Dr Devi Shetty’s article in The Times of India brings out many contradictions. Though what he has achieved along with Karnataka Government through “Yashaswini” scheme to bring low cost healthcare to the masses is commendable but it would be too simplistic to assume that Narayana Hrudayalaya (now Narayana Health) and its affiliated hospitals have taken care of 100% healthcare needs of the people of Karnataka. To assume that similar scheme in larger form like asking all mobile users to pay Rs 20 per month will take care of all healthcare needs of the nation is assuming too much. For one this Rs 20 per person per month will net Rs 3,600 crores only, which is slightly more than 10% of the current healthcare budget.
When a person of the eminence of Dr Devi Shetty gives a statement that healthcare needs can be met without spending money, our politicians and government babus cut out the article, frame it and put it up in their offices to show when some rational folks ask them why their healthcare spending is so low.
Let there be no doubt in the matter; Insurance in any form is not the answer. Government has to spend from its own budget to develop more government hospitals where free or subsidised treatment can be given to the masses. The amount of pilferage of funds that occurs in the name of healthcare insurance is mind-boggling. It is an open secret that people find ways to siphon off the insurance money which is then shared by the patient / insurance company / hospital / and the omnipresent local politician. Those in real need, the ones who die unattended on roadside, those without relatives, without clout or muscle or without resources to even reach a hospital do not benefit from the rigmarole of healthcare insurance.
What is needed is a hospital where the poorest of the poor who walks in without any identification proof and who cannot read or write is taken care of whether or not he has any relatives accompanying him. This can only occur in good government hospitals of the likes of PGIMER Chandigarh and AIIMS and so many others across the country. Unfortunately, the Government wishes to abdicate its responsibility to provide healthcare to its citizens and is pushing desperately to pass on this responsibility to the private sector healthcare either by force or inducement. Those who are rooting for the private sector participation in otherwise a totally government duty see an opportunity to make money and have no intention to provide healthcare to the masses.
Increasing healthcare spending from abysmal 1.1% to a more realistic 5% (if not 10%) is a non-negotiable demand of MLAG (Medicos Legal Action Group) and of all those who sincerely wish to improve the situation in the country. Increased budget will increase the number of jobs available for doctors to work in the Primary Health Centres where as on date only 2,600 vacancies exist for MBBS doctors. Healthcare indices do not change drastically with the work done by cardiothoracic surgeons. It changes with the grassroots medical professionals who can advise ORS to diarrhoea patients and provide proper guidance and advice instead of the myths and misconceptions prevalent in the rural households.
I agree, however, that the Medical Council of India (MCI) needs to come out of its straightjacket and permit those with experience and training to do the specialists’ work and these guidelines need to be communicated to courts that are currently restraining those with even 20 years of experience in cardiology from practising cardiology because they are “only MD Medicine”. I also agree totally with Dr Shetty’s views that medical teachers should be recruited from the private sector and need not be full time employees of medical colleges. The criterion of who can be a medical teacher needs to change drastically. Increasing postgraduate seats is a good idea but not by reducing the quality of the postgraduates.
Dr Devi Shetty’s views on AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy) practitioners being given training for six months to prescribe modern medicines bothers me the most. But then since Narayana Hrudayalaya has been providing Diploma/Certificate in Emergency Medicine to AYUSH doctors already for some time, these views do not surprise me. I have tremendous respect for indigenous systems of medicine.
If available manpower is the problem what is wrong with the 1 lakh plus trained Foreign Medical Graduates who have been trained in Modern Medicine but cannot practise medicine in India. Their only crime is that they did not pay Rs 60 lakh as fee to Indian private medical colleges where they did not get admission due to reasons other than merit. They saved nearly Rs 45 lakh by doing their MBBS outside India but then our politicians who own most of the private medical colleges feel cheated of these Rs 60 lakh. Directing the MCI to punish these Foreign Medical Graduates by holding an exam so stringent that even AIIMS graduates would find it difficult to clear, the politicians have improved the sales of MBBS seats in their colleges.
And now they are wanting a Homeopathic graduate who has been taught and trained that increasing dilution of the medicine increases its potency to use increasing doses of antibiotics to treat resistant infections. A person who has no training in the principles of modern medicine is being forced to practise modern medicine. If Dr Devi Shetty’s argument is to be assumed correct then is he also proposing these AYUSH graduates be given postgraduate seats in Modern Medicine training programmes because that, according to him, is where the deficiency lies.
Dr Neeraj Nagpal
Convenor, Medicos Legal Action Group
Managing Director, MLAG Indemnity
Ex-President, IMA Chandigarh