We urgently need a regulatory authority for the Health Sector
Manohar Manoj, Editor, Economy India
Author of the books, A Crusade Against Corruption and A Dialogue on System Change
Like education, health is also one of the big sectors, which is abruptly ridden with corruption. For many years, on a trot, the reports of ‘transparency international’ (TI) found health as the most corrupt sector in India. These TI findings can be regarded as upright one because people feel the music of a corrupt health system in a more poignant manner. Health is a very sensitive issue, which is one of the most priority areas for any government, society and families. Like education, health is also being carried out by all three tires of democratic governments. Secondly, like education, it is also covered by public, private and NGO. But, it is slightly different from the education sector on this count that in the health sector, we have no much difference between the private sector and NGOs. Most of the private hospitals run themselves on a charitable trust basis. In the name of charity, they get several incentives from the government but ultimately run themselves in a profitable manner. There are few charitable trusts working in the health sector, which run their operation free of cost on the line of the public health system. Thirdly, health also has many categories; firstly health centers/hospitals of which there is two types. The first type is the general hospital, which ranges from primary health centers to general hospitals; the second type starts from specialty hospitals to super specialty hospitals. Second is the availing drugs and medicines and third is the health education, these all constitute the essential composition of our health system.
Talking about the role of the central government, its role in the health sector is very much on the line of the education sector, under which it runs some super specialty hospitals, health institutions and some medical colleges also. The central government also has a regulatory role in terms of the National medical commission (NMC), which is an organization giving professional certification to all medical degree holders as well as affiliation to any start-up of medical college.
The central government has many health schemes, out of which the national immunization program is the most important. This program has got a huge success and has been instrumental in improving maternity health and child care in the country. This program has reduced the child mortality rate in a drastic manner and a bit has controlled the country’s population growth.
Centre sponsors many health programs like the National rural health mission (NRHM), which has been hugely crippled by corruption. We know the NHRM scam in UP. In the same manner Affiliation authority, MCI( earlier name of NMC) has also been notorious for corruption and so its ex-chairman is facing a judicial trial over the charges of corruption.
On the state level mismanagement in the hospitals, corruption in the procurement and in the distribution of drugs, and negligence of duty, all have the status of corruption in almost all hospitals, whether they belong to any tier of governance or any public-private health system. The fact is that hospital management has always been on the poor side in any category of health services. Faulty health policies and lack of full proof medical system have been instrumental to the emergence of multi-dimensional corruption in the health sector.
Health is a service and an industry both. Doctors and all other medical and paramedical staffs render services, whereas the hospital buildings, medical equipment, and all apparatus, drugs and medicines are part of the industry. We have corruption on both fronts. In government hospitals, doctors do not pay proper attention to the patient, they do not display proper behavior with the patients, and they lack involvement. Their applications always have been under a question mark. Private practice by the doctors of government hospitals has always been a big issue. Some state governments have made laws to bar their practices, but it went in vain. On the whole, there is still no equilibrium between the demand and supply of health services in government hospitals, so there is a huge rush there.
The OPD(outpatient department) hours in government hospitals are always been inconvenient to the patients. Therefore, on-demand quality health service has been just an unfulfilled dream for many. The medical services as well as medical education primarily come under the second tier of governance. Here we find that corruption is visible in terms of inconvenience to the public also. Most government hospitals are not well equipped with the proper public convenience. There is a lackluster on the part of hospital governance and an absence of maintenance and surveillance of various medical equipment. Admission of highly critical patients in the hospital becomes very tough there, whereas in private hospitals, huge charges are being taken and doctors are not very qualified there.
Medical corruption has innumerable dimensions. The most notable among them is the prescribing number of investigations to the patients for any disease. This is a well-intentional act done by the doctors. Part of the expenses over several pathologies goes into the pocket of doctors. The pathological laboratory available in government hospitals have to face huge queues. People are compelled to do it from the open market. Second is the prescribing of medicine by the doctors what they have been dictated by the medical representatives belonging to a particular several drug company. Forty to fifty percent commission is being paid over selling of any drugs and thus patients are being looted in the existing health system.
Private hospitals are operating in such a manner that they can be easily termed as a great symbol of corruption. Patients are allured, then cheated, misguided and finally looted. All medical ethics are drowned while treating any patient. In child-born cases, where cesarean is not required, it is done just because of making money. Where a stunt is not required while bypass surgery, it is installed only to make money. An inappropriate amount of consultancy fees on frequent mode, unnecessary investigations, higher charges of beds etc. have become modes of corruption in hospitals, whereas in the name of charity, these hospitals are being allotted land and being given several tax incentives, but they loot the patients.
Kidney racket is also one of the prevalent ways of corruption, under which the poor, ignorant and needy persons are allured and cheated and then their kidneys are being removed just with a few amount of money. Then these kidneys are being transplanted to the needy in millions of rupees.
