Our health care needs restructuring
DR. P.K.SASIDHARAN
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Inadequate utilisation of available resources to tackle the burden of communicable diseases
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Our people and the administration believe that treatment of diseases is all that is meant by health care. We have forgotten that genuine health care is making available all the basic needs like a balanced diet for all, proper sanitation and environmental hygiene, safe drinking water, facilities for recreation and exercise, etc. It is not possible to provide health by building hospitals and increasing the number and expertise of doctors. Even for disease care we have no comprehensive plan since we blindly follow the U.S. model of expensive insurance-based, organ-based, investigation-oriented care.
Our health care is in for crisis, and is collapsing due to lack of proper planning and prioritisation. There is an explosive increase in complex modalities of treatment, without cost concerns, pushing people into debt-traps and suicides and more so neglect of basic health care, because the professionals are preoccupied with treatment of diseases and the available resources are all utilised for disease care. In the developed countries health care has become hospitals and disease management strategies because they have already achieved perfect waste management, clean and safe drinking water for everyone and access to a balanced diet.
Their problems and priorities are different but we follow them blindly by establishing only centres for disease care that too with hi-tech gadgets and costly medicines, ignoring basic facilities and cheaper conservative treatment plans. We have a huge burden of communicable diseases, due to malnutrition, lack of sanitation, dirty surroundings and contaminated drinking water. India has got the resource for providing good health care, but we do not have a health policy and our planning in disease care, is basically doctor/VIP oriented, and not community oriented.
The NHS model
The National Health Service of the U.K. (NHS) ensures equal access to heath care to all people regardless of their income. The foundation of the NHS is based on the belief that “no society can call itself civilised if a sick person is denied medical aid because of lack of means.”
Almost all the medical facilities are owned by the government and all the people working in the NHS are employed by the government. General Practitioners (GP) act as a guide and a filter to the appropriate specialist which helps overcome the problem of consumer ignorance and provides a means for controlling the demand. All services are free at the point of delivery and there are no gaps or stigma attached; every citizen gets equal opportunities and facilities. The NHS has continued to be popular and seems to be a remarkably successful instrument for making the rationing of scarce resources socially and politically acceptable.
Misrepresented
In fact, the minor apparent disadvantages of the U.K. health care were shown to be the long wait to get costly investigations and some procedures done, whereas in India, there is no need to wait to get these done. It is obvious that the waiting period in the U.K. is only for chronic problems which we know are due to abnormal lifestyles and diet. Otherwise they have an excellent system to tackle all emergencies without any waiting for investigation or procedure. Both emergency care and genuine health care are promptly and properly delivered to all citizens of the UK irrespective of their financial or social status.
This is possible because they collect 10 per cent of the income to National Insurance. A major portion of the money collected is utilised for managing the NHS. They have an effective referral system and there are guidelines for the citizens on what they should do in case of illness. They all know whom they should approach and what all they should do in case of illness. They all have to go to the specific GP with whom they are registered. Unlike here, they have no right to choose their doctor. Only if the GP thinks that they need a referral, they can ever consult a specialist. The government promotes the general doctors more than the specialists and GP is the key person in their system. Problem cases requiring detailed evaluation alone are referred to specialists as per the decision of the GP and not of the patient or relatives.
In our country, the lack of referral system leads to an ever increasing artificial demand of specialists and of super specialty hospitals and consequent overuse of hospital services and investigations. The government is now going to meet the increasing cost by medical insurance through private companies and private hospitals resulting in more diversion of the meagre resources to the private sector.
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