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Healthcare and medical education crying for reforms:Recommendations to PM

Healthcare and medical education crying for reforms:Recommendations to PM

Society for promotion of Ethical and Affordable health Care (SPEAK)

( # 232,sector 16A Chandigarh  phones 0172 2770499, 9876016232, speakforhealthyindia@gmail.com)

Recommendations made to PM MODI, GOI/State Chief Ministers: Presentation at Chandigarh Press Club

  1. Reforms in medical education

  • Admit MBBS those with aptitude to serve, compassion, empathy-not marks alone.

Will he help a dog in distress on priority, or throw it down from the roof, as a student?

  • Training in ethics be made compulsory before final MBBS examination or graduation

  • Need to develop highly skilled faculty: Faculty development institutes need to be set up.

  • To set up Family Medicine department in medical colleges to produce doctors with primary health care and prevention skills. Need for more general family physicians than super-specialists.

  • Need to improve skill of doctors by practical training, than to produce more doctors who are not properly skilled. India is not really deficient in number of doctors, their practical skill is poor.

  • Doctors & staff: sensitization towards Patient in Quality, safety, cost, accessibility, politeness, contentment, honesty, ethics at the entry into service.

  • To administer warning about perils of medicalization to medical students and public about medicines, tests, doctors, surgery etc. Need to discourage over-use of medicines and medical services.

  • Medical Admissions based on caste, religion, gender, region etc should be null and void de novo

  1. Reforms in Primary Healthcare

  • Enhancing health sector outlay to 6% from 1% as at present for health financing.

  • Need to enhance investment in healthy life style & health literacy, health promotion and awareness, ethics as a curriculum in the schools, colleges and other institutions etc

  • To set up @My clinics all over the country: free tests, free medicines, second opinion centres,: Charging no fee of any kind; thus eliminating all unethical practices alleged on account of pharma, diagnostic centers’ kickbacks or inducements for avoidable surgeries.

  • To replace fee for service model, with PPP model. The setting up/ running of clinic should be at Government cost. Rural service allowance and proper housing should be assured. MBBS doctors be posted in rural India, paid by the government for each patient they treat. This model of barefoot doctors would be much cheaper for the exchequer. This will provide employment to doctors sitting idle in cities

  • Need to enhance the salaries of regular Government doctors at Tehsil /District hospitals at par with IAS officers. These hospitals should be equipped to perform most of the common surgeries.

  • Need to discourage health insurance realization through corporate hospitals, which stink with unethical practices, overcharging and commercialization of noble service, need to put cap on all charges for various services

  • Need to have paradigm shift from private to public sector-total overhaul and rejuvenated public health system. To lower out of pocket expenditure to 20% from 80% at present.

  • Let voluntary (retired or otherwise) doctors and other health workers serve free of cost, where the vacancies exist. Many are willing to work. A segment of this manpower can work in the second opinion centers also.

  • Need to have a ’national program to reduce obesity and malnutrition’ to 20% level from about 60% at present in Chandigarh, Punjab and other states. Swachh Bharat and National Yoga programmes need to be made a reality.

  1. Reforms in tertiary healthcare

  • To set up Medi-cities in public sector in each district, with all facilities of surgery/investigations etc. There is a need to have medical audit for the services rendered as a quality check and to ensure ethical services.

  • To constitute boards/ethic committees, to decide ‘this patient unlikely to be cured’. After that patient is shifted to hospice or sent home to avoid national wastage of scarce tertiary care.

  • Need to manufacture stents and other medical devices under ‘make in India’ at affordable price say 5000/- instead of allowing selling of imported stents at 1.2 lacs.

  • Universities need to conduct research in incidence, causes and remedies of unethical practices

  1. Need to enact/modify laws concerning healthcare

  • Need to modify clinical establishment Act so as to make it voluntary for those doctors, who are willing and equipped to offer round the clock services and not punitive to all, irrespective of age, health status, knowledge, experience, infrastructure etc.

  • Consumer protection Act should not be blindly applied to all-where there is a difference of opinion in medicine or surgery between the primary doctor and subsequent ones, but treatment was done in good faith, no case should be made out-like the judicial services.

  • Enact a law for medical students: Can switch over to other profession mid stream, if approach is found to be commercialization.

  • Law against violence against doctors: To ensure legal safeguard of the life, property, respect of the hospitals/doctors in the event of a death of a patient or another un-favorable outcome. After an adverse outcome of any patient, doctors, staff or hospital should not become the targets of hooliganism or violence.

  • Enact a law to limit private charges to the affordable level. Let government be purchaser and corporate/private sector as provider under strong regulation, accreditation, and supervisory framework.

  • Enact a law to safeguard ethics committee members who declare-‘unlikely to survive’ and allow life support system to be removed.

  • Enact a law to put a cap of 20% profit on medicines, devices and other consumables and put an embargo on overall earning by doctors and hospitals. While making bills the discretion of price be done away with in private hospitals. It should be as per notified rates.

 

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