Charging higher amounts of room rent has become one of the prevalent modes of making money in private hospitals. They just exploit the circumstances and conditions of patients, if they suffer from emergency kinds of things, these hospitals just try to grab money as much as possible from them and marta kya na karta , a dying person can go to any extent. We have a large no. of cases, when it has been seen, even at the fag end of life, hospitals kept them alive through artificial life support systems etc. and make their bills in lakhs.
Pirated drugs and fake medicine has been also one of the most prevalent modes of corruption in the health sector. We have many scandals that took place in this regard. In states like Bihar and UP, many drug rackets have been found.
Next corruption is related to medical education. For taking admission to medical colleges, there is a huge prevalence of capitation fee which ranges between 25 lakh to even one crore. Private medical colleges have been unbridled, so they take hefty money from the aspirants. These are the things, which make doctors, who studied here, corrupt. Therefore, these medical students go after big money while practicing their profession.
Our health sector lacks policy and resources. If a public-private partnership model under a competitive regulatory mechanism is brought into the health sector, it will maintain a proper balance between the both. Medical insurance has also become one of the new ways of committing corruption in the health sector. As we know, insurance is just a risk business, so is medical insurance also a business. There is a lobby in the health sector that supports the idea of spreading the network of medical insurance to the maximum level in order to suppress the effect of high charges being committed by private hospitals.
The fact is that this lobby works for expanding the network of medical insurance all over the country, but medical insurance does not cover each and every health need of the public. Generally, in hospitals, the coverage of diseases for the insured’s very selective; sometimes they are ready for cashless treatment, and sometimes not. Secondly, the corruption in medical insurance is the same as what it looks like in motor insurance. First, the client is not being given the proper coverage; second, the size of coverage is left over the whims and fancies and the discretion of the surveyor, in the same manner, it is up to doctors, how much disease coverage is he permitting over the insurance.
The best method to provide health services to the public can be rendered only through fixing rates for all kinds of health services under some regulatory authorities. It will provide a level playing field for both public and private players as well as it will promote competition between public and private players.
Decreasing morality and ethics in the medical profession has become the order of the day. Doctors have forgotten the sensitivity and service motto of their profession. There are many doctors who misguide their patients and also make them frightened.
There was a time when the doctor’s profession was just next to God because they were termed as saviors of mankind’s life, but now doctors have forgotten all this and they are just after money. It is true that the growing commercialization of the medical profession has made medical education a very costly affair. As we often say that electioneering is costlier, so politicians succumb to being more corrupt, in the same manner after making lots of hard work in competing medical exams and spending huge amounts of money on their studies, if someone becomes a doctor, he thinks about nothing but only money. I think medical education must be made easier and smooth and it must be diversified towards various other systems of medical treatment. For doctors, fame, and glory is a bigger things than money, so they must always stick to ethics and morals. One, who violates this, must be made ashamed of this.
Pinpoint corrupt deeds of Doctors and Health Staff
Avoiding medical ethics and making this humanity-oriented work, a money-making profession is in fact a big corruption for society. We have innumerable examples of corruption being committed by the doctors. which can be pointed out in the following ways:
- Prescribing medicine as per the suggestion of Medical representatives (MR). Medical Representatives pamper the doctors and the medical practitioners.
- Prescribing medicine on that sheet of pharmacist with whom doctors have a personal rapport on a commission basis
3. Prescribing investigations for getting commission from the pathologists
4. compelling patients to go for costlier treatment, which actually can be avoided
5. Charging consultancy fees on a frequent note
6. Misbehaving with patients and ignoring their troubles
7. Many times recklessness are being shown while surgery treatment
8. Indulgence of government doctors in private practice
9. To avoid truth while preparing medical reports and post mortem under some pressure or greed
10 Many times, doctors are found to be not showing humanity in the dire need of the patients. They refuse to treat patients, who do not have the required amount of money.
Why do we need health insurance or health reform?
Prime Minister Narendra Modi a few years ago launched Pradhan Mantri Rashtriya Arogya Yojana. There are two main components of this scheme, in which the first is to provide all the health facilities of the primary stage by the governments at their own level across the country, under which about one and a half lakh primary sub-health centers will be established in a state-of-the-art manner across the country, in which primary treatment, Vaccination, mother-child care, yoga and fitness works will be conducted. Its second component is to provide insurance cover of a maximum Rs.5 lakh for type-2 and type-3 diseases to about fifty crore members of about ten crore socially backward families of the country.
