Mediconomics: A running battle
The noble traditions of medical profession have been virtually washed away by the strong financial and economic reasons.india Updated: Jan 22, 2006 23:32 IST
The noble traditions of medical profession have been virtually washed away by the strong financial and economic reasons. There has been an explosion of private health care institutions leading to aggressive competition.
Degeneration of moral and ethical values we encounter in today's setting owe their origin to this cutthroat competition. Less than healthy competition is also evident in the pharma companies' race for the magic cure. In order to market their drugs some of them spend around 25 per cent of their turnover on sales promotion. It is common to give expensive gifts, foreign vacation in the guise of "educational symposium" and tempting promotion materials and even cash and commission to physicians, eroding the basic principle of the profession.
Currently Indian healthcare industry is valued at $23 billion and is expected to grow by around 13 per cent per year for the next four years. The growth of our healthcare industry is evident from the fact that though government finance on healthcare has shrunk to 0.9 per cent of its GDP, private healthcare has grown exponentially, widening its range of activities. Not only have general and specialists hospitals, nursing homes and individual practice grown, but there has also been a proliferation of sophisticated diagnostic and pathological centres. The pattern of growth, mostly unplanned and unexpected has raised the question of medical ethics and narrowing the access of healthcare to a large section of the population.
The growth matrix is also evident from the fact that India has become a preferred destination for medical tourism, clinical trials and cutting-edge R&D. Clinical trial business according to FICCI in 2003-04 was $59.5 million, an increase of 104 per cent from the previous year. And according to CII, India can attract one million health tourists every year, which can contribute $5 billion to the economy.
India's healthcare system is skewed towards private medical services. A WHO study points out that the private health care accounts for 70 per cent of medical care and employs about 80 per cent of the country's medical professionals. It is estimated that only around 10 per cent of the population is covered through various health insurance schemes. But within the system there are several leakages and cases of fake prescriptions, hospitalisation bills, are rampant, forcing insurance companies to rethink about their business.
Though we make considerable use of private health sector, the NSS 2001 data reveals that the average cost of treatment in the private sector for urban patients is 2.4 times higher than in the public sector. Technology advances are associated with a decrease in cost, but the reverse holds true for the medical sector, where technology developments have been capital-intensive making healthcare expensive. Proliferation of medical equipment and technologies in urban areas has led to excess capacities and consequently unnecessary and irrational use of these technologies.
The corporatisation of our healthcare sys tem started in the nineties, but the big fillip came in the form of the National Health Policy 2002. Private hospitals were given concessional land, customs exemption and liberal tax breaks against a commitment to reserve beds for poor patients for free treatments. But unfortunately no procedures exist to monitor this and the disclosure systems are far from transparent, redressal of patient grievances is poor and allegations of cuts and commissions to promote needless procedures are common.
Similarly, a Planning Commission study says that the bulk of private healthcare units are run by doctors and doctors-entrepreneurs and remain unregulated either in terms of facility of competence standards or quality and accountability of practice and sometimes operate without systematic medical records and audits. And on their part, doctors argue that medical education has become more expensive with rapid technological advances. But the reward expectations in private practice, earlier spread out over career long earnings, are squeezed into a few years, which become possible only by working in hi-tech hospitals.
While there is no objection to user fees, adequate care must be taken to rationalise it. A line must be drawn not so much between public and private roles, but between institutions run as business or those run as a social enterprise with an economic dimension. In a market economy, healthcare is subject to three links: one, between the state and the citizen's entitlement for health; second, between the consumer and the provider of health services; and, lastly the link between the physician and the patient. None of these should become out of balance with the other. And that is an area of medical ethics. The next section discusses how the hi-tech medical technology is linked to ethics.