Events & Issues
New
Delhi, 27 December 2017
Health Services
WANTED ETHICS, NOT BUSINESS VIEW
By Dr S Saraswathi
(Former Director, ICSSR, New Delhi)
The World Bank and the World Health Organisation
have released a joint report “Tracking Universal Health Coverage: 2017 Global Monitoring
Report” which exposes the abominable state of healthcare facilities in many
countries including India. As health like education is a vital parameter for
sustainable development anywhere at any time, the report demands serious
consideration and immediate remedial action.
This report is focused on health spending and
accessibility of health services -- two major problems that drain the resources
of the middle and lower income groups. Healthcare is a luxury for common people
in India who go to doctors only when they are very sick and incur enormous
expenditure and debts. WHO reports have been showing India as the worst
performing region in health services after Africa.
Goal No.3 of the Sustainable Development
Goals focuses on ensuring healthy lives and promoting well-being for all. Specific targets set in 3.8 are achieving
universal health coverage (UHC) including financial risk protection, access to
good quality essential health services,
and to safe, effective, and affordable essential medicines and vaccines for all.
UHC -- recognised by the World Health
Assembly as a key imperative for all nations to consolidate public health
advances achieved so far -- has been accepted by many countries. It means
availability of health services including public health services to all people without
heavy financial hardships. Indeed, it is an essential investment for economic
growth. But, conditions in India are such that an idea as this seems a day
dream as healthcare remains a low priority matter in public spending.
Two indicators are set for UHC, namely,
coverage of health services, and proportion of health expenditure. This report states
that at least half of world’s population cannot obtain essential health
services and every year about 100 million people are being pushed into poverty
because of heavy expenditure on healthcare described in the report as
“catastrophic” spending.
The report reveals that currently 800 million
people spend at least 10 per cent of their household budgets on health expenses
for themselves and their family. In India, about 17 per cent of households
spend more than 10 per cent of household total income, and about nearly
one-quarter of the population spend more than one-quarter of household income
for health care.
Among BRICS countries, Russia has a
predominantly State-funded healthcare system. Expenditure being considered the
central point of UHC, the report places Africa and Asia at the lowest level
with people impoverished under medical expenses.
Healthcare is a State subject under the
Indian Constitution. The expenditure of State governments on the whole is much
less than that of the people, but varies substantially between the States.
Bihar, Jharkhand, Andhra Pradesh, and Uttar Pradesh governments report lowest
health expenditure that is less than Rs.600 per capita per year and at the top
is Himachal Pradesh showing over Rs. 2,000. Uttarakhand, Kerala, Jammu & Kashmir,
Gujarat, Tamil Nadu, and Telangana governments show an expenditure of over Rs.
1,000 per capita and other States between Rs.500 and Rs.1,000.
However, per capita total expenditure on
healthcare has been rising in India, but due more to increase in private
expenditure than public. National Health Profile confirms steady rise in private
expenditure on health for many years exceeding three to four times the amount
of public expenditure.
Noteworthy is the enormous private spending
in Kerala and Punjab compared to government health spending. In Andhra Pradesh,
private expenditure is very near 80 per cent of total health spending. Health
policies of the State governments and availability of professional services
vary between States.
The National Health Policy 2017 envisages
raising public health expenditure in the country from 1.4 per cent to 2.5 per
cent with more than two-thirds of this going to primary healthcare. Diagnostics,
drugs, emergency and essential care services in all public hospitals free of
cost, and bigger role for PHCs, are envisaged.
A robust health accountancy system will be
put into effect to improve public sector efficiency in resource
allocation/payments. The principle of equity will inform healthcare by taking
into consideration differential financial ability and healthcare needs by
districts, and by targeting specific sub-groups and geographical areas to
ensure equity.
The Supreme Court, on the basis of international
instruments, inferred health as a fundamental right 25 year ago and in 1995
stated that right to health was an “integral fact of a meaningful right to
life”. Next year, it declared that it was the primary duty of a welfare State
to ensure that medical facilities were adequate and failure to fulfil its
obligation would violate fundamental rights. Thus, India had always been in the
forefront to acknowledge the importance of healthcare orally and in writing,
while remaining in the backyard in taking effective action in the field.
Bulk of public health expenditure goes to
wages and salaries and not to medical services. A year back, a study of State
health accounts showed that payment to medical personnel in the total public
expenditure on health amounted to 86 per cent in Punjab, 72 per cent in
Maharashtra, 65 per cent in Kerala, and 52.5 per cent in Madhya Pradesh. Still,
there are only grievances leading to strikes over financial aspects of medical
professionals.
Healthcare seems to have lost its character as
a service and has assumed the role of a business. Result is growing malpractices in the medical
profession. A few days back, the Income Tax department uncovered a multi-crore
scam involving doctor referral fees in a number of medical establishments in
Bangalore. Enormous cash, jewels, and foreign currency accumulated as “referral
commission” were recovered in raids by the department. Doctor-laboratories
nexus is believed to be flourishing in all States compelling patients to
undergo wanted and unwanted tests periodically for diagnosis and treatment, and
to find out patient reaction. Poor and illiterate patients cannot even
distinguish tests and treatment.
Organ replacement and organ donation has
become a big racket ever since organ transplantation has become a medical
possibility. Sex determination clinics are started even in remote villages
where there is no proper health centre.
Correspondingly medical colleges have become
commercial enterprises run on exorbitant capitation fees, erratic selection
system, and a practice of extracting enormous donations for admission.
Despite commercialism dominating medical
education and hospital management, there is dearth of medical and paramedical
professionals in the country. Doctors are overworked and patients are required
to share beds in emergencies -- a situation far removed from the core
principles of UHC.
The National Health Policy 2017 has
delineated several key principles of health care like professionalism,
integrity, ethics, equity, affordability, universality, accountability, quality
care, etc., which are salient features of UHC. The stated objective is also to
achieve universal health coverage.
Good professional conduct is a must for
doctors and other medical professionals. But, if run on business lines devoid
of imparting professional ethics as the first principle, medical education is
not likely to infuse humaneness in doctors and managers and administrators of
medical institutions.
Indeed, professionalism and professional
ethics are required in all fields not just medicine. It means that our entire
educational system must be based on certain basic values. ---INFA
(Copyright, India
News & Feature Alliance)
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