something as substantial as the UK Highway code. But again, lack of clinical governance is just as if not more applicable to private healthcare in India - who governs an indpendent GP or surgeon, who inspects their practice - no one (MCI does not even make us pay an annual membership, they do not know if a doctor is dead or alive or has changed residence).

Managers - are welcome, but we will get better results by skilling up doctors with the acumen for such matters rather than having independent managers who do not understand medicine (I say this because poor decisions are made by best of managers if they have no clue of what medicine is about - 50 years ago, one economist studied British rails and found out massive number of lines made no profit - all these lines were stopped - today, 50 years on, we know it was  a stupid, costly mistake as cars are not the answer - a purist view of an economist failed UK rail network). Like clinical governance - not a single doctor in India gets even an hour of management training. Having spent almost a decade in UK, I can state that my clinical skills learnt in public teaching hospital in Mumbai are at par with best of trainings worldwide - but I learnt Management only after getting to UK - and there are enough like me, some even more experienced, who will love to contribute to reforming India's health care provided we knew we had a say in these matters.

As for whether there is a sloution - one needs to go back to 1948 and study the politics and history of how the NHS Act was passed - pre 48, UK healthcare was no different from what we have in India today - so there is hope - we only need look around for answers. Interestingly, 90% doctors in UK opposed the bill, by the time of it being passed, 90% had registered as NHS doctors on the simple fundamental basis of being assured an industry standard salary - ask a local GP if he/she will like to induldge in cut practice for making a living or get a lakh rupees a month as ssalary for working honestly - its not hard to guess as we all want to sleep well with a clear conscience.

Medicine is costly - its evolved a lot - as we live longer, the agenda of prevention which is our sole focus can't remain the sole focus. This is why there is an urgent need for reforms.

I won't come back to this again, but those keen on having further disussions on writing a paper which can be sumbitted to local governments, please write a private message.

ASJ

Marble flooring, bar-like environs, gleaming brass staircases, air conditioned, page3 nurses in starched uniforms out of 10 stuttering around, hardly 3/4 are actually trained nurses - doctors - mostly just MBBS medicos wanting to gain experience and certificate for paltry sums like Rs.1500 to Rs.2000 for almost 6/8 hours duty (MY DOCTOR SON AND DOCTOR DAUGHTER IN LAW ARE LIVING EXAMPLES) - just out of Medical Colleges - Even a coolie in a Railway Station/clerk in a govt office earns more.  

In case of emergencies, the sleeping doctors should not be disturbed by these half baked nurses, specialists will flutter and come only when they are free or when it is too late.  These nurses try their whatever best, finally when somebody croaks, put them on artificial respiration, make the relatives of patients believe that their patient is serious without allowing them near the 'body' and shift the body into the operation theatre, get some so called specialist run in and after some time just to come out and announce that the body is dead.  (This is a true incident).

And diagnostic centers are profit making centers - for the doctors who make the patients believe that without such diagnostic results, they cannot and should not diagonise a patient's illness and prescribe a number of tests/scanning etc., for making their own life that much easier.  These centers are milking the gullible patients because doctors have a cut in each and every test that is prescribed by them and conducted by private centers.

How much do you think a blood sugar test costs?  My son who is a diabetologist shocked me when I asked him to be truthful to his father as to how much it costs for this fasting blood sugar etc.?  He could not escape.

Including everything that goes into conducting a test like antegens, chemicals, testing apparatus, building, nurses, technician fees, profit etc., etc.,  it should not cost more than Rs.20 per test.

- Avoid illness - Touch wood - adopt prevention is better than cure method. If there are adgoolajjiees, ask them - they may suggest Tulasi leaves for cure of simple cold, or arishinada pudi for caugh and throat problem, or karpoora with coconut oil for curing chest infection.

- Health care system in India is not worth talking about. Government hospitals are hell holes - by mistake I had become unconscious while working in the office and had been admitted to an emergency ward in a government hospital.  When I gained consciousness and came to know from my peon who was kind enough to stay back with me at that late hour, I was about to go into coma and just managed to help myself, remove all the trappings that had been put on me, managed to put on my pant and hoodwinked the staff, managed to get out and ran for my life.  Real life experience. I can go on but..

- Saaka innoo Beka? 

- Vasanth Mysoremath 

 Marble flooring, bar-like environs, gleaming brass staircases, air conditioned, page3 nurses in starched uniforms out of 10 stuttering around.

