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Government should become health insurance provider

Primary role of the government is offering primary healthcare for the under privileged. We are grateful to the government for creating perhaps the largest network of primary health centers in the world. Unfortunately, they don't deliver, writes Dr Devi Shetty.

india Updated: Aug 11, 2009 11:11 IST

Our advice to the government is to become a health insurance provider rather than a healthcare provider. Government has realized that they cannot run hotels, they cannot run IT industries. Believe me healthcare industry is 100 times more complex than those industries. When we suggest a health insurance programme by government we are not taking about mediclaim type of insurance premium of Rs. 2,000/-. We are talking about health insurance where the premium is approximately five rupees per month. This is the insurance we launched in Karnataka 6 years ago and today it is enjoying a subscription based over 3 million farmers and it is likely to cover 60% of the state population. Similar insurance was launched by Andhra Pradesh with a great success. As the time passes by, in our industry there will be more and more super specialists who are extremely skilled and eccentric people. Unless you create an environment, which challenges their wisdom, they will not stay and government is the last place where there will be freedom and the flexibility to hang on to the extremely talented people. Primary role of the government is offering primary healthcare for the under privileged. We are grateful to the government for creating perhaps the largest network of primary health centers in the world. Unfortunately, they don't deliver. We strongly believe that government should let this infrastructure for private doctors to practice who will offer their services to the patients entirely free and government should only compensate for their services. As the doctors see more patients, they get more money from the government, this will be the only way doctors will be motivated to see large number of patients in rural India. We strongly believe that primary healthcare should be offered to the rural population entirely free. We have been running the primary healthcare of entire Amethi for the last 3 years and it is not very expensive to run these clinics. Most important component of this healthcare delivery is the presence of a doctor and that makes all the difference.

Today every employee of any level starting from lowermost worker of a software company to the CEO everyone works based on the incentives by involving the local general practitioners to manage the primary health center where the infrastructure is provided by the government the productivity of the person will be more because as he sees more patients he will get more money and most important is that it is not the patient who pays the money.

Every state must create a website for every major illness like heart disease, cancer, TB or mental illness. Every doctor in the state should be encouraged to enroll the patient details at the website as soon as the diagnosis is made. I will give a simple example as how it will help the patients. Suppose if we create a website for children with heart disease and all the children born in poor families seeking help for their child's operation put their child's Echocardiography report and their inability to pay for the cost, first thing what happens is the state policy makers will have the knowledge of the quantum of the disease. Supposing we launched this programme in state like Karnataka and in less than 3 months we collect details about 2 Lakh children with heart disease entire government machinery will wake up to the reality that children with heart disease is a major problem in that state and something has to be done. Also there are large numbers of private hospitals that constantly receive donor's support for sponsoring these types of operations. Essentially by putting the details you will have the information about the quantum of the disease so right kind of policies can be implemented and also you can get help from donors all across the world, since net will give an opportunity to talk to the society and ask for help. Central government should tie up with WHO and other countries government to create a supranational university, which will offer degree in medicine, nursing and paramedical areas. Today in country like ours medical education is a state subjects. Supposing we would like to start a nursing school in Bihar, first we have to get a no objection certificate from the government, which is not easy then we need to get the clearance from the local nursing council followed by Indian nursing council. All these bodies have their own idea about how big the nursing school should be even though reality of the world has changed. In Singapore 5000 Sqft. nursing school train 500 nurses a year where a huge building in India meant for nursing college cannot train more than 60 nurses. There is a acute shortage of nurses all across the world and all we need is one advertisement from US Health Department that they have welcomed Indian nurses and believe me all hospitals of our country will close down and doctors have to wear nurses dress to treat the patients.

You think it is not possible but believe me it happened in Philippines when there was exodus of nurses to America and doctors were working as nurses. By creating the supranational body first thing we will achieve is the boundariless opportunity for the young doctors, nurses and technicians. Fundamental philosophy of every human being is self-preservation and self-interest. When someone joins a medical or nursing or a paramedical school he would like to know what is the value of his degree in India, Africa and America. If he/she realizes that they can go to any part of the world and have the license to practice more number of youngsters will enroll for the medical education and by keeping a supranational body, you remove the local influencing factors in the selection process introduce college as well as the results of the final year examination. Today we have more than few hundred degree-giving bodies in various medical specialties of India with variable standard and when these graduates apply for a job outside India they do not know which degree to believe and which one not to in the process they don't believe any of our degrees. What has happened? When an Indian doctors goes to Middle East and works like a senior doctor doing all types of heart operations he gets lesser salary than a British qualified surgeon who may not be able to cut the hair but because of his degree he will get higher salary than our doctors.

First thing we should understand that there is nothing Indian about taking away the pain. For a patient it does not matter whether you use allopathic or homeopathic or any other Mexican method as long as he relieved from the pain. We should not try to promote our nationhood at the expense of patient pain. I am an admirer of Indian traditional medicine but that should be promoted at the cost of standardize western medicine, which patients believe. In the area of healthcare, it is what patient believes what matters.

In difficult terrain like North Eastern, hill regions or disturbed areas, government should encourage corporate houses to put up the infrastructure of a large hospital and get some other enterprises to manage it with very clear terms and conditions. Corporate houses must be incentivised for doing this job. Of course it will be ideal for the government to put up the structures but we understand the difficulties and we strongly believe that government should re-warmth the healthcare without spending any money just by the right polices.

There is enough money in this world for delivery of the healthcare provided right policies are in. We get disturbed when we read in the newspaper that government has allotted few hundred crore rupees for a big hospital project in some god forsaken area. We appreciate the government's concern and their desire to do something in those areas. But the grass root reality is that it is not the buildings and machines, which delivers healthcare. It is the people who are behind the machines, which makes the difference. These are human beings with family, commitments and aspirations. Unless these are all addressed, it will be very hard for government to retain talented work force. I am not looking down upon the government's ability to retain talent. Please discuss with people who are running hospitals in private sectors, find out the length they have to go to retain these talented specialists. When we hire a qualified doctor from USA or Europe as a policy we don't spend much time in interviewing him, we spend more time interviewing his wife, find out what she wants, and how many children they have and which school they want to join and address those issues first before we start discussing with the surgeon about his aspiration. This is the reality and I don't expect government to start discussion the domestic problem of an outstanding surgeon.

Dr. Devi Prasad Shetty is the Chairman of Narayana Hrudayalaya, Bangalore.