Open Forum

New Delhi, 6 October 2010

India’s Health Care

SPEND MORE, CHECK NEGLIGENCE

By Suraj Saraf

The health care scenario in India is disconcerting and requires serious attention. This is a clear message which emerges after going through a few important reports on the subject.

India had not done well enough on public health front and that a far better progress on malaria control could have been achieved, is an assessment of the Special Advisor to UN Secretary General on Millennium Development Goals (MDG’s), Jeffrey Sachs. While highlighting the significances of National Rural Health Mission as the “World’s largest effort to meet the goal related to maternal and child health,” Sachs, however, underlined the urgency for raising government investment in public health and stated that private spending was no answer to India’s public health challenge.

“India’s spending on public health should go up to at least four to five per cent of the GDP against the current one per cent. About 75 per cent of the health spending should come from the Government sector”.  Sachs also dwelt on the challenges facing the NRHM and said that the single largest challenge was “lack of public spending and political will for the purpose.”

He went on to add: “We hope this issue is seen as national and is not subjected to whims of politicians. India should take heart from the rapid progress being made under NRHM, which is a highly dynamic public health initiative that has done well to bring health to the poorest of the poor. It could well be an example for similarly situated nations.”

The NHRM has made such a mark that Sachs had decided to introduce it to the health ministers of other nations. At the same time, he called for higher expenditure on health, saying that not spending enough for decades had left India’s health sector severely deficient which will take time to go.

A national health assessment had also underlined the increasing cases of medical negligence and “ambulance chasing lawyers”. According to experts, there are primarily “two reasons why the number of medical negligence cases is on the rise. One, the awareness among people about their rights against medical negligence and in some cases it is “ambulance chasing lawyers.” Sadly, lawyers encourage patients to file cases against the doctor or hospital in civil or consumer courts to earn compensation. They take a share in return, admits former President of the Indian Medical Association, Dr. Ajay Kumar.

The assessment further pointed out that according to a criminal lawyer in New Delhi, “There is an 8 to 10 per cent increase in the number of cases over a year which shows that people are now becoming aware against medical negligence”. In every 100 cases 20 per cent are insurance-related and 5 to 10 per cent medical negligence”.

Interestingly, the NGO, Consumer Voice, had carried out a survey on the consumer friendliness and accountability of the country’s healthcare system which had underlined: ”70 per cent patient in a well-known hospital are poorly informed about the treatment charges. In a premier government institution patients have to wait for over one hour for registration while the average time is 15 to 20 minutes”.

The problem a patient faces in proving his case is that it is a case of ‘high degree of negligence’ and not just a case of “simple lack of care” or an accident. This is so because the Supreme Court had in a case held that merely a simple error or accident does not constitute proof of negligence”.

There are laws in place for the poor patient, but private hospitals rarely provide care to those who cannot afford it. With India becoming the hub of medical tourism, NRIs and foreigners pumping in money into the healthcare sector the net result is that costs for the Indians are going up.

A World Bank study has shown that expenditure on health in the family is the second-most common cause of impoverishment in India. Of those who seek medical help in India, about 40 per cent have been pushed into poverty. The National Sample Survey had placed medical expenses at 7 per cent of total consumer expenditure in rural and 5 per cent in urban India.

The Indian Medical Association too notes that it is “for the welfare of the people, to make them aware and therefore they should come directly to us before going to the court if they have any complaint.” Interestingly, the ratio of the cases of medical negligence is almost equal in private and government hospitals”.

A McKinsey report 2007 has stated that driven by increasing affordability, shifting disease patterns and modest healthcare reforms, the total consumer spending on healthcare products and services in the country grew at a compounded annual rate of 14 per cent from 2000 to 2005. Healthcare grew from 4 per cent of an average household income to 7 per cent between 1995 and 2005, and is expected to grow to 13 per cent by 2025, said the assessment.

In India issue of ethics vis-à-vis medical profession, especially biomedical research has also assumed intense significance for the past few years. Keeping this in mind, the Centre has decided to bring the issue of medical ethics within the preview of law. Accordingly, the Union Health and Welfare Ministry is going to amend the Drug and Cosmetics Act to make violation of medical ethics punishable under law. This is likely to be done by adding a separate chapter on media ethics in the Act, assures Health Minister Ghulam Nabi Azad.

At present the Ethics Committee, whether at the national, State or hospital level, can only suspend trials in case of violation. If any doctor is directly involved in such a trial, license can be cancelled. Law does not prescribe any punishment for such an offence. The MCI too has set up a working group on medical ethics’ reforms that would recommend strictures against medical malpractices.

Under the amended Act, all clinical establishments will have to register themselves with the State council for clinical Establishment. These include hospitals, maternity homes, nursing homes, dispensaries, clinics and similar facilities that offer diagnosis, treatment or care for illness or injury or pregnancy under the recognized system.

Indeed, this has been necessitated by the revelations that some Indian scientists, who participated in the controversial superbug study, of a dangerous antibiotic resistance bacterium, did so without seeking the permission under the existing law. Notices have been issued to such scientists “This study has raised a vital issue. We are not against research but the implication of unregulated export of biomedical material has to be ascertained considering we are a transforming economy and hub for clinical trials in the world. We can’t just let biological material go out or come in sans controls. Let us not forget that HIV spread was also courtesy lack of such regulation,” warns the Union Health Secretary, Sujatha Rao.

Meanwhile, the Centre has set up a task force to draft a National Antibiotic Policy to regulate the use and enforcement of antibiotics in the country. Clearly, there is need for the creation of an overreaching regulatory body to curb such malpractices, which have to be checked without any further delay. ---INFA

(Copyright, India News and Feature Alliance)