Why do we assume rickety buses and spit stained walls are appropriate to dole out to the downtrodden? Regardless of your hyperbole a decent clean environment with hygenic attenders will speed up the time to recovery.

Its a free country, a free forum and like 90k spectators who think they know better than Tendulkar we have commentators who have little if any clue. Ctrl+C and then make a statement but nothing else.

Is it not obvious we are talking about India? Do the examples above seem to have come from a EU country?

Have you counted number of Govt hospital beds and private beds in Bangalore? Those who care to will realise in no time that almost of all Indian healthcare provision is private.

One needs to understand the bigger picture, 100 CT scanners doing the work of 10.....it actually means we have as a country ended up investing in 90 scanners for no good reason...they would serve us better if there was one in each village.

I keep promising my self not to bother trying to convince the category of - don't know, but don't know that they don't know (and hence think they know every thing and sit taking pot shots).

Study the situation, leave the arm chair, then we may get somewhere.

ASJ

Dr.ASJ,

With due respect to you (and I have a great deal of it) the "arm chair" comment was harsh on IDS.   Understandably this issue is very close to your heart and you have an advantage over most of us here.  But that should not stop a lively debate. 

We are all pretty much arm chair commentators here.  The purpose of this forum is to get people interested in civil issues.  Not everyone has the same grasp of grassroot problems.  some of us tend to see privatization with very rosy eyed glasses, some of us with skepticism and even suspicion.  I think we cover a fair bit of the political spectrum on this forum.

IDS and I pretty much disagree on all economic issues (he being a right winger and I am on the centre left).  But that is the beauty of this forum - that we can disagree and debate without coming to fisticuffs.  

Thanks,

Srivathsa

SY,

Allow me to reiprocate that the feeling for respect between us is mutual.

But there is a limit to all talk and no play. I have finished my quota of patience for sarcasm such as 'So which country are we talking about here?' - Is it not blatantly obvious which country I was referring to.

Neither do I have time for repeated cut n paste approach where a line is taken out of context, petty time spent on semantics and some comments made without slightest of backing with either data or experience.

Rude I may have been, but unfair, I do not think so.

To be honest, I very much anticipated this, I made a reference to this and it was never hard to second guess who it may be. Its rather amazing that people have told me off in language that can be interpreted as 'personal attack' on other threads for harping on certain models be it London or Mumbai, yet the very same people seem to not bat a eyelid when talking / displaying pictures from Singapore to LA.

To be fair to this forum, this is a serious forum not Tweetor nor Facebook. I expect more, if I am wrong in expecting better quality debate, then so and I will make sure not to return.

ASJ

I expect more, if I am wrong in expecting better quality debate

As a practitioner you have the upper hand, so the quality of the debate is in your hands. I have asked a cumulative of  9 questions (with question marks) in all my comments and a few other opinions which can be answered dispassionately if there is an intention of sharing knowledge with non practitioners. 

Funnily enough it is not a debate if everybody agrees with you. 

what accountability is there is private sector?

What in my posts does not answer this question? The answer is 'NONE'.

Who is enforcing accountability? What is the enforcers failure? How are they being taken to task?

Have I not covered this? No structures exsist to manage this, its obvious from what I describe above. Is it not obvious from the day light quackery on our streets, do I need to even qualify this any further?  

Also why cant we have private hospital maintenance but public caregivers?

Again, reading the entire post helps. A fundamental conflict is introduced when a doctor patient relationship is influenced by $$$ - and yet, I said, I can come up with a model where there is room for private players. For goodness sake, even you cars insurance has fixed pricing tags on it......will you get in to a rickshaw with no meter......why not just leave the price of a rickshaw ride to market force, and that of food.....

So which country are we talking about here?

Its obvious, is it not, do I have to reply to this question? I would expect people on this forum to find some answers to their questions - you have google at your finger tips, my reply to you was to go find the differential between private beds and public beds, then you would have an answer to your question.

And there was this whole business of private sector taking on the burdon of public sector....does my narration of cut practice, which afflicts 90% of the doctors not explain how they create a burdon on common man......I have to charge you 500 to make sure I keep a decent amount with me as 40% per charge per appointment is a handout.........if this did not exsist, would healthcare not be cheaper?

Can't find any more questions worthy of my time.

ASJ

 Also why cant we have private hospital maintenance but public caregivers?

