Our country boasts the oldest organised system of health care with surgical and medical schools dating centuries before the Christian era. The compendiums of Susruta, Bhela, Vaghabhata and Madhava among others emphasise the reach and comprehensiveness of Indian medicine and surgery. But that was the past. Today, we stare with futility as the problems of a massive population keep growing. The plans we lay are barely implemented and we are always behind in terms of both manpower and resources.
The current Indian scenario has developed gradually and the development can be divided into the following eras:
Era of government and
There was a time that the government general hospital or mission hospitals were all that was available for both the rich and the poor. The ultra rich went overseas for treatment and this trend continues. This should be criticised as it conveys the inadequacy of the system and allows for stagnation. The best must be available, and to all.
Era of corporate hospitals
Private hospitals in Mumbai and Vijaya Hospital and Apollo Hospitals in Chennai were early pioneers, but the gross profit-based systems are bound to fail eventually, as compassion and care cannot always be bartered and sold. Sometimes, in these commercial institutions, the ends begin to justify the means and the medical profession is auctioned to the highest bidder. This system did bring in up-to-date technology and reversed the brain drain by holding back thousands of patients who would have gone overseas for their treatment. But these hospitals have limited capability for academic and research progress, which is the lynchpin for modern health care delivery.
Era of sub-speciality hospitals
The fact that it is easy to manage a single speciality under one roof led to the rise of institutions like Sankara Nethralaya, Kanchi Kamakoti Childs Trust Hospital and dental hospitals. But as these institutions lack the back-up of other specialities, which is an absolute necessity especially when there are inpatients, these may not be sustainable in the long run. Else, they will have to liaise with multi-speciality institutions for transfer of patients, which can sometimes lead to delays and lapses in treatment.
Era of university hospitals
The university hospitals experiment started with Johns Hopkins, with the combined effort of John S. Billings, William Henry Welch, William Stewart Halsted and William Osler among others. The Mayo Clinic and the Cleveland Clinic are other illustrative models. Both in America and in Europe, large university hospitals were started and this model is just beginning to take shape in India. It comprises a university campus hospital, comprehensive infrastructure, highest quality of manpower and world class facilities. These university hospitals are usually situated in the outskirts of large cities and cater to both the urban and rural population.
The SRM Institute of Medical Sciences is one such effort. The university medical colleges should seek to draw the best minds and surgical hands to their faculty. The presence of young minds from all nationalities is the key to the emergence of India as the Banaras of health care to the world.
The current problems faced by the Indian health care sector are:
Lack of doctors: The Indian health care sector is facing the greatest crisis as the medical profession is failing to attract students. This must be tackled on an emergency basis, as there is a severe shortage of trained and talented people. Brain drain occurs when an unhindered work atmosphere that ensures financial stability is not available.
Lack of nurses: Indian nurses are, perhaps, the best, but are currently the lowest paid and undervalued of all professional groups. Health care leaders need to wake up and provide adequate remuneration and incentives to this paramedical backbone to encourage them to stay on in our country.
Lack of specialists: The era of the non-specialist is over, but saying so the general practitioner also is a specialist of sorts now, as he becomes the sorter and decides who goes to whom and manages health care resources. The general practitioner is a highly neglected specialist in our system and his or her role needs to be upgraded and further defined.
Lack of super-specialists: The tragedy of the super-specialist is the rapid fragmentation of specialities into hyper-specialities with the most brilliant minds struggling to keep up with recent techniques and instrumentation.
Lack of biomedical infrastructure: The health care system is struggling with a huge amount of resources invested in high-grade medical equipment manufactured in other countries. The biomedical infrastructure is inadequate and its possible remedy lies in the university model where biomedical engineering is a department in itself. There is no way the health care infrastructure can keep up unless new alternatives are thought of. The markets and commercial establishments must be taken off the roads and initiatives such as ThinkFirst (a US-based injury prevention foundation) should be replicated and implemented in India.
Tyranny of technology: The health care sector is now dominated by technology. Only hospitals with the latest innovations in imaging, therapy and palliative care are likely to survive. Investment is the key to stay at the top and attract paying patients from all parts of the world.
Rising costs: Today, a basic neurosurgery or cardio thoracic unit can cost an average of a few crores. The costs of manpower and maintenance are also often under-assessed. The university model needs to develop to perfect the Robinhood Plan, that is the rich taking up part of the burden of funds for the treatment of the poor.
The economies of the west are dominated by the single factor of health care costs. There has recently been a turn for the better in the Indian scenario with the government opening its purse to pay for health care delivered. The initiatives of the Tatas, Birlas, Ambanis and other industrial houses have been important, but, perhaps, Bill Gates's criticism that Indian millionaires spend much less seems valid.
Unprofessional planning: The practising high volume surgeons and physicians must have more say in the functioning of the Medical Council of India, and planning and implementation of health care should be in the hands of professionals. The future is moving to a technocracy where professional guilds have more say in the policies that affect both doctors and patients. Advocacy by the profession is absolutely necessary to change the current lopsided chaotic medical infrastructure.
The author is CEO and director, department of neurosciences, SRM Institute for Medical Sciences.