CONTEMPLATING NOVEL SOLUTIONS – IMPROVISATION OF HEALTHCARE DELIVERY IN INDIA

When it comes to resolving any problem in India, thinking “out of the box” is simpler! Every problem is made more complicated by unnecessary tangling with social angle and politics, not to forget indiscipline, corruption and nepotism. Sometimes, it is futile to get into the problem and lost within the magnanimous maze of complexities that is created within!

This article is about one such “out of the box” solution to Healthcare delivery in India. The inspiration for this solution is our own Indian Railways. But, any further comparison stops beyond that!

There is no better example of “United India” than our Indian Railways. Technically, these railway lines have embodied the soul of India. It is impossible to imagine India without railways. Such railways have differential pricing system depending upon the facilities and comfort offered. Although the same engine pulls the train, there are First class, AC class, Sleeper Class, General class and so on. Why not the same arrangement in government hospitals?

As of now, most of the Govt hospitals follow “one size fits all” policy. Why not follow the concept of Railways and have different levels of comfort and pricing for Govt hospitals?

An example of a model can make this narration easier: In cities, close to the last stop of Metro rail stations, in around 100 acre Govt owned land, there should be Govt Hospital Complexes. There should be Four tiers of care. The first tier is completely free. Nothing should be charged from people getting healthcare at this level. Second tier should be “Helathcare at concessional fare”. Although everything is charged at this tier, it should be concessional and reasonably subsidized. The Third tier should be “No loss – No profit” model. Here, the hospital should take care of itself financially. There should not be any free treatment and at the same time, it should be subsidized either. There should not be any motive for profit, but the expenses should be taken care with own earning. The Fourth tier should be “Luxury healthcare”, wherein the pricing should match that of major corporate hospitals with facilities at par with them or even better. The income generated from the fourth tier should be utilized for managing the first two tiers. Overall, the entire health complex should have an objective of self-sustenance or minimal funding from Government, without any objective of making profit.

There should be an expert panel comprising of economists, legal advisors and doctors (and not politicians!) which would decide the pricing of tier 2, 3 and 4, which will be revised by the panel every 6 monthly. The latest prevailing pricing of these tiers should be accessible to everyone through websites. The price fixed for tier 4 should be enforced to private hospitals. No private hospital should be allowed to charge more than what pricing is levied for tier 4. The panel should also decide the staffing and heterogeneity of doctors for entire health complex. The administration of each health complex should be fairly independent and should be devoid of political and official interferences.

The health complex should also house the residences of staff and doctors. It should also have place for patients’ attendants, again in multiple tiers – from free dormitories to luxury suites. The health complex should also have schools, shopping of essentials and provision for all basic needs. In fact, Govt medical college can be shifted to this complex and can be administrated as a holistic model for health needs of our nation.

The salary and incentives for doctors and staff working at lower tiers should be partially higher. This should be as per latest central pay commission guidelines. The four tier system should be transparent, strict and fool-proof. Each patient should be allowed to decide at what level they would like to get treated, irrespective of barriers like ration card or income certificate or any similar proofs. There should not be any cross-over treatments. Someone getting admitted to tier 3 should not be allowed to have free treatment for any reason. Similarly, someone influential should not be allowed to get admitted in tier 1 and get treated at tier 4 with manipulation of records. The payment protocols should be completely cashless and the entire complex should be equipped to handle cashless transactions with seamless ease. 

Similar models can be set up at every 200 km with the nearest railway station at minimal accessible distance. All the health complexes should be interlinked with high-speed fibrenet connectivity with extensive limited access wi-fi facility. There should be video based telemedicine network between the health complexes for discussion of difficult cases at peripheral centres. The railway link should ease the transfer of patient from one centre to another with minimal effort. 

Each such health complex should be graded and such grades should be publically displayed. There should be additional incentives for maintaining high grades and consistent improvement in grades. The health complexes chronically obtaining low grades should be taken seriously and efforts should be made to improve the standards at best of discipline. There should not be unnecessary transfer of doctors and trained staff. The reporting system should be eased and happen at minimal levels to obtain best speed in execution.

If the Govt gets serious on such a revolution, it can make the first facility actually happen within 2 years! Good salary, adequate incentives, impressive facilities, fearless atmosphere, ample protection can draw doctors to any corner of state to carry on with functioning. The overall expenditure on health for the exchequer will be much lesser than what it is now. The model is replicable in all the state at a pan-national level. An expert committee should improvise this model and create an executable blueprint. 

The fact that the private entrepreneurs are becoming victorious in every field where the Govt has failed, shows that the population of this nation is still honest, hard working and diligent. Healthcare should not be unreachable even for the last person. Health for all should not just be rhetoric, but it should be a Gandhian dream come true.