Again, reading the entire post helps. A fundamental conflict is introduced when a doctor patient relationship is influenced by $$$

I was talking about facility maintenance not doctor patient relationship. 

and yet, I said, I can come up with a model where there is room for private players

This is encouraging.  I would like to hear more of this. What areas can private people participate to make health care better for the public? How will the govt play a role in regulation of quality of health care?

Help me understand this so we know socialism does not mean trashing private participation in public life.

a. Need for a broad consensus that the government should have its hands only where absolutely needed - BPL.  Private players will not go where this is no profit - e.g. rural health care. education for poor people, etc.   Or if they are forced to go can tend to give bare minimum.   The question to be asked is - Can the government make a difference or will it offer parity services ?  If the former, then they stay, if the latter they exit (case in point - Air India)

b. Need for it to develop its regulatory framework for each public service.  Who, how, how much, etc.  How will it be measured?  Who is accountable?  What are the rewards and punishments? Without this we are setting ourselves up for disaster.  

c. How do we bell the elephant in the room - Corruption?  We have reached a point where pretty much everything is for sale.  What is the guarantee that numbers won't be fudged, dirt swept under the carpet.  Yes it happens today, but profit is a huge motive to do more of it.

Srivathsa

There is a need for a bill / Act to be passed in the parlament. As I hinted, UK is where it is today because of NHS act, a bill passed in 1948.

There is plenty of know how, doctors in EU, US, down under from Indian orgin with experience and knowledge (of having worked in different systems, many like me have also had intimate knowledge of working in Indian Public sector, the private practice in india and then leaving because the grass seems greener on other side of the pond) to help write such a bill (and we would love to help).....................but is there a will?

The sole reason why IT professionals of today unlike those of 70s who were part of brain drain return to India is because they can make a decent living here - anyone who want to revive this profession and bring back some of its honour has to find a way of ensuring that doctors are paid decent salaries (private teaching hospitals pay same salaries as Govt teaching hospitals despite lakhs of rupees in donations).

As a medic, I know how it feels to have disparity. When I was a registrar in Mumbai, in 3 years I managed to earn and save some 60K - this was 4 times less than doctor of same experience in Delhi? Its demoralising that a cardiac surgeon earns tens of lakhs per day (not even UK docs ear that in a month) when an equally important skin specialist, GP, a psychiatrist, a pathologist are offered petty salaries in these private hospitals.

I attended a conference in 07, it was in the 7* hotel at Powai. I could make out which doctor was doing well at his business (that is what we should call it) and who was not. Those who gave cuts, had eneough patients, wrote lot of prescriptions........they were escorted in air-conditioned cars by pharmaceuticals, they had rooms booked in same hotel or other 5* hotles.............the honest colleague almost certainly had to find his way to the conference in BEST, train or rickshaw. Half of my colleagues every year make round trips to EU and abroad...all courtesy Pharma..........other half can't dream of finding money to attend such conferences from their pockets simply because they somehow do not generate enough business................can we stoop any lower?

ASJ

 The sole reason why IT professionals of today unlike those of 70s who were part of brain drain return to India is because they can make a decent living here

It is important to analyse what role this industry has played, physically and psychologically, in the prosperity and growth of India. Also important to understand what role (if any) the government have played in wage control or creation of opportunities for people returning back. Hope we pass on the lessons good and bad to other industries and get them to shine similarly. We should look at this maybe in another thread or blog.

The Stigma of HIV/AIDS/cancer and other incurable diseases will be forcing setting up of AIDS NAGARS in all urban aglomerations.

I foresee that by 2020 many nations, particularly under developed and over developed countries will have separate AIDS NAGARS due to absence of proper health care / awareness programes.

Havn't Prajas had enough of high level interaction and many lightning flashes straight from the Stallion's mouth - Dr.ASJ?

Isn't it time to cull out plausible variables and deliverables for presenting it to Government so that the Budget may consider favorably the health sector and see that the poorest of the poor who are more prone to simple ailments that turn out to be deadly can be nipped in the bud?

We cannot expect government to deliver a good health care system because they always look at any project aimed at people with MISTRUST and there is a conspicuous absence of transparency in executing anything and they have their own doubts about their credibility.

Time to either deliver or raise hands and surrender to privatisation which cannot be the anathema. 

- Vasanth Mysoremath

I think Praja has enough information to act on, leave aside a healthy debate. That I speak so openly of my profession should have sufficed. I can envisage different models, but this is not the place to spend time writing about them.

