Modern Medicare: Issues &Challenges

Dr. R. Harsvardhan

Head, Department of Hospital Administration Sanjay Gandhi Post Graduate Institute of Medical Sciences

The Hippocratic Oath given by ancient Greeks has underwent numerous changes all courtesy to the Homo sapiens  leading to the evolution of Modern Medicare in today’s setting which flexes into bionic silk grafts, gold nanoparticles bolstered to act as potent anti-cancerous agents and targeted cellular delivery mechanisms to alleviate the sufferings of pain.  

The foray of Artificial Intelligence by tech- giants and robotic surgery for precision based therapy to decrease human errors beautifully exemplifies our desire to do more but we can’t undermine the acts of automation making manpower redundant would entail the psycho-socio-economic costs falling within the basic definition of disease as given by World Health Organization(WHO). 

Secondly, tens of thousands of Indian doctors and nurses are working abroad and there is shortage of doctors with a ratio of 0.758 physician per 1000 population as per WHO (2016) statistics coupled with severe under-investment in primary healthcare. This is where India has been slipping badly. For instance, it had only about 1,800 hospitals in rural areas, according to the government’s rural health statistics for 2017. The shortfall in percentage terms vis-à-vis the population (based on the 2011 Census) is 19% in terms of sub-centres, 22% in terms of primary health centres and 30% in terms of community health centres. As of March 2017, the number of buildings required to be constructed to meet requirements had crossed 40,000.

Thirdly, with dissolving geographical barriers and techniques like “Three parent baby” being legalized in the United Kingdom and China also embarking upon, we are gradually moving towards creation of a new race of healthy humans which if, unfortunately lands into the hands of evil spirited can be used to create the “in-humans to take humanity to crossroads” or even enslave them which can give competition to poverty in terms of magnitude spanning beyond our cognitive coherence.

Fourth, we being a poor country and spending a much lower percentage of our GDP on health, given the fact that out-of-pocket expenditure on healthcare is nearly 63% of the country’s total healthcare expenditure (one of the highest in the world — it’s 32% in China, 11% in the U.S. and the world average is 18.2%), and “catastrophic expenditure” on healthcare pushes millions back into poverty every year in India. The government’s initiative to make healthcare affordable to the common man by providing an insurance scheme which provides up to a ₹5 lakh cover sounds like a great idea. Health industry that operates in India using Indian resources is so pricey that the majority of the people of India can’t afford its services. For this, the government directed generic drug prescriptions by doctors and drug substitution by chemists. This posed a big challenge.

Fifth, the term “ethical doctor” has become an oxymoron, especially in the private sector that is infested with overt greed and corruption, resulting in healthcare services being priced beyond the reach of common man. Fortis Hospital in Gurgaon and Max Hospital at Shalimar Bagh in the capital were in the news — for wrong reasons – on alleged overpricing and medical negligence, respectively. These two incidents and many others caused loss of confidence of common man on the health care services in India. It’s a wakeup call for the powers.

Medical Tourism and other hi-tech medico – clinical interventions as projected in the NHP 2017 are all fine statements of intention but the common man is still in the woods.  The NHP falls flat on the balance that  needs  to  be  exercised  between  the  preventive  and  curative components  of  health  care  whereas  the  NHP  2017  is  heavily  skewed towards Private partnerships for secondary and tertiary services. It seems that a long haul awaits the poor to avail of a benign Medicare system which is affordable and yet accessible.

In the end, we have opened a Pandora’s box that do gives us goodies but the bitter truth is that we are nurturing the dawn of neo -civilization or a new beginning to Anthropocene II for a promising planet to look after.

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