Demand for Nationalization of Healthcare Services
Dr Maya Valecha, MD, DGO, Vadodara, Gujarat
09 Apr 2022
As is thoroughly exposed during this corona time, not only the fact that private sector healthcare service is of no use when it comes to the health care of vast majority of poor people during normal time but during a health crisis it was of no use also to the minority of rich people from whom it earned exorbitantly all along.
It was only our government hospitals which were neglected in the era of privatization, that came to the rescue of We the People of India.
80% of the patients prior to lockdown were going to private healthcare especially because in the era of privatization governments neglected funding government hospitals. There have been instances when prestigious government hospitals with attached medical college, would not have even proper ECG machine. Patients are advised routinely to get medical tests and medicine from outside. From equipments to staff to drugs government hospitals always faced shortages.
Private doctors in even otherwise normal times charged heavily and large-scale malpractice in terms of unnecessary investigations, drugs and surgeries is an open secret. We keep on getting reports in between and label it as some bad apples in the basket. With five star corporate hospitals on one hand to substandard small private hospitals, patients were suffering financially and in terms of healthcare.
But the corona has exposed the whole system fully. As soon as the lockdown was declared private hospitals shut down their shutters. They stop seeing or admitting even the non-corona patients. And even the ambulance service which is 10 times more in private sector in most cities than government ambulances, stopped functioning. When they were forced to open for covid patients we know how heavily they charged. Instances were reported when non covid patients were treated after bargaining for heavy charge to give treatment. So the greed for money was exposed like any other business.
Government hospitals were overburdened because of this sudden closure of private sector and the policy of admitting mild patients of corona and institutional quarantine even of asymptomatic corona positive persons. Obviously some medical and other care was diverted for even asymptomatic persons. And with extra procedures for crematoriums and the patients dying only in government hospitals, who were dying previously all spread over the city, now we saw piling up of dead bodies.
LET US ALL ACCEPT IN SPITE OF ALL THIS IT WAS THE GOVERNMENT FACILITIES CREATED MAINLY AFTER INDEPENDENCE TILL 1990s THAT STOOD AS OUR BACKBONE IN THIS CRISIS.
The lesson that We The People of India have learnt from this is that health is such a sensitive and important part of our life that we cannot neglect it with private and public sectors running parallel. We have seen that in such a situation with number of factors playing part the public sector is neglected and private sector becomes more and more commercial. In the end public interest is not served. Some Charity Hospitals giving good services can always be integrated in the public health infrastructure created.
Pharma Industry is an integral part of healthcare system. Not only for availability of medicine at affordable prices but also orientation of researches as per the need of the people. There are examples. Once BCG vaccine has been introduced in Universal Program, further evaluation of its effectiveness, need to develop any other variety is never examined. And we have more than 1400 people dying of Tuberculosis daily. In case of Oral Pulse Polio in spite of knowledge that it was causing harm, it took years to change it. And though injectable polio vaccine is the safest for children, just because it is costlier oral doses are universalized.
So when we demand Nationalization of Healthcare, Pharma Industry is included to have the optimum, need based production and availability of medicines.
What we need is one robust National Healthcare System where all the resources of our country are channelized for the best care of our people. Of course the government will have to spend more. And for that government will have to tax rich people. For years they are given all tax benefits, subsidies, tax free periods, tax cuts, bailouts and host of other advantages. Superrich tax is one such but even otherwise tax slabs are too low for rich.
Because of the schemes like Ayushman Bharat scheme or the Medical Insurance Schemes the poor people’s money is ultimately transferred to the private drug companies and private doctors. My citizenship of this country is my permanent Insurance. No other insurance or premium should be there. It is possible to create a system where quality healthcare can be provided to all without any payment. It has been calculated that just the wealth tax and inheritance tax can cover basic necessities like health, education, old age pension and schemes for differently abled people.
Lives of the people are far more important than the extra luxurious life for few. It is the experience world over that wherever the healthcare is nationalized with good governance, on one hand unnecessary investigations, medicines and surgeries are avoided but when required, it is always available.
For that we demand following:
- Immediate takeover of all private hospitals with reasonable compensation at depreciated value of assets. Small clinics can be converted to government Mohalla clinics.
- Strengthen and expand the already existing chain of government health infrastructure from Sub-Centers in villages, Primary Healthcare Centers, Community Healthcare Centers to District Level Hospitals and Multi-specialty Hospitals.
- Enough Doctors, Nurses and other paramedical staff should be available at all the levels. A compulsory village level service is a must for all doctors before post graduation and then in rotation as per the need. Let us remember the resources of the country and poor patients are used for training the doctors.
- Let us pay a dignified handsome salary to doctors as well as all other medical staff. Class 1 salary and then as the experience and degree goes higher, the way IAS officers are given, they can go higher in the ladder.
- The most important part is the direct democratic control of people to oversee the functioning of healthcare system.
- A committee of hospital administration, doctors’ representative, other paramedical staff’s representatives and people’s representatives elected directly for this should be formed to solve day to day problems.
- The hospitals have to hold a public meeting every month to hear the suggestions, complains of people apart from complain and suggestion boxes. The boxes should also be opened in these meetings.
- Every patient should be offered a survey form (digital for those who can), about their experience after each visit the way many banks and other companies are doing it to improve performance.
- A strong suggestion is made to teach different practices of medicine, that is Allopathy, Homeopathy, Ayurved and others at undergraduate level to all students and only at specialization level they do separate training. That way the best practices of all can be used for patients. Instead of mutually exclusive all these should become complementary. Today, the patient who is the least knowledgeable decides which practice she should choose for a particular sickness.
- Environment science should become important part of curriculum.
- After the nationalization of Drug Companies, all decisions will be taken in a transparent manner. Even for the administration of these companies those experts and administrators will be appointed in whom people will show their faith after listening to them in open public discussions.
A wide spread demand from people to force the government to do all this and take the lives of people seriously is the only way to a secure future.
Dr Maya Valecha, MD, DGO, Vadodara, Gujarat