People expect significantly more from country's healthcare system. In order to correctly define an effective, cost efficient, and appropriate healthcare system for all Indians, we must first address the fundamental issues, disconnects, and problems. Therefore deal with the disease not the symptoms - we need to first identify and agree on what the fundamental problems are.
We believe we can find simpler, stronger, efficient system for all to get care they need in crisis and the care they want by choice. They must exist in manner that systematically provide certain controls, checks and balances. We must reset our own false expectations for better reflect the reality of the care that can be provided in order to minimize extraneous cost. Price certainly, transparency, portability and effectiveness need to be codified as requirements of any solution. Oversight and responsibility at ividual level also very important factor to be integrated into the healthcare system. The solution must provide an effective safety net for all the helpless while filtering out the clueless - who inadverteltly and significantly increases costs and utilization of scarce resources - and the fraudsters who purposely game the system in order to inappropriately receive disproportionate and unnecessary gain while also consuming available resources from those who desparately need them. Finally, the solution shall at its safety net, basic care level, provide the same access, scope and treatment options for all regardless of income or means with no additional hidden costs, taxes, fees or shifting of costs, from one system to the other.
We need to create a basic marketplace, focused on a equal access, treatment, and affordable cost to all Indians. The system should provide for individual care they want, beyond basic care needs. These systems should be tighly integrated through a central point of access and administration that provides for full coordination of care and benefits across all available sources - as well as other benefits.
What are the Challenges?
India is the second most populous country in the world
The death rate has declined but birth rates continue to be high in most of the states.
Health care structure in the country is over-burdened by increasing population
Family planning programs need to be (re)activated
India faces the twin epidemic of continuing/emerging infectious diseases as well as chronic degenerative diseases.
The former is related to poor implementation of the public health programs, and the latter to demographic transition with increase in life expectancy.
Economic deprivation in a large segment of population results in poor access to health care.
Poor educational status leads to non-utilization of scanty health services and increase in avoidable risk factors.
Both are closely related to life expectancy and IMR.
Advances in medicine are responsible for no more than half of the observed improvement in health indices.
Longevity, literacy and GDP per capita are the main indicators of human development
Longevity is a measure of state of health, and is linked to income and education
Weakness in health sector has an adverse effect on longevity
India ranks low (115th) amongst world nations judged by HDI
India faces high burden of disease because of lack of environmental sanitation and safe drinking water, under-nutrition, poor living conditions, and limited access to preventive and curative health services
Lack of education, gender inequality and explosive growth of population contribute to increasing burden of disease
Full impact of the HIV epidemic and tobacco related diseases is yet to be felt
Expenditure on health by the Government continues to be low. It is not viewed as an investment but rather as a dead loss!
States under financial constraints cut expenditure on health
Growth in national income by itself is not enough, if the benefits do not manifest themselves in the form of more food, better access to health and education: Amartyo K Sen
India has 48 doctors per 100,000 persons which is fewer than in developed nations
Wide urban-rural gap in the availability of medical services: Inequity
Poor facilities even in large Government institutions compared to corporate hospitals (Lack of funds, poor management, political and bureaucratic interference, lack of leadership in medical community)
Health Care in India: Curative Health Services
Increasing cost of curative medical services
High tech curative services not free even in government hospitals
Limited health benefits to employees
Health insurance expensive
Curative health services not accessible to rural populations
Components of healthy life style
Abstinence from tobacco use
Regular physical exercise
Balanced nutritious diet rich in vegetables and fruits, and low in fats and refined sugar
Avoidance of pre and extramarital sex
Yoga and meditation
Avoidance of alcohol and substance abuse
All people benefit from regular physical activity
Moderate physical activity for 30-45 minutes on all days of the week is required
Additional benefits can be gained from more strenuous activity for longer periods
Physical activity reduces the risk of premature death, CAD, hypertension, diabetes and colon cancer. It also improves mental health.
A large number of adults including youths are not regularly physically active
Certain interventions to promote physical activity in schools, work site and health care settings have been found to be beneficial
Interventions with a large potential impact on health outcomes
Immunization (EPI plus)
DOTs for tuberculosis
Maternal health and safe motherhood interventions
School health interventions
Integrated management of childhood illnesses
Treatment of STD
Rational use of diagnostic tests
Inappropriate and irrational use of high tech and expensive diagnostic tests is widely prevalent in developing countries (CT, serology for TB)
Market forces, misinformation, desire to do something
Governmental regulation not feasible; improved diagnostic reasoning required
There has been an explosion of high tech diagnostic, therapeutic and preventive interventions in the field of medicine and surgery
This has resulted in physicians spending less time in history taking and physical examination.
Rational Drug Use
Can prevent emergence of anti-microbial drug resistance, and reduce drug toxicity, adverse drug reactions, and the cost of treatment
Requires coordinated approach: Patient and physician education, antibiotic policy, hospital infection control team, regional and national antibiotic resistance surveillance
Health Care in Developing Countries
Existing infrastructure for health care needs to be strengthened. Health should be perceived as an investment and receive greater budgetary allocation
Education, safe water and sanitation need priority
Vaccination coverage to be improved
Better implementation of national health programs
Judicious use of the scant resources by promoting most cost-effective strategies for disease prevention
Inclusion of all level of stakeholders in planning and policy making using tremendous human resource available in the country