IMA’s Promotion of Healthcare Privatization Through Insidious Attack on NCERT Textbook

Manali Shah (name changed on request), a 33-year-old software engineer working in the private  sector, lost her savings of eight years in a day when her father, 65, underwent a liver transplant in a private hospital. “Not only did my savings go, I also had to borrow money from the family to foot the bill. The procedure and hospitalisation cost almost Rs 30 lakh, and we have to continue spending Rs 10,000 each month for medicines, follow-up consultations and diagnostics,” she says

Each round of chemotherapy and radiation costs her almost Rs 1 lakh, but she didn’t consider AIIMS because the radiotherapy machine there is booked for the next seven months. [The cost of one round of chemotherapy in AIIMS was just Rs 750/- at that time, hence the overbooking]. From a report in Hindustan Times, 20 October 2013

Doctor, heal thyself, was my initial reaction when I read the front page report in The Hindu that ‘Docs’ were opposing ‘negative’ portrayal by NCERT. The objection raised by them is that the class VII textbook, Social and Political Life II, contained “objectionable description ” of the medical profession. Or so you believe till you realize, by the time you are into the third paragraph of the report, that the issue is not at all about the negative portrayal of the medical profession as such but of its elite practitioners who are making a killing in elite private medical institutions and hospitals at the expense of the ordinary people.

So it is not doctors in general – those who work in trying conditions in government hospitals – who are raising the objection but the Indian Medical Association that professes to be “the only representative, national voluntary organisation of Doctors of Modern Scientific System of Medicine, which looks after the interest of doctors as well as the well being of the community at large”.  The IMA says the news report, has written to the President Pranab Mukherjee and Prime Minister Narendra Modi “demanding immediate remedial action”. IMA’s objection is to the following passage in  Chapter 2, on the ‘Role of government in health’, under the sub-heading: ‘Private health facilities’:

“In order to earn more money, these private services encourage practices that are incorrect. At times, cheaper methods, though available, are not used. For example, it is common to find doctors prescribing unnecessary medicines, injections or saline bottles when tablets or simple medicines can suffice.”

And what precisely is the objection? Here it is in the words of IMA’s own office-bearers and spokespersons:

“This is a wrong depiction. They have shown that the cost of treating the same illness is Rs.3,500 in private sector and Rs.150 in government sector,” said Dr. K.K. Aggarwal, honorary secretary general, IMA.

IMA national president Dr. A. Marthanda Pillai said: “The message which will go to the students is that private sector fleeces money.”

Honourable Drs KK Aggarwal and Marthanda Pillai may believe that the ordinary person is waiting for the NCERT textbook to disclose to her the true state of what the private sector in health care means, but for millions of people in India today, this is already a known fact. I have cited a case from a Hindustan Times report at the beginning of this post, Dr Pillai, that shows precisely that one round of chemotherapy in AIIMS costs a mere Rs 750/- as opposed to Rs 1 lakh in the private hospital where Manali Shah got her father treated. And the same report also tells us something revealing- that almost 40 percent of the people getting treated for cancer in AIIMS cannot even afford this Rs 750/-. The difference between the private hospital and AIIMS is 133 times, a way above the 23. 33 times difference suggested in Aggarwal’s fictional example. And yet Drs Pillai and Aggarwal want us to believe in the fairy tales they tell about privatization. True, there is a lot that is wrong with government hospitals and things need to be urgently rectified there, especially working conditions of doctors. Many of the ills of government hospitals have to do with overcrowding simply  because costs elsewhere are just beyond their wildest imagination for most of the people. Conditions have only worsened with cuts in government spending on the health sector.

I recently lost a cousin who had been suffering from multiple ailments and at one critical moment a few months ago, had to be admitted to a private hospital in South Delhi. In a matter of two hours, his family was handed over a bill of close to Rs 25, 000. This was just for tests. His wife then decided to move him from there in that critical condition, to AIIMS. He survived for a few months after his treatment but the point here is simply that even for a family like ours which is not poor by any standards, it was impossible to meet the projected expenses of the private hospital. So if ordinary people believe, Dr Pillai, that the “private sector fleeces money”, they do not have to read the class VII textbook. Your ilk has drummed home this message to us poor and middle class alike.

In fact, we can go a step further and say that there is something really mala fide in the statement made by the IMA that purports to be an organization representing doctors’ interests as well as those of “the community at large” and yet, makes here a clear pitch for privatization/ corporatization of the health sector. Doctors in the private sector, many of whom have been trained with government (and therefore tax-payers’ money) in government hospitals who have been ‘bought over’ by the private sector, are the ones whose interests are perhaps at stake here. It needs little imagination to see how diametrically opposed the interests of “the community at large” are to those of corporate sharks that seek profit from people’s misery.

