Sunday, October 04, 2009

Rights of Admission Reserved

Middle India's horror of the prospect of having to be admitted to a government hospital is probably equaled only by the prospect of having to apply for a driver's license, buying a house and having the servant not turning up for work because her kid is sick.

We of course never step into one unless we've been in an accident, in case of which one of our relatives will promptly transfer us to the nearest private hospital as soon as we are stable, or to get a doctor's certificate. We pay for it. Why do we not use it? Why let the rickshawwalla monopolise the GHs? We pay horrible amounts to the private hospitals which we could save if only we forced the policy makers to shift some thought to the sick sick sick state of healthcare in India.

Be warned, our private hospitals too are slipping away. We'll soon have no choice.. and by that time it could be too late. If you've noticed the proliferation of white and arab faces in the lobbies of the private hospitals, you'll know what I'm talking about. Medical tourism has brought smiles to the faces of doctors, hospitals and the hospitality industry. And it has increased the healthcare costs of the middle class. The doctors have no time for you, the Indian acute angina patient.. you only pay around two lakhs for care. The arab guy in the 5* room next door pays 20. The white guy in the other 5* room pays 20 too and the sweet fella even tips the wardboy and nurses in the thousands while you snap at them to dust your luggage. What are your chances? of getting a smile from the cute nurse? a decent wash from the wardboy without missing a spot? They'll get their chest shaved with a mach4 and you with a seven o'clock single blade.

Most of the problems in modern India can probably be traced to the complete apathy towards the society from middle India. The only people with the opportunity and resources to change the face of India are only too happy to sit on their asses and complain in the kitty party or the smoking corner of the office about the servant who didn't show up.

We don't only have modern day tragedies like the above right beside our glittering skyscrapers (ok.. 30 storey buildings anyways), we're building a future tragedy for ourselves.

Seriously, how do we get away from this trap? We already subsidise a spoilt bunch of brats to do the MBBS. Now we're letting an environment create itself where they'll probably have to be forced by regulation to treat Indians. They're already railing against the 1 year rural stint. We'll probably have doctors protesting against what they'll call a quota system where for every 1 case of medical tourism, they'll have to treat an Indian (we have the right to choose who we treat, rights of admission reserved, its a competitive world - if you can't afford it go to the unani/siddha practitioner). There's talk of a parallel system to treat rural patients with a 3 year medical course. We, with our medical insurance, better sanitation and currently grinning docs, couldn't care less about second rate care for the rural patients. Won't we soon be relegated to second rate care too when the pathetically small number of medical professionals that India turns out (and a significant %age of which bleed out to developed nations) would rather treat those who pay them better?

Lets remember that we have no "public option", no social security net. We're completely dependent on ourselves and our relatives/friends in case of a medical catastrophe without de-risking. We've let the government healthcare system get screwed and in our apathy, we've also left out other parts of healthcare like malpractice laws, accountability of doctors in both public and private practice, primary care, emergency care, urban and rural sanitation etc. etc. etc.

Its time we got involved in our future health. Unlike the short sighted people of Surat who kept their houses sparkling and dumbed crap on the streets and then found themselves in muck of their own making, lets start concentrating on real issues. Indian hockey and the sad state of Indian theatre will sort itself out.

Support the govt when it asks the newly minted docs to do a rural stint or at the very least in a in a semi-urban govt facilty. A secondary cadre of medical professionals is OK as long as they are never mistaken for doctors - paramedics with training in primary and emergency care should be more like it. We need medical schools much more than we need IIMs. Instead of expanding already stressed govt. medical colleges, open more secondary and tertiary care centers in semi-urban centers. If IT/ITES, real-estate firms and auto manfs. see potential in Tier 2/3 cities, so can the govt. Create mechanisms to identify good students from govt. schools to be trained as docs with subsidies and loans - they'll be less susceptible to taking the subsidy and running to the US/UK. Create an NRI quota to explicitly cross subsidise poorer students.. their fees shouldn't be just fully costed, they should have a nice fat profit margin. Tax medical tourism liberally, not as a luxury or to punish but enought to help cross subsidise primary care in India and keep the industry competitive. Loans are a far better way of administering student education expenses. Instead of subsidising any student, the govt. can pay a large percentage of the EMI as long as the person stays back in India.