Most private doctors one may consult are products of public teaching hospitals. I have spent enough time in public teaching hospitals of Mumbai and barring a handful of experiences, I would say given the limited financial resources, these hospitals and their staff do a phenomenal job (go on a visit for 10 days to make full sense of it all). These hospitals have not failed because of lack of expertise, they have failed because of lack of money.

Even if (its a big if) private players are thought to have role and offer treatment for poor for which the government pays fixed contracted prices - where is the money going to come from? That is the moot question.

This takes me back to the very first step I suggested - we need mandatory national insurance to create a corpus - this is not about 100 million people who can buy their way out, it is about a population of over a billion.

I have no time for circular arguments, Praja can contact me if they manage to take an expedition to state health sec / minister and they show interest in considering the first step suggested above.........everything else rests on this promise of starting a mandatory insurance scheme.

ASJ

Thanks Dr. ASJ for your insightful comments.

I have visited some Primary Health centres around Delhi and what did they keep in their small refrigerators ? Shoes. Yes shoes! Since  there was no power almost whole day, the fridge practically had no use for them. This seems to be the general pattern in rural hospitals.

Private hospitals is another story. Apart from fleecing patients with a battery of unwanted tests, most of them do not even dispose off  deadly medical wastes properly beacuse there are no stringent measures to tackle those who break rules.

I feel  in Public Government hospitals there are very good committed doctors and support staff. What  they need is  some good administration to show that the system works. We must support, nurture and improve govt. hospitals with better  infrastructure. finance and management. These are OUR hospitals. We can't throw them away, because they are sick! All the more reason to take care of its health.  They will surely deliver.

ERR

When should the government leave the healthcare?

It should not. Even a hardend rightwinger will agree healthcare, defense and core strategic sectors cannot privatize completely. But identification of opportunities even in these core sectors where non-govt parties can bring in expertise to make things better is very important to any system. 

Here is a simple private partnership agenda I suggest for Health care.

1. Draw up the facilities that any hospital needs and define mandatory service level of these facilities in terms of infrastructure(equipment etc), availability, cleanliness and hygene

2. Put a tender and have the private sector construct and lease it to you while they own the service levels. 

Let me know why this cannot be done.

We have regulatore for telecom, insurance, stockmarket, etc. why it is not applicable to healthcare? 

I whole heartedly agree with the regulation part. Every sector needs a regulator. Price fixing is not acceptable while band limits can be set. For example there is a circuit breaker in the stock exchange, while it is not price fixing it ensures there is sufficient control.

I have answered your question. My father in law had his angioplasty at Sion Hospital in Mumbai. If you or someone drops unconscious on the road with no other relative, trust me, chances of surviving will be higher if you are taken to a public hospital. I remember a man brought in unconscious, we did the ususal set tests, had a diagnosis, gave him 50 cc of magic (i will not say what it was) and he rose up with his alcoholic smell to fling abuse at all saying 'how dare, he, the son of xyz be taken to a Municipal hospital.........and walked out...................he did that only because we kept him alive

Secondly, its obvious that private healthcare is corrupt. Kidney scams from Bangalore itself are well known world over, they were connected to private setups.

I have worked in public hospitals, I have done private practice and I can vouch for the fact that many doctors provide the care to the best of their abilities in limited resources. The examples I narrate above highlight something - public hospitals are deprived settings, deprived of much needed money, they are not deprived of doctors with high standrads, and many who left for private practice would remain with these Institutes if better pay was offered. On the other hand, massive scams await to be unearthed in private settings.

Its should shock people that when a private consultant asks Rs 500/- as fees, actually this is so only because of the epidemic of cut practice in vouge, and it all happens only in private set-up (the question of cuts does not arise in a public health setting).

A handful of good private hospitals does not negate the fact that majority of private healthcare in India is involved in corrupt practice, nor does it suggest that public hospitals are bad simply because the building is crumbling. The real reason why people from lower-middle class and above won't go to public hospital is not because care is missing, its because you and me can't stand the fact that these overworked hospitals are frequencted by the BPL families from across the state in huge numbers and it just so happens that we are lucky to have few pennies to avert standing in long queues, crowded wards with dirty linen or toilets where tiles have not been changed for 20 years. Its the very same reason some give for not using the red / black board bus, its the same reasons that stop us from sending our middle class kids to a Municipal school................these school are deprived and most certainly not as corrupt as private schools............they do not have good teachers because the salaries are pathetic..............the buildings are crumbling not because someone siphoned away the money....the money was never there in adequate amounts.

