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Current state of health of medical care in India

The current state of health of medical care in India is a cause for optimism and concern in equal measure.

On the one hand, many forces to the good play a positive role. These include an improved underlying health awareness among the populace, enabled by technology, social media, and a mushrooming of wellness clinics and immunity boosters both allopathic and Ayurvedic. The acceptance of the benefits of insurance coverage, both by state schemes and private players, has led to a paradigm shift in the availability of tertiary care treatment for those in need, irrespective of economic standards.

In the medical domain, there is a standardization of training and development of treatment guidelines based on evidence from data in the country, and an acknowledgement of the role played by private hospitals in tertiary care, which has enabled the formal accreditation of training programs in them. The growth of the Indian startup ecosystem, made possible by programs, such as Startup India makes cutting-edge technology affordable due to indigenization, though this is very much a work in progress.

Those of us who commenced practice in the previous century understand the implications of these changes, which have enabled us to deliver scientific medicine on par with worldwide standards, hence comparable outcomes to the patients in India. The large influx of patients from abroad (dismissively and unfairly labelled as medical tourism) bears testimony to this.

On the other hand, there are many disturbing trends, such as an increasing tendency for political populism to influence health policy and an abysmally poor public funding of the health sector, as a percentage of GDP, leading to a paucity of public health initiatives. Given the disparate socio-economic structure and digital divide in the country, these initiatives or lack thereof impact the populace differently. In the private sector, the focus on short-term profitability, a corollary to the capital intensive nature of industry, has further unintended outcomes.

The role played by social media, in the direct access it provides to a gullible patient population, while creating awareness of alternatives, also leads to unreasonable expectations based on superficial information, has led to a drop in public confidence in the profession. There is now a tendency to view adverse outcomes and complications to be due to medical negligence, unless proven otherwise. The easy access of patients to consumer forums and legal advice to resort to civil and criminal litigation for complaint redressal has dampened the morale of the caregivers. The threat of and increasing resort to physical violence, with tacit support of the public and civil authority in spite of multiple legal and civil pronouncements warning of consequences, is a sad reality of the times.

The healthcare industry employee ratio is increasingly skewed in favor of those who are not directly involved with patient care, and this, with the availability of much safer, higher-paying options in other sectors, has affected the quality and motivation of the people seeking admission in medical and paramedical schools, which must be an area of concern.

Global trends, such as selective restrictions to new drug availability, exorbitant pricing of original research drugs, motivated misinformation on