Putting these two components of the Ayushman Bharat scheme on the ground seems to be a herculean task at first glance. Those who know the current structure of the country’s health system know that both of these steps cannot rejuvenate the existing basic health system of the country. First of all, if the construction cost of a fitness center is also fixed at ten lakh rupees, then the total cost of setting up all 1.5 lakh hi-tech and state and art primary health sub-centers will be around 15 trillion rupees. Secondly, Ayushman Bharat’s public health insurance scheme, the whole process of which has not yet been determined concretely, in which the final agreement has not been made with the government regarding the rates of treatment of diseases by private hospitals, what will be its future form? Don’t know what shape it will take. Those who advocate health insurance instead of bringing reforms to the health system in the country should know that health insurance itself is a big area of corruption. The patient is not covered easily for all diseases. A lot of running has to be done. Instead of the actual and reasonable expenditure for the treatment of the disease, its bill is made in an unaccounted way. Then the next question is whether this health insurance scheme will be able to eliminate all the structural deficiencies and countless corruption in this public and private medical system of the country.
At the time of the advent of the Modi government, the then Health Minister Harsh Vardhan had issued a guideline for the doctors that they should conduct pathology for the patient only in very urgent circumstances. Another directive was issued that doctors should not prescribe any medicine at the request of the publicity representative of any pharmaceutical company.
For this, a provision has also been made to punish the representative of the pharmaceutical companies on any request to the doctors. But both these steps have not yet been implemented effectively. Today the entire allopathy medical system is being run through the pathologists and MRs of the drugs company and the syndicate of private hospitals, in which this business is carried out at the cost of the patient’s trouble and money. Now the question is that for those with money, private hospitals have come where one and a half to two lakh rupees are charged for each operation. While these hospitals are opened in the name of charity, huge evasion of taxes is done and on the other hand, the patient’s pocket is cut. Several reports of the CAG have revealed this fact.
The Modi government is trying to increase the circulation of generic medicines to provide medicines at cheaper rates, while the reality is that 115 percent to 360 percent profit margin is taken by the pharma companies and their retailers on these medicines. The Modi government definitely brought a decree to drastically reduce the prices of heart stents and knee replacement plates But these pieces of equipment are being made available by the hospitals with great difficulty at the rates fixed by the government, rather in the name of better quality, these types of equipment are still being sold at expensive prices by the pharmaceutical companies and private hospitals.
According to a report, big hospitals in the country earn 1700 times more profit on the items needed by the patient. To curb this trend, the Modi government has established about 3000 Jan Aushadhi Kendras across the country. But one, people do not know about these medicine centers, shopkeepers are not present there, all medicines are not available here and then people are forced to take shelter in private medicine shops.
The plight of health services in India is at its peak. From the primary health centers located at the lowest rung of the country to the highest institute of medicine AIIMS, there is a state of plight everywhere. The condition of the hospitals is such that there are no patients, there is a crowd of sheep and goats.
It is as if you have come to the hospital to do some agitation, not to show your illness. Today there is no humanity and sympathy toward the patient left in the mind of the doctors. They only care about money. Distortions and disparities prevalent in the field of medicine in India are not only about the institutional structure of hospitals and doctors but also about the promotion and suitability of different systems of medicine. It is also about what should be the policy for entry of government sector, private sector and multinational companies in the field of health care. The medical institutions coming in these three areas cannot be left to the choice of the patient. It is known to all that the government cannot take care of the entire medical needs of the country’s 1.25 billion population on its own. For this, there is a great need for private and foreign investment.
The interesting thing is that in the southern states of the country, most of the medical work is being done by the private sector, yet the medical fees there are very low because there are many players in the medical education field. Due to this, there is an abundance of doctors. An MBBS student studying in Karnataka told that there a fee ranging from Rs.25 to Rs.100 is charged for the checkup of the patient. The government talks about reserving 25 percent of beds for poor patients in lieu of giving subsidized land in private hospitals.
Firstly, no poor patient dares to go to hospitals like Apollo Max. The government should fix the charges of these hospitals in such a way that at least one lower-middle-class patient can also go there for treatment. This will also reduce the crowd in government hospitals. Right now the situation is that if you go to a private hospital, even if the patient does not need to be admitted in the ward, he will be asked to get admitted for the greed of money. Rates of doctor’s fees, rates of disease investigation, rates of medicines, rates of hospital beds and rooms, rates of medical and surgical pieces of equipment, cost of organ transplant, patient’s emergency services, delivery and vaccination in all the clinics running in the country. Methods, the solution to all these can be found in a better way through three-tier health regulation authority and private-public partnerships set up at the center, state, and district levels. The alternative to this step is not health insurance, but it is possible only through health regulation authority and private-public partnership and mutual competition among them, so that government, private and non-government organizations will be able to provide health facilities at reasonable rates to all medical institutions. With this, health facilities in the country will also be able to create a win-win situation in both the economy and society like telecom services. With this, health facilities in the country will also be able to create a win-win situation in both economy and society like telecom services. The health insurance system will only give birth to a new type of corruption in the country, which will lead to the corporatization of this very humane aspect of the 
health system. Only a new dimension will be attained.