I am not suggesting for one minute here that there is no corruption in public hospitals, its there even in well developed countries like UK.............but I can tell you that in a public hospital majority of staff are people who are honest and hardworking.

This post may be about Bangalore, a city, 7 million people aspiring to make the most for having been born with a golden spoon..................my vision is not restricted to 6 Metro cities of India, it applies to urban poor and more so the 850 million languishing out there in remote India - its a myth that heart disease is a rich mans disease....porr people suffer from exactly the same illnesses.........who is to provide them with the bypass or an angioplasty? Or do they not deserve to live longer?  

ASJ

Majority of the developed world countries have a model which is socialist in idealogy, the proof that it works is very much out there. The proof that skewed private healthcare is not healthy is also very much out there, the most glaring example is India.

In India we have implemented only corruption, we never really did justice to term socialism, to say that something failed when it never was...........that is a wrongful conclusion. And yet, we have living examples of many public sector provisions being the very best.............as I asked - if your son/daughter was getting admission to IIT or KEM Hospital in Mumbai as well as private colleges - where will you send them?

Our helth spend ensures we are in bottom 20% of countries on this planet in terms of per capita expenditure.

There are various reasons why BMTC, BBMC, PMC and the like can be deemed useless, corruption is not the only reason. Incompetent people are placed with responsibility of running our Institutions in general - why may be this case? Other than failed implementation of positive discrimination (something I support but not in the manner it is now), it is largely poor salaries. How many IITians would have stayed back if they were offered the right salaries in Govt sector? Many doctors like me would love to serve in public hospitals, but it won't happen if a value of 25K a month is placed on someone who has been around 20 years in this profession. Many like me detest the unregulated largely corrupt private healthcare, very few doctors do not dream of leaving for greener pastures. Only few years ago, the cream of Indian psychiatry, almost all from places like NIMHANS (a 100 or more), many with 20 years of service and working at level of Profs left for UK (irnoically Indian Govt gave full support to UK Govt in this fellowship scheme offering salaries between 90K to 120K (Sterling).

ASJ

 Majority of the developed world countries have a model which is socialist in idealogy

This is misrepresentation to suit an ideology you are promiting. Want proof? See below a map of all countries who declared themselves to be socialist states, under any definition, at some point in their history. You will notice socialist countries represent some of the poorest and underdeveloped nations of the world where freedom of choice takes a back seat and corruption rules the roost. There is nothing more to say, the proof is in the pudding. 

Many like me detest the unregulated largely corrupt private healthcare

I tend to agree that we should get to a regulated private healthcare system which can complement an effecient and regulated public healthcare system. 

That is the only reason why you do not see slums and rough sleepers in thousands on their streets. 

Capitalism has been dominant in the Western world since the end of feudalism. Capitalism gradually spread throughout Europe, and in the 19th and 20th centuries, it provided the main means of industrialization throughout much of the world. It has been proven at least for the last 100 years that inclusive growth can only come when private enterprises participate in the public space and not otherwise. 

Further reading

The point is that capitalism has had its succes because of free democracy, these countries are democracies first (not capitalists as being tried to make out). Free democracy killed feudalism (not capitalism).

And anyway what is the point, its so out of context. Bottom line is that significant number of capitalists (if that is what you want to call them) countries have huge investment in socialist agenda.

ASJ

Now we are ready for a lesson in history.

Carry on - till you feel satisfied.

ASJ

The poor souls doesn't care as along as they get some helping hand in need.

People should have more demands and "know, care, participate" rather than stay poor souls.  That is my solution, but I suppose that is not a solution that we can take to anybody. 

http://epaper.timesofindia.com/Repository/ml.asp?Ref=VE9JTS8yMDA5LzA3LzA5I0FyMDAzMDA=&Mode=HTML&Locale=english-skin-custom

Gives salaries and discordance in the same across the country when same amount of work is done, in fact Delhi resident doctors work in shifts of specified periods.

Pay scales are better in States closer to power. Karnataka has amongst the lowest salaries. BTW there is another strike going on in TN currently.

Interestingly, a doctor in training in Delhi gets more than Associate Profs in Mumbai who may have served 10 years or more beyond 9 years of training.

Make no mistake, resident doctors may be deemed as trainees, but they are already MBBS and are the backbone of medical Institutes (in EU this is recognised to a point that the hardworking frontline resident doctor in EU earns salaries close to those earned by their consultants).

ASJ