Dr Pillai actually goes much further and argues that

When calculating the cost of government hospital treatment, it [the textbook] does not take into account the cost of infrastructure, medical equipment, staff salary, doctors’ salary, cost of attached medical colleges etc…

“There is no way the cost of health care in government sector can be compared to the cost in private sector without taking into consideration the above factors.”

Is that what students and teachers – and tax payers at large – should be concerned about? About how corporations and elite doctors can make their money from ordinary patients and find alibis for high costs of private health care? Or should they be taught how health care can be made available at reasonable cost to all people – irrespective of whether they are in government hands or not? It does not take a visionary to see which side IMA stand on here.

The Hindu’s report then goes on to say that

Doctors have found the sentence “in order to earn more money, these private services encourage practices that are incorrect” as judgmental. Doctors said content like this in NCERT textbooks will brainwash the students and ruin their faith in private health care services.

Thus, says the IMA in its letter, “The matter should be taken seriously and the NCERT should be directed to delete or re-write this chapter it.”

This is, as it were, the most intriguing and pernicious part of the letter. There is no question of a public debate on the ethics of private health care, there is no question of any debate or contestation and the right of defense allowed to NCERT or those who have written the textbook. The IMA demands that “NCERT should be directed” – clearly by the PM and/ or President, that is, by administrative fiat, to simply delete and re-write the chapter. That is why they did not go to the court, where they would have to argue and defend their own bogus case.

For our part, we see this as an opportunity to initiate afresh a full-scale public debate on the ethics of the corporatized health system. Let us be clear here that the point here is not simply about government versus private health care – an easy opposition which requires no thinking, for in that universe there is always only one answer to everything thing: privatize, privatize, privatize. But behind this slogan stand corporate armies of plunderers and I can already see neoliberal ideology warriors jump on to their horses, rattling their sabres, ready to charge forth.

No, the question here is far more complex. It is not against private health care but against corporate takeover of health care – and this includes the predatory insurance corporations as much as it does, corporate hospitals.

To conclude then, let me cite the following extract from a piece penned by two doctors, Amit Sengupta and Samiran Nundy:

Until about 20 years ago the private sector comprised solo practitioners and small hospitals and nursing homes. Many of the services provided were of exemplary quality, especially those hospitals run by charitable trusts and religious foundations. As the practice of medicine has become more driven by technology, however, smaller organisations have become less able to compete in the private healthcare business. Large corporations, such as drug and information technology companies, and wealthy individuals—often from the Indian diaspora (commonly called non-resident Indians)—have started providing health care to make money. They now dominate the upper end of the market, with five star hospitals manned by foreign trained doctors who provide services at prices that only foreigners and the richest Indians can afford. These hospitals are largely unregulated, with no standardisation of quality or costs. Their success may be gauged by their large profits and ability to raise funds through foreign investments.

This puts things in perspective by bringing into the picture the vast range of non-governmental players in the health sector. Religious institutions have played a significant part here and continue to do so. So have what Sengupta and Nundy call solo practitioners and small hospitals. Even today, outside the network of government institutions, they are the ones who most ordinary people have to fall back upon.

IMA has thrown us a challenge that cannot be allowed to go uncontested. This challenge can only be met by bringing the entire ethics and practices of the corporate medical sector into the centre of debate.

30 thoughts on “IMA’s Promotion of Healthcare Privatization Through Insidious Attack on NCERT Textbook

  1. G Shah

    Our healthcare system is a catastrophic mess. Public expenditure on healthcare is the fifth lowest in the world, barely a percent of GDP for a billion plus population. The vast majority of this goes into paying salaries, so the facilities hospitals / health centers, wherever they are, are crumbling, without basics such as 24 hour water or electric supply, medicines or equipment. Sudden / catastrophic expenditure on healthcare is the biggest cause of falling into poverty (dowry being the second). There has recently been a cut in health funding by a further 20%!

    It comes as a shock to many when they hear that our (supposedly a future superpower) health outcomes (for example: life expectancy, infant & maternal mortality, immunization rates) are the worst in the entire region – worse than Bangladesh, Sri Lanka, Nepal or Bhutan. Our child malnutrition rates approaching 50% are far worse of than sub Saharan Africa (30%).

