Reforming Healthcare Systems

What is the issue?

The West Bengal Clinical Establishment Regulatory Commission has fined Apollo hospital chain Rs 30 lakh over the death of a 4-month-old.
The commission was set up in response to widespread public protests over mistreatment and overcharging.

What did the WHO recommend?

WHO representative in India had sought regulation of the private healthcare sector.
It also asked the government to consider tax based financing of universal health coverage.
This, along with a degree of regulation of private delivery can achieve something meaningful.

What is the present state of healthcare?

There is a massive shortfall in state delivery of affordable healthcare.
Therefore, people are forced to turn to private deliverers and becoming prone to overcharge and underserve.
Over 80% of what Indians spend on healthcare is out of pocket.
In 2016-17 state and central governments spent 1.4% of GDP on health compared to a global average of 5.99%.
The far greater challenge is to improve the quality of management of the public health service.
So that the enhanced state funding translates into at least somewhat acceptable delivery.

What are the problems?

Lack of functioning primary health centres across the country which have doctors, paramedics and a stock of essential medicines to distribute.
Over concentration of new super speciality hospitals.
A lot of investment has been made in equipment but there is often an issue with staff being posted to run them.
The national doctor patient ratio is poor compared to international benchmarks, but the ratio for rural areas is even worse.
This is because doctors are reluctant to move out of urban areas.

What might be an effective solution?

Make district hospitals into teaching hospitals where a preference is given to local students.
This increases the hances of them working in areas where they come from.
Rural areas also face a severe shortage of paramedics.
Have more nursing colleges and train the students to become ‘nurse practitioners’, who can deliver basic diagnosis and prescribe essential treatment.
Two-year courses for nurse practitioners in critical care have been started.

Source: Business Line