I was part of a committee appointed by the Hon Judge of Mumbai High Court to fix tariffs for the subscribers of the Central Government Health Scheme. This brought me in interface with the various efforts that the central government is doing to make an impact on the health infrastructure which is owned or subsidized by it. The National Rural Health Mission (NRHM) is making its impact silently with a total outlay of 220,000 million INR. I have firsthand experience of working for some of these schemes in Uttar Pradesh, Bihar, Jharkhand, Madhya Pradesh, etc and can vouch for the steady progress that is being made.
ESIC hospitals are on a major modernization drive on one hand and the corporation is tightening the noose on companies which are not following the rules as laid down for subscribing the scheme on the other. I will not be surprised if the corporation increases the compulsory enrollment slab of salary from Rs 10,000 to Rs 15,000. This will bring in more beneficiaries into the gambit of ESIC which may not be a bad idea at all. The facelift of ESIC hospitals is something to watch out for in future and will surely reverse the flow of beneficiaries who are currently being referred to private hospitals back into these dispensaries and hospitals. There are medical colleges also on the anvil for some of the bigger hospitals with more than 500 beds and more seats planned for post graduate programs.
The Indian Army is also planning a major uplift and redevelopment of its hospitals. Last year, a survey was awarded to ascertain the level of modernization and preparation of block schematics with budgets. There were almost 200 hospitals of various sizes identified for this project. The Indian Railways is similarly thinking of modernization and expansion of their health care facilities. Some of these institutions would also provide undergraduate/post graduate training for medical professionals. There are 18 hospitals undergoing up-gradation of facilities under the Pradhan Mantri Swasthya Suraksha Yojana. There are 6 AIIMS-like institutions coming up in various parts of the country.
It does not stop there. The NHSRC (National Health Systems and Resource Centre) is making change in a very innovative way. It is mandated to improve Quality of services in district hospitals and lower level of healthcare across the country. There have been successful pilots of implementing ISO 9000 systems and have been a mixed success. The move will help us gain confidence of the community that there is qualitative improvement in these hospitals and thereby increasing the footfalls in these institutions. The staff is also motivated and have a gain in self esteem due to the accreditation. In the future, this can pave the way for insurance linked reimbursement of even government services, something akin to what Rajiv Arogyasri Scheme is doing the Andhra Pradesh.
All these laudable efforts that the Government is undertaking are a step in the right direction as it is obvious that India cannot privatize its healthcare like the USA and will need a judicious mix of public and private sector, particularly because we still have substantial population which cannot afford private healthcare.
Lately last decade has seen much changes and much corrective action and also decentralization of power in hands of mission directors with adequate responsibility has brought in changes which is applaudable.
Though currently the mix of private and public sector have a mix , but with the rise of economy and rupee becoming stronger the more capitalist approach might bring in a bigger stake for private healthcare delivery. Imposing quality system in current time is little burdening for hospitals. I have read in some forums where Physicians from US complain that even JCAHO is a burden which only allows technicians to operate equipments and not the physicians, stringent regulations and quality systems sometimes create hurdles rather than making things better, If we suppose, we follow stringently the manpower matrix required for a hospital commensurate to the critical severity index , can we supplement and comply ? More industry participation is needed , A multidisciplinary team approach for fixing national strategy for health is needed and implementation of strategy formed is also needed along with coherence from all forms of healthcare delivery, No person should be deprived from healthcare facility.
Health for all by 2000—I attended a seminar long back—now,they say by 2020—well,govt has been doing its bit but what they say is—Too little and Too late—–
Accreditations do hinder innovation and flexibility in the system—an overdrive makes the system too rigid—
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