    Higher medical education (MBBS, MD/MS) is increasingly in the private sector. Quality of education is horribly substandard with almost no infrastructure / patients / faculties and facilities. Reports of rampant corruption during the medical college inspections are far too many. People heading the Medical Council of India and the Indian Council of Medical Research, the apex regulatory bodies, have been investigated on charges of fraud and corruption. The all India pre-medical exam (graduate medical program’s entrance test) has been cancelled and would be held again. The tuition fee (and capitation fee) is exorbitant (in hundreds of thousands of $), so we have mostly either the very rich or rarely some under huge debt who become doctors. None of whom would be working on the pathetic public sector salaries (<<$1000) in difficult places. So (if) we have jobs there are no doctors willing to work those jobs. There is a huge stress on specialization so freshly trained medical doctors choose to stay at home for years and prepare for medical specialty post graduate exams. Government's way to send doctors to rural areas is by forcing them into "bonds" – contracts forcing them into several years of mandatory rural service or huge financial penalties.

    The private sector medical (mal)practice is quite open to fraud with commissions on investigations and referrals quite common place. So much so that these basically decide the treatment. Regular news reports of doctors removing uterus from unmarried females or rat poison deaths in medicines used for (forced?) sterilization operations. Many of these result from harebrained family planning / government schemes with their strict targets.

    We also have more unlicensed providers – those who had previously worked with a medical doctor in any capacity working on their own as independent medial practitioners – than the licensed medical practitioners. This is in addition to state support to Homeopathy, Ayurveda, Yoga and Siddha where the government sets up "medical colleges" in these "specialties" graduating an almost equal number of these "alternative" medical graduates who after graduation practice allopathic medicine without any allopathic medical training.

    Oh we also have medical tourists, getting treatment in a top class hospitals which an average Indian can only afford in his dreams. Don't get me started on medical insurance or Vyapam type doctors!

    And now we have this IMA objection, I wonder what galactic system they live in?!

  2. Aditya G

    I agree completely. But any debate about the nature of public healthcare, must take into account the formation of consensus in the medical community. As a final year mbbs student, I have first hand experience regarding this collective egoism. Any comments perceived to be against the interests of the individual doctor, is immediately criticised as being ‘anti doctor’. Any mention of high costs is justified by a statement similar to that in your article (I initially thought it must have been copy-pasted from one those whiny WhatsApp messages often posted on our group).
    I am still puzzled that how this consensus is formed. I thought that many students, being from impoverished families themselves, would have some sympathy with the concerns of the general public. Then I discovered a concept called ‘professional closure’. It means, atleast in my understanding, the tendency of a professional class to protect it’s own. Many live together in hostels and face the academic challenges,which are indeed immense, together. This gives them a shared understanding and mutual sympathy. The problem is that the outside world is nowhere in the picture. I believe this is also true of soldiers and lawyers. Practically this phenomenon turns out to be : You scratch my back, I scratch your back.

    So the professional class starts acting like a hive mind and, not without some exaggeration, a cult. And as you know the first rule of the cult is, punish the traitors. Any person uttering so much as a whisper about the callous behaviour of doctors in public hospitals, will face the disapproval of his/her fellow students and teachers. Viva exams will suddenly get tougher for you, no will inform you about a change in the timetable, no one will assist you with a difficult case and no one will refer patients to your clinic. You will, in short, be shunned, made a pariah and hated.

    I made this mistake once and I won’t be doing it against. I have only a few friends as it is. I cannot wait to get out of here.

    So anyone concerned about public healthcare should look to break through these protective chains, help the dissenters and look to promote a public outlook in medical students.

    I could go on, but I have a 7 hour long lecture to attend in a private tuition, which will supposedly help me in my postgraduate exams. :-)

    1. Dr. Suresh S.

      Bravo Aditya… Dont worry about having few friends, they are the real ones. And more are waiting for you in Jan Swasthya Abhiyan, a coalition of doctors, health activists, peoples organisations, NGOs etc., working together for the cause of ‘Health for all’. Please e mail me drsureshjvv@gmail.com

    1. Ivian

      The articles recommendations on AYUSH are sensible, on insurance based health-care appropriate, and on private practice of health care appalling.Consider;
      “Income tax, luxury tax, and service tax in hospitals and Value Added Tax on drugs goes contrary to the vision of making health a fundamental right.”
      Plainly, the whole system of private medical care goes against the vision of making health a fundamental right. Why? Example;
      “Government, on the other hand, can demand at least 15% free care in these institutions for poor patients.”
      15 percent is a joke, where roughly 30 percent (by ridiculously conservative official estimates) cannot even afford decent meals.

  3. The situation in the both the private and public medical sector are appalling. Both face their own unique and different problems. The public sector hospitals face the problem of MASSIVE overcrowding. Since there are few properly functioning public health hospitals, the ones which do function are made to work beyond all reason or limits. There are days when I as an intern have seen over 130 patients, morning and evening opd included. On average, I see 60-70 patients plus inpatients. This would be unthinkable, in a western developed country. Also, we have to get more degrees, to be respected as a doctor. There is the constant pressure, how will I get an MD? Will that be enough? The private sector faces the opposite problem, You will get any salary you demand, as long as you demand unnecessary tests, CTs, MRIs etc from your patients. Drug reps will insist that you prescribe their medication, instead of generic medication so that their MNC earns more money. Higher end hospitals resemble a five star hotel, while the treatment is only as good as the public hospital, they will provide you unnecessary “services” like parking valets, satellite tv, air conditioning and such nonsense and then charge you 1-1.5 lakh for a simple hernia surgery. Life saving stents are provided for 5 times the cost of production. What we need is massive expansion of public sector to save the medical industry, so the vast public need not depend on the few islands of reasonably good inexpensive health care like aiims. Price control, a strict one, needs to be imposed on essential drugs, not the diluted norms adopted recently by the central government.

  4. Nothing is free in this world, not even mothers’ milk. If one wants five star comforts the price will be high. A private hospital must please nearly 60 Govt. departments to run the show and money is involved in all cases. That money must come from the suffering patients, is the unfortunate truth.

    An architect can be paid the percentage of the cost of construction for the paper and pencil he use for a few hours. A lawyer must be paid lakhs for each appearance. An IT man gets lakhs every month for working 8 hrs x 5 days a week. Apply all these on private hospitals and the consumer court verdicts to pay crores in the name of negligence. Every insurance agent or skilled worker gets a commission for the amount involved in addition to regular pay. Everywhere the public is cheated. Sathyameva Jayathe can move the people and no one is ready to face the sathyam or truth. Stop going to private hospitals and permit them to bleed you white. Ask the Govt. to nationalise private hospitals and bring it to the level of public hospitals. Sir Aditya will be happy, I hope.

    The last Para is really touching — “IMA has thrown us a challenge that cannot be allowed to go uncontested. This challenge can only be met by bringing the entire ethics and practices of the corporate medical sector into the centre of debate.” This is a welcome idea.

    Kindly include “Hotel Asoka” and a “Tea shop” also in your debate. What prevent Hotel Asoka from serving tea for Rs. 5 available on the road side? Small one doctor hospitals are closing and this debate will make it faster.

    The proposed debate, I hope, will help close all major private hospitals and help us go back to the 18th century. Good luck dear Aditya Nigam.

    1. Aditya G

      I think you’ll find that your mother’s milk is one of the few things that are indeed free.
      Also we’re talking about public health not tea,software development or construction (I’d like to know more about the legal aid system in our country), so please stay on topic.

  5. Pingback: IMA, NCERT and Existing Inequalities – Issues Around Availability and Accessibility of Health Care: Sarojini N. B. and Deepa V. | Kafila

  6. Rajender Sharma

    The bashing of IMA for trying to protect the image of doctors is totally uncalled for. IMA is for protecting the interests of its members. The sweeping statement in NCERT 7th class text book is damaging to the overall image of private doctors ,Doctors in general are not looters or fleecers, The examples quoted are of big corporate hospitals. Why peoplel fail to understand that the money charged by such hospitals doesn’t go the doctor’s pockets , Rs 30 Lakh for liver transplant would not have gone to the transplant surgeon . He is just an employee there . Nobody will question the management , not even the writer , all will blame the doctors for high charges. BTW liver transplant is not a joke, its highly specialized procedure done at very few centres have this facility.. It is certainly life saving procedure and needs huge investments in machines, medicines and highly trained medical personnel and that doesn’t come cheap. .Now post transplant medicine cost has to be borne by the patient it is must for success of transplant and why blame doctor for those charges. Doctor didn’t inflict the disease upon the patient.and he is not forcing the patient to take these medicines out of his own sweet will, these are essential for his survival . She chose private hospital over AIIMS then why crib about charges.. If there is waiting list in AIIMS for radiotherapy ,then is it the fault of private doctors? is this a valid excuse for branding private doctors as looters across the board in a text book.? People want high end treatment facilities along 5 star room facilities but don’t want to pay up. Same people will go to stay in 5 star hotel and will pay through their nose will complain to no one rather will brag about it. When it comes to treatment costs they will make a song and dance about it.. Please remember its not the doctor who fleeces, but the management of the hospital , but nobody will blame them not even this writer

    1. Aditya G

      You sound very confused. If you are asking us to blame the management rather than the doctors, how can you say that the ima is defending its members? Or is the ima speaking for corporate hospitals?
      The debate is about resource imbalance. The private sector has more ability to capture more resources and deliver better results. But many are being deprived of these superior results exactly due to such imbalances. This is unacceptable in a democratic society.

      1. Rajender Sharma

        ,I fail to understand,your repeated assertions that IMA is defending corporates, its not. IMA Chandigarh, which started the whole protest by writing letters is clearly of the view that corporates are responsible for the present scene, I being office bearer of IMA Punjab is of firm view that intrests of individual doctors doing honest and ethical practice are our priority. We have opposed new legislation which favours corporates tooth and nail.Even in case of NCERT text book our opinion is that for sins of corporate sector individual private doctors shouldn’t be labelled as greedy,unethical and looters. Put the blame at door of the actual culprits. But the perception created by statement in the text book is that all private doctors are greedy and looters, which is not true, and IMA is contesting that. Please make a distinction between private doctors and private big corporate hospitals.

  7. There are three facets to provide any service, interrelated to each other: Access, quality and cost. In a Utopian world everyone would have access to high quality healthcare all the time with no (or cheap) cost. However in real world it is not so. High quality healthcare (like the liver transplants) comes with a cost that limits the access to most people. Low quality healthcare (e.g. Quacks or sundry untrained/ partially trained “professionals”) is easy to access and is cheap, but of course is of low quality.

    Just like any other service, everyone has a different expectation. Some are ready to pay for quality/access. Some would wait long or travel far to find access/ quality. Some can’t or would not pay for their healthcare needs. Plus healthcare needs of an individual and the society are diverse and keep changing with time. So how to provide healthcare to a community with such diverse needs vis a vis need and cost?

    One model is the socialist model, where a single payer (e.g. Government) takes the responsibility to provide healthcare to all the citizens. This model works well in countries with high spend of GDP on healthcare (e.g. UK’s NHS). The government pays the cost of everything, so the government decides what level of healthcare to be given and to whom.
    Naturally people complain about quality and access (e.g. wait time for non-emergent surgeries sometimes cane be over a year in UK).

    Another model is the capitalist model, where private sector provides healthcare facility. Since private enterprise would like to be paid for the investments and risks involved in delivery of a service, it is natural that the service is going to cost. If a venture is profitable, more people/ companies are apt to indulge in it, which increases competition, improves quality and increases penetration of the said services to larger areas.

    Most countries, including India, have healthcare facilities from both the spectrums. The advantage is people have “choice”. If one can afford it, one can have access to timely and high quality healthcare. And for those who cannot afford it, a safety net is provided by government healthcare facilities, where access is limited simply due to too many people vying for the same service.

    Private sector comprises of 70% of India’s healthcare facilities. These are diverse, ranging from single owner clinics, day care facilities, short stay facilities like nursing homes and lastly the providers for the most complex demands of healthcare- the big hospitals. For every price-point and every need, one has the free to choose which healthcare facility will meet his/ her needs. Despite the brouhaha regarding its ethics or greed, the popularity of private sector healthcare remains unabated, which can be gauged from the fact that it is one of the recession proof sectors which can be depended upon in time of need.

    Where as the socialist healthcare sector run by the government suffers from poor investment, resulting in poorly manned shoddy facilities which often fails its citizens.

    Which healthcare model would you choose when your near and dear ones need it?

    1. Aditya G

      Will you honestly tell me whether doctors support or oppose more investment in public health?

      If they oppose it, they are simply looking to protect their own margins that would suffer if a truly universal system were to emerge. It would also reduce their potential clientele as universal healthcare has been shown to be superior in prevention of diseases.
      So, in short they are simply looking after their self interest.

      If on the other hand they support public investment that would save the lives of the poor and working class, they are working against their own self interest. This absolutely cannot happen according to Rational Choice Theory (of which you are clearly a fan).

      And as you intend on making this personal, I’ll ask you to imagine yourself as a doctor working in the private sector. You have a family to look after. Which option will YOU choose?

      As it happens my friend, individual interests are best achieved by organising and collectively striving for betterment. The doctors have already done this. Don’t moan if you’re opponents do the same.

      1. Doctors, especially private doctors, have a little say in dictating health policy. It is the government which chooses whether to invest in healthcare sector or not. So far the government has decided that it can get away with investing little.
        In reality if government does decide to invest massively in health care sector and make healthcare universal, the doctors too will benefit. Why would anyone invest one’s hard earned money in a risky, cost and time intensive venture when the government can employ you with all the perks of an organized industry and no personal risk whatsoever. Its only because the current employment opportunities for doctors are little and work conditions abysmal that a newly graduate doctor is forced to fend for himself.

  8. This is very well said by R Sharma. The tendency of our media is to pinpoint the blame on the doctors at large for all ills is the problem rather than solving the problems. The corporate hospitals may be blamed, which are governed mostly by business houses guided by MBAs who sit on the heads of doctors with targets which most doctors working in the corporate hospital would not relish.There may be a few unethical doctors too, but do not brandish all with the same stick. Already fewer children are opting for Medicine as a profession. Those who opt for are moving to Western countries where their talent is more valued and respected.So it is true that the NCERT books should not give such a wrong prejudiced view of the Medical profession

  9. Aditya Nigam

    Rajender Sharma, I rest my case with your statement. Once again, you have made the interest of some elite doctors masquerade as the interest of all doctors. I have taken special care to make this point that most doctors are not looters or fleecers. As such, I do not think your comment really merits any response.

    And truly astounding is your intelligence, Kishore Kumar!! When I wrote in the post above that:

    Let us be clear here that the point here is not simply about government versus private health care – an easy opposition which requires no thinking, for in that universe there is always only one answer to everything thing: privatize, privatize, privatize. But behind this slogan stand corporate armies of plunderers and I can already see neoliberal ideology warriors jump on to their horses, rattling their sabres, ready to charge forth.

    Trust me, I was thinking of you. You were so eager to jump in in defense of corporatization that you could not even wait to read the post and what it was all about. The post was not about choice. Of course, there is no problem in saying that if someone wants five-star facilities, s/he should pay for it. The point of the post is a particular NCERT textbook and what should be taught, NOT about whether people should have the right to blow up their money. Going by IMA’s perverse logic, not only does a criticism of privatization/ corporatization amount to a criticism of the profession as such; worse, they want to reserve the right to bash the public health system (how else do they justify themselves, see your own comment and that of Rajender Sharma) but want no criticism of the private sector. By all means, those who want to have a cup of tea for Rs 500 where others can have for Rs 5/- – should have the freedom to do so. The point of this post in not at all concerned about what people who have more money than they know what to do with should do! They can light a bonfire of their money for all I care.

    1. Alok

      The ideas that private enterprises are inherently greedy/ bad and everyone should have an equal go at the utilisation of resources are Socialist philosophies. Considering the failure of such doctrines in real world , one can conjecture that a socialist approach to health care is similarly doomed. However Man, being a social animal and apt to be besieged with guilt on not being able to provide help to the unfortunate ones, will always keep on bringing socialist philosophies in various guises. Because capitalism, even though it works, is a bitter pill to swallow…

      1. Aditya Nigam

        Alok, this is the problem with ideology warriors. You do not even read what is being said, before jumping in to comment. I have not opposed privatization either in the post or in the comments. Here is what I have said, citing Sengupta and Nandy:

        Until about 20 years ago the private sector comprised solo practitioners and small hospitals and nursing homes. Many of the services provided were of exemplary quality, especially those hospitals run by charitable trusts and religious foundations.

        So, if you are stuck in the state versus private frame, that is not my problem, I suppose. Elsewhere, I have indeed also been arguing against a conflation of private enterprise with capitalism – so this is really not a bitter pill for me at any rate:)

        1. My bad, seems you are not against private healthcare but specifically against corporate medicine. Big business taking over medicine big time.

          However providing healthcare is becoming more and more difficult for solo practitioners and small nursing homes. For example, to open a nursing home in Delhi, there are approx. 30 government licences one must apply. All these ever increasing regulations by the government, ostensibly for the benefit of common man, are actually pressuring small doctors to close their shop. Add to it that modern medicine is becoming increasingly complex and procedure oriented, something which requires massive amount of investments which no solo player or charitable trust can risk. And only those with big pockets can play this game..

          1. rikhia

            mr nigam i think the larger question your post raises is not about socialist vs capitalist attitude to medicine. or what your nuanced approach to corporate players vs private practitioners is. the question is whether class 7 kids are old enough to understand these debates and grey areas. don’t you think there’s plenty of time for them to make up their own opinions about what healthcare needs when they grow up. there are a lot of wrong things in this world, including health care. we don’t necessarily need to shove all our resentment down impressionable children’s throats. or do you actually want an entire generation to be brought up with the firm belief that all doctors are bad.

    2. Rajender Sharma

      Dear Mr Aditya, you got me wrong partially, I didn’t advocate the cause of ” some elite doctor” ,you might have got some impression to this effect from my defence of cost of liver transplant and subsequent treatment cost , I was only trying to put the things in right perspective that liver transplant itself is not an easy process and very complicated procedure which requires high investment both in machine and men , but that doesn’t mean that I an advocating the cause of some elite doctor., I am just trying to focus on the gravity and enormity of the job. I have emphatically written and repeat that even in the quoted case the money has gone to hospital management, and its the management which should be hauled up for such high charges and not the doctors. I have been repeatedly saying in many foras that its the corporatization of the health services which has resulted in making the treatments so costly and out of the reach of the common man, like the medical education itself in private colleges has become unaffordable Doctors running small and medium hospitals are still giving affordable and quality health services and IMA is for protecting their interests. Corporates can take care of themselves, they don’t need IMA support.

    3. Sir Aditya, I know that the topic of discussion is the message to the young ones to hate private sector and to patronize the public sector. The reason cited is the high cost for healthcare in private sector and other nonsense generalized in the text book. To justify the textbook message, you conveniently ignored all other places where the cost is high.

      With the coming of Consumer Protection Act, medical practice is now “defensive” and every private doctor and hospital to be on the safer side is very serious in making/keeping all medical records straight and every patient is considered a litigant until proved. So naturally, it is now mandatory to generate all the required test records to be on the safe side and the patient pays for it. The cost is very high as said by you and majority would have been avoided, if the sword is removed from the neck of the doctor(s) involved.

      In the US this happened following harassment from Insurance firms and in India it was the Consumer Protection Act made applicable to healthcare services. The society is responsible for this shift in the attitude of the doctors. Now, small hospitals are not prepared to take any risk to save a patient. It (saving a patient) is a thankless job now. A registered medical practitioner (RMP) is a target for physical attack from relatives of patients and a “quack” is safe.

      However, major private hospitals cannot deny treatment and they are forced to take the risk and the cost is high. The Govt. instead of improving healthcare spending is trying to impose newer restrictions and appears to be fond of giving everything free to the people by a private citizen. Clinical Establishment Act is one example. That is meant to close all single doctor clinic/hospital all over India, and the public ignorant of the outcome.

      I humbly request you to take up the challenge from IMA and see that those in your wavelength are winning. Good luck Sir. We get what we deserve.

  10. In any case Universal health care (and by universal, I mean EVERY healthcare need is provided by a single payer or government) for a humongously populated country like India will remain a pipe dream; the governments have long abandoned this goal. At the most, in future, the government will force private sector to provide health care to masses for free or at government decided rates (as has already happened in education sector).
    But lets imagine that government does take up the challenge and provides universal health care. Will it cover, lets say, Liver transplants ? If yes, then people, who could not afford transplants before will make a bee line for it, fast outstripping the facility’s ability to provide. And the demand always keeps increasing, especially if a resource is free. How much money can any government pump in for costly procedures like these?
    Experience with universal healthcare systems all over the world says that sooner or later the government starts to ration the care, based on some criteria or the other. Which, effectively, is no better than the rationing we have now, where the criteria is money.

  11. Dear Aditya and others

    Please don’t be under the impressions that there are only a few apostles to fight for access to health care in this country. There are efforts put in by a large section of people- including doctors, associations, who all are trying their best to improve the health of the nation

    After all when we are debating, it should be healthy and with evidence. Have you have any evidence to say that IMA stands for corporates rather than smaller hospitals/ clinics(Own Account Enterprises). IMA’s stand is very clear. IMA is there to protect the small and medium hospitals and not corporates. IMA believes that corporatisation of healthcare has created more inequity in this country. Read the excerpts from IMA national president’s letter to Government regarding the new draft health policy

    “In a situation where the private sector provides care for 70% of the population, it is high time we considered them as mainstream players and provided them with incentives for performance in line with national goals. Income tax, luxury tax, and service tax in hospitals and Value Added Tax on drugs goes contrary to the vision of making health a fundamental right. The policy should influence and encourage private health care establishments by exempting them from the purview of income taxes and providing subsidies to these institutions. Government, on the other hand, can demand at least 15% free care in these institutions for poor patients. This will reduce the cost of care, eventually avoiding catastrophic health expenses. Government also should provide water electricity and basic amenities at reduced rates to hospitals. This “aided hospital” model will be a cost-effective alternative to heavy investments required for insurance based health systems. The failure of the American model of insurance driven health care provisioning can be taken as a lesson. Given the fact that the majority of health care in the country is still delivered by small-scale healthcare institutions, these small players play a major role in moving the national health indices up or down. The policy should aim to sustain and promote these own-account-enterprises so that affordability and accessibility are not affected. Corporate culture in healthcare, which drives up the cost of treatment and limits accessibility, should be discouraged.”

    now, coming to provision of health care, why the text book is silent on the meagre amount of money allocated by govt to health in this country, even lower than most of the african countries and less developed countries even in asia? who is to be blamed for that? IMA? Private drs? or the political leadership? is there any mention in the text book in this direction. wouldn’t it have been better if that issue was incorporated , so that our children in future, will learn to raise voice to demand govt to increase allocation to health care? or was it a systematic attempt by the then govt machinery to conveniently put the blame on private sector and escape from responsibility?

    when it comes to out of pocket expenses, the notion that public service provision is value for money is a misconcept. even with crores being spend by govt on public institutions, if a delivery still incur around 1500 rupees in public facility, what does it tell you, when it’s 14000 in private facility which does not have any govt aid, but also have to pay all sorts of taxes, besides pleasing govt officials in more than 40 departments to get their license in place

    So, let us be realistic. don’t shoot in the dark, you are missing the real enemies by doing so
    Open your eyes widely and be constructive in criticism

    endnote: Please don’t tell me that none of us writing here will go to private hospital now onwards, because they are all money oriented :)

  12. Siddhartha Soman Mookerjee

    Dear Mr. Nigam,
    first of all I feel you need to have your facts straight. there are several aspects of healthcare which i doubt if you are aware of. Are you aware of the costs of a single multipara monitor which, unfortunately for you, the doctors don’t sell but are sold by companies like phillips, GE etc at not- negotiable costs. These machines, allow several parameters of a patient to be monitored and is the standard of care in the west and helps provide better treatment. Now they are so expensive, each retailing at 50000 and above a piece, that apart from Governments and Big Elite corporates you hold so much grudge against are able to afford. We doctors go through several stages, having have to start from the Government hospitals and see the apathy in buying such equipment, and even if bought will be provided in such pitiful aplenty that they fail to serve the purpose- a machine meant for a single patient may well be allocated for 10. I feel the corporates are doing exemplary service by at least buying and using them the proper way rather than being a sham. Now purchasing these come at a cost, which i have already mentioned are non-negotiable. Unfortunately when you go to a corporate hospital you don’t find representatives of GE or Philips, or for that matter Cipla, Zuventus or any other Pharma companies who have made healthcare as expensive as it is today with their pricing policies. To an average consumer at a corporate hospital the anger is directed at big bills generated due to the high prices demanded because of the consumables and medicines as well as the equipments without which the state of the art procedures such as a liver transpalantation will be virtually impossible. after all please remember, that computer engineer’s father got a new lease of life. and life definitely doesn’t come cheap.
    latest medical technologies are bringing cures to diseases hitherto thought incurable- no doubt but please remember these came about through millions of dollars worth of research, which translated into patents and subsequently when you are at the usage end you have to pay for it. Please don’t live in an utopian world. In this world, people like you have taught us that everything is about money when you brought your own life and health under the ambit of Consumer Protection Law and expect your life to be treated like a consumable and you the “Consumer” of our services. Thus please don’t behave like a spoilt child and want to have the cake and eat it too. Please don’t expect nobility and discounts and be prepared to pay if you want to live because neither Pharma Companies, nor Biomedical companies provide you any nobility or discounts, and since you have similar trust and faith in us expect similar treatment.
    And since (hopefully) a full grown adult like you is unable to understand these basic facts, expecting a class 7 child to understand the nuances is sheer insanity and thus please ponder over the rationality of berating the IMA for pointing out a proper thing.

  13. Pingback: Opinion: To create a terrorist, catch them young | India Medical Times

  14. Ajit

    The problem is not so much privatisation or government , but complete erosion of lack of ethics by the medical professionals over last couple of decades.The government has failed brutally in delivering healthcare to masses ,the hospitals are unhygenic at best , so that even poor opt for private healthcare systems.
    The private hospitals consider these people as money minting opportunities proposing myriad of diagnostic tests , unrelated to the conditions, overcharging unnecessary surgeries,denial of discharge or of body on failure to pay the fees , negligence and so on and so forth.the 25% ebc criteria is joke in most of these private hospitals and is problematic.
    Then the government is subsiding the private hospital chains when they avail of exemptions from medical insurance.An excellent business standard article pointed out that such exemptions mounted to 20000 crore in 5 years ample money for govt to build new hospitals and change the current practices.
    The living conditions for residential doctors in public hospitals should be a cause of concern to everyone. TB/Dengue seems to be too common to such doctors and there is a need for better protocols in place for them.
    If we treat our newly graduate doctors with such appalling indifference over matters of life and death, its unlikely that they would be empathetic to us.

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