Ensure delivery of quality medicare in govt hospitals

The ease of accessing treatment in top public-sector hospitals must be in sync with the pace at which our economy is expanding. Recently a friend of mine with some health issues went to the OPD, PGIMER, Chandigarh. He reached the hospital at around 8.30 am only to be free by around 2.30 pm. He was 100th patient to be seen by OPD skin doctors, mostly Junior and Senior Residents, sitting in a particular room. Though the trials and tribulations of availing of treatment in tertiary care government hospitals are in public domain, some of his observations were loaded with meaning and need to be shared here with the readers.

Such feedback is of paramount importance as we are on the way to becoming a $5 trillion economy by 2025 and recently surpassed the United Kingdom to earn the sobriquet of being the world's 5thlargest projected economy. People's health and how ethical, affordable and accessible the existing health facilities are - can be and should be viewed as the most important pointers to the quality, inclusivity, vibrancy and robustness of an economy.

The rest has little or perhaps no relevance, to be precise.According to my friend's observations, most patients at different OPDs on the floor were from lower-middle income groups, who could not afford private hospitals. A large number of them were from far flung areas of neighbouring states like Himachal Pradesh, Punjab, Haryana, Uttarakhand and Western Uttar Pradesh. As per the official details, PGIMER, Chandigarh, now gets patients from almost every north and north-eastern Indian state as far as Bihar, West Bengal and Odisha. Given the rush of patients at all OPDs, he felt that there was a need for the expansion of facilities and infrastructure on a priority basis.

A hospital like PGIMER, Chandigarh, should have multiple blocks for different departments so that patients don't have to face any hardships nor doctors have to see an endless number of patients at the cost of their own health. In fact, the expansion of health facilities in the public sector was never a priority of our governance. The process was further delayed with the advent of private sector health players where the rich and heavily insured people among us get the best of treatment in a hassle-free manner. Nothing to be jealous of them, but 90 per cent ordinary people too deserves the best of health and education facilities which are affordable and of top quality.

My friend, himself a senior journalist with almost three decades of experience of writing on socio-economic and political issues and editing, was also upset to see the plight of patients from distant areas, who were living in the parking lot of the hospital, waiting for their turn of treatment. No hospital can provide accommodation to the attendants of patients but the patients undergoing treatment but not getting admission must be taken care of properly. While he was ready to digest the conditions in which patients were constrained to live in the parking lot for reasons known or not known to the stakeholders, what was glaringly missing was human empathy and administrative vision in ensuring hassle-free access to medical advice to the needy in one of the top most tertiary care hospitals in the government sector. There is a huge mismatch between the growing number of patients and the pace with which the capacity building is taking place in the public sector for affordable, quality and ethical healthcare.

The future challenges are going to be grimmer and much more severe. The burden of healthcare on our economy and the state exchequer will be huge if OPDs are not made more efficient, effective and easier at primary, secondary and tertiary levels in preventing non-communicable diseases (NCDs) from becoming major ailments. India is grappling with multifaceted health challenges, and the most poignant among them is the fact that in majority of cases patients meet their doctors only when the ailment gets serious. We don't have an ecosystem where people can regularly be guided about the importance of maintaining a healthy weight, exercising regularly, following a nutritious diet, and not smoking, which are commonly associated with the risk of developing the most common and deadly chronic diseases. Something which could have been treated well at the very outset snowballs into a major health issue simply because patients – for want of money or facilities – could not meet their doctors on time. As the majority of the people have to spend from their own pockets for treatment, the constraints arising out of their limitations also prove a major deterrent for them in visiting the hospital or a clinic timely.

For want of adequate number of doctors, beds, diagnostic facilities within hospital premises, worsening value-system, commercialization of human ethos, dilution of professional commitment and integrity in general are posing serious threats to the entire health system in the public sector. After retirement, top doctors from leading government hospitals become a means of earning for the private sector facilities, where unfortunately there is no cap on fees and costs of medical interventions. It is, barring a few exceptions, free for all. During the coronavirus pandemic we were passive and hapless onlookers of the way the private sector hospitals were fleecing the patients. Finally, rates of various treatments were fixed by the state governments but sadly these were also heavily tilted in favour of the private sector players.

To be fair to private sector players, they invest hugely in building infrastructure and pay handsomely to doctors and other staff if we talk about leading company owned and operated entities in the country. Even primary and secondary level players have to spend a lot.

Wherever there is investment, the expectation for return on investments (ROIs) is natural. Many private sector hospitals at the very outset of admitting a patient like to know whether the patient is insured or his company will bear the cost of treatment or not. It gets quite depressing for them if the patient tells them that he has borrowed money from relatives or has mortgaged some properties or gold for the treatment.

So, in a country like ours where nearly 25 crore people are living below the poverty line and another 25-crore people are slightly above the poverty line as is being claimed, one doesn't see any reason not to have a fine tuned network of hospitals in the public sector. Private sector players should have a limited role in tertiary healthcare. They should be restricted to primary and secondary healthcare while the government should focus on secondary and tertiary care.

(The writer is a senior journalist, columnist and author. The views expressed are strictly his personal)