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Ethical and affordable healthcare in India

Ethical and affordable healthcare in India

Public hospitals have become victims of apathy, absenteeism and corruption thus denying competent, compassionate and accessible healthcare to the citizen. In private hospitals, services are unaffordable, where even the rich have to pay through their nose by un-necessary interventions, risking their lives.  Now many members of society, including some doctors believe that corruption has crept into the holy precincts of ‘this noble profession’ viz. avoidable Insertion of coronary stents, un-necessary and over-priced cataract surgery, uterus removal and caesareans and joint replacements has become increasingly common. There is a need to cut costs of procedures, medicines, devices and reduce investigations, giving precedence to clinical acumen.

That good healthcare is scarce all over the country, can be judged by the following figures: Infant mortality rate is three times higher than China’s and seven times greater than that of the U.S. Of the 2 million Indians in need of heart surgery, fewer than 5% get it. The majority of the country’s estimated 63 million diabetics and 2.5 million cancer sufferers haven’t been diagnosed, let alone treated. Seventy percent of India’s 12 million blind people could be cured by a simple cataract surgery—if good facilities were available to them. While rich over exploit and un-necessary use the resources, poor are denied because of affordability issues.

Unethical practices have made the services un-affordable

Even in smaller practices or charitable set ups it has become common for some doctors to thrive on commissions, from pharmaceutical companies and diagnostic centres . And then there are the unnecessary tests and surgeries that put the patient’s life  to risk, which the unsuspecting patients are made to undergo by health workers, all driven by greed. It is a common knowledge that just as unscrupulous health workers cheat their patients, many hospitals fleece the insurance companies and the government too, especially if the government is paying the bill under schemes such as the Central Government Health Scheme (CGHS). Hospitals being accused of excessive and fraudulent billing under the CGHS, followed by disputes and suspension of service to government employees, have caused much distress to patients and their relatives. Many persons bribe the prescribing doctors to help them milk the government and insurance companies to pay false claims.

 Need of the hour: ethical and affordable

There is a large section of clinicians who are strictly ethical. Most doctors still believe in the welfare of patients. However as compared to all other professions corruption in healthcare sector has been hyped more while the quantum and percentage of corrupt is less in this profession. Even normal fee for consultation is being labeled as ‘loot’. Media hype and frequent litigations and astronomical compensation by the courts have put the doctors in a piquant situation where they have started practicing defensive medicine i e either to shirk a serious or complicated patient or order un-necessary tests and surgeries. The fear of punishment has forced the doctors to withdraw from doing their best and many bright students not choosing medical profession .  “Doctors are under tremendous pressure. Any bad outcome today gets labeled as ‘medical negligence’, with friends and family of the patient threatening to call television channels to scare a hospital into waiving off their bills. Or resorting to violence”

 Patient first

No doubt, there is a need to give first priority to the patients’ interest. The medical fraternity and the government has to encourage and provide platforms for respecting and creating “role model clinicians” who follow ethical principles and values along with display of clinical knowledge and skills. The role models will only inspire younger doctors if the respect is not only in the form of a certificate or medal but also includes a substantive cash prize and promotion in their jobs because hardly anyone wants to emulate “poverty stricken idealists”.  Particularly in the Indian context, affordable medical care and effective treatment based on the clinical acumen of doctors also requires addressing larger social issues or resources and roles and responsibilities of doctors vis-a-vis patients.

Corruption in healthcare

All institutions are prone to corruption and Health care institutions, whether public or private, are no exception. Corruption in this particular sector is more sinful because it directly impacts those who are already suffering, in misery, pain, or may be at the end of their lives and may not be in good financial health either. Some of them put at stake all their life’s savings and come seeking respite for a dear one. The sad part is that Patients and their caregivers become the most unsuspecting victims of corruption in health care.

Transparency international focused several situations of undue gain/profit at various levels viz. students bribe the faculty to get good results, government doctors pay more attention to their private patients, pharmacists sell their licenses to unqualified persons to run chemist shops, doctors prescribe unnecessary diagnostic tests and drugs, doctors accept perks from pharmaceutical companies and prescribing expensive medications to patients. The medico-legal certificates are issued upon payment of bribes; medications are pilfered by medical staff. Favors accepted by doctors from pharmaceutical industry, even in the form of cars, wedding receptions, foreign trips, land and other luxurious items. Private medical colleges selling seats, government posting and transfers by either payments or using the influential connections, not attending patients in time, ignoring emergency calls, consumption of drugs or alcohol while on duty and much more. Similarly, it has been reported that eminent personalities in academic medicine accept huge grants from pharmaceutical companies and would not report the accounts to the concerned universities. The dual practice that is driven by a lack of resources in the public sector and low pay has been associated with the unauthorized use of public resources and corruption.

Dr.R.Kumar

Eye specialist and health columnist Chandigarh

 

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