Dr Hemchandra, Prof. and HOD of Hospital Administration and Medical Superintendent, Sanjay Gandhi Post Graduate Institute of Medical Sciences
For the healthcare sector in the 21st century, stakeholders around the globe are looking for quality of care along with best outcomes. Innovative and cost-effective ways should be adopted to deliver patient-centered, technology-enabled smart healthcare. Opportunity to enter the market is ripe but India spends only 4.69 percent of total GDP on healthcare services (whereas US spends 17.9 percent). India’s staggering population lives in rural areas where there is limited or no access to hospitals and clinics.
They can be subject to harm in the hands of quacks who mislead the poor and maltreat them in the name of medicine and cure. More often the rural population is dependent on alternative medical sources or government aided programs. This needs to be rectified.
On budgetary allocation in healthcare
India spends 4.69 percent of total GDP in healthcare, wherein the government spends 1.41 percent and the private sector spends 3.48 percent of GDP. The government spends for healthcare financing should be raised to minimum 3.5 percent excluding the private healthcare financing thus meeting requirements of WHO. A 0.23 percentage-point decline over 2017–2018 in the Union Budget’s share of funding to the Human Resource Development (HRD) ministry, makes it the lowest since 2014–2015; a 7 percent cut in allocation for the Swachh Bharat Mission budget from 2017 to 2018’s revised estimates.
National Health Protection Scheme is the latest avatar of the Rashtriya Swasthya Suraksha Yojana (RSSY), which was previously the Rashtriya Swasthya Bima Yojana (RSBY) under the labor ministry. There has only been a 2.7 percent increase in allocations to the health sector, from Rs. 53,198 crore in 2017–2018 (revised estimates) to Rs. 54,667 crore (budget estimate).
On planned budgetary allocation for the fiscal year 2018–2019, and proportion allotted for the procurement of medical equipment and devices
The SGPGIMS is a pioneer autonomous medical institution (as deemed university by act of U.P. assembly) and tertiary care super-specialty hospital and is known for using modern and innovative management techniques. The funding of the institute is done by the state government. The planned budgetary allocation for the fiscal year 2018–2019 for the institute is `71,022.40 lakh (revenue) and `13,300 lakh (capital) making a total of `84,322.40 lakh. The budget allotted for procurement of medical equipment and devices is `7300 lakh (8.65 percent) which includes equipment for the newly established Apex Trauma Centre and Tertiary Care Cancer Centre.
On outlook for health and family welfare and challenges faced
To establish the most effective and efficient healthcare delivery system with a sustainable approach and simultaneously maintain the highest standards of quality-based services shall be the vision statement of health and family welfare. Healthcare organizations are continually battling conflicting priorities wherein collaborating hospitals’ own policy with external services, the financial challenges, patient safety, patient satisfaction, hospital security, compliance with regulatory standards, and fulfilling the demand and supply of health services are the most common challenges faced during implementation of health services.
On monitoring the quality of private healthcare
The private medical sector in India remains the primary source of healthcare for 70 percent of households in urban areas and 63 percent of households in rural areas. Healthcare generally consists of hospital activities, medical and dental practice activities, and other human health activities. The last class involves activities of, or under the supervision of nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, patient advocates, or other allied health professions.
The general perception about the private healthcare system is that their sole purpose is to generate money. This perception is based on massive exploitation done by several private healthcare chains on the common public. Hence, it is of utmost importance to have a proper nationwide integrated private healthcare monitoring system which can prevent such large-scale exploitation. This system will have the responsibility to check and assess quality of all healthcare services, checking the infrastructure of the centers, verifying the billing methodology, and getting feedback from both patients and the service provider.
The huge extent of private healthcare prevents such a monitoring system to be independent of manual intervention. Hence, such a system has to be technology driven with manual supervision on the system. For example, it can be mandated that the bills generated by these centers are valid for payment only if they are verified by an online system. That online system can do checks on the services and its charges, and if there is any overcharging done that bill can be cancelled or the centers could be asked for the reasons for such high rates.
Further quality of services can be managed by placing feedback devices in the centers where the patient or the patient’s caretaker is free to report any issue with the center along with a mandate for these centers to maintain an e-diagnosis which will contain all records of medications, procedures, etc. done with the patient. That e-diagnosis can be checked on the online system to red-flag any wrong medication or procedure being done against the disease and update it to the center.
Likewise many other ways can be devised to ease the monitoring and cause minimum interference with the daily work of those centers, thereby improving the quality of service of those centers.
On importance of public private partnership in making healthcare a success
PPPs have been acknowledged for their role and contribution by enabling the government to collaborate with the private sector in pooling resources to improve the efficiency of services thereby also providing them the ultimate supervision. Various successful projects have been initiated through central and state governments which have successfully helped in improving the healthcare sector like awareness programs wherein central and state governments and international agencies have partnered with NGOs to conduct awareness programs in various fields, specifically for HIV-AIDS, family welfare, MCH, disasters preparedness; medical interventional services – conduct family planning clinics, HIV testing and counseling services, MCH, provide primary and secondary curative services; and contracting for maintenance services – cleaning and maintenance of the buildings, security, waste management, laundry, catering, immunization, counseling, blood bank, blood donation camps, eye camps, and allied services.
On areas where government should invest to make healthcare available all go
India is undergoing epidemiological and demographic transition, thus making the domain of public health very dynamic. The population burden further complicates the situation. Extensive and planned integration of information technology (IT) is of utmost importance for proper implementation and regulation of health policies, revolutionizing school health programs, urban and rural planning for basic healthcare facilities to reach the grass root level, promote participation of public volunteers in spreading health education, and making the population aware of facilities offered by the government.
On policy intervention that the healthcare sector in the state needs to align with healthcare objectives at the national level
Our strength and at the same time challenge of governance in health is the distribution of responsibility between the center and the states. Better assistance to states should be provided to develop state-specific strategic plans, through the active involvement of local self-government and through community-based monitoring (CBM) of health outputs. Panchayats should be strengthened to play an enhanced role at different levels. There is need of appropriate distribution of doctors, paramedics, and other staff, especially at borders and other sensitive and remote areas. Human resource management in the healthcare sector should be dealt by senior/experienced persons in public health management cadre. IT must be integrated in the healthcare sector effectively and efficiently and all the staff related to healthcare must be trained in utilizing IT according to their work. Grievance redressal systems must be better implemented especially at the grass root level. Legal framework must be improved to check and control flaws in implementation of health programs.