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Management of the Sick Health-Care System
private practice, the number of doctors in the private practice will be reduced. That in itself will help in reducing the malpractices in private practice to some extent. There is a second population group comprising the poorest section of the society of nearly 40% of the total population who are helpless. They are incapable of getting medical assistance with their own income and, therefore, are totally dependent on the government, municipalities, zilha parishads and the state and central governments who have set up large infrastructure starting from dispensary, primary health centers, upgraded dispensaries, taluka level hospitals to district hospitals to highly specialized medical college hospitals or other specialized hospitals. Ideally twenty five per cent to thirty per cent of the medical personnel ought to be absorbed in this section. But at present only a small percentage of doctors are working in this public sector serving poor people. Their apathy and the laxity of the government machinery makes it easy for these doctors to break the rules and enter into private practice. As mentioned earlier these doctors could be paid adequately but their performance must be assessed by the charges collected or the number of patients treated, so that sincere doctors will be better rewarded than their colleague counter parts by early promotion. This was discussed in more details earlier. But under no circumstances should they be allowed to enter into private practice. That leaves only a small section of about 25% people who are not covered by either their own organization or by government machinery but could afford to spend for their health. A certain percentage of patients from organized sector and from the poor section who are dissatisfied with the services offered to them in their respective hospitals would prefer to take treatment in this private sector. The total number may, therefore, go to 35% to 40% of the population. With the controls mentioned earlier namely accreditation of the hospitals, specific duties for each strata of the medical personnels, display of charges as suggested by Indian Medical Council and the over-all control of the Health Council, the private sector also would become more disciplined. The charges would be more regulated and malpractices would be minimized. QQ
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Miscellaneous
There are some other aspects of health-care system which remain uncovered, the main being the need and inadequacy of paramedical services, transport of serious patients and ambulance services and disaster managemet or critical care management in the peripheral parts (not cities, where it is overemphasized as usual) The need for nurses is supposed to be double that of doctors, presently they are less than half the total number of doctors – the deficit is 4 times the actual need. Physiotherapiests are clustered in big cities, technicians are scanty, but strangely the need is only half-felt because the ‘basic’ doctors manage to do half of these jobs, while some other functions can be conveniently neglected. It is a pity to see doctors doing clerical or semi clerical, purely administrative work or paramedical work – Not so much a problem of dignity but of wasteful expenditure of creating a doctor at a formidable cost and giving him a job which could easily be done by people who are being trained at a much lesser cost. Sometimes, I feel that we have too many ambulances but indiscipline and total apathy to coordinate gives us a paradoxical picture of inordinate delay in getting an ambulance while plenty of them are parked idly, all over the city. We lack administration and management. I have decided to refrain from entering into these aspects in greater detail because 1) I myself have very scanty data and experience in this field and 2) because what I have written so far appears to be too complex and ‘head-breaking’ if I may coin such a word. Will this one Man Committee report – self appointed – work? Will it serve any purpose ? I do not know. If it falls in the hands of high level medical administrators, or bodies or persons in high places in any social field, who are concerned about our health-care system, it would atleast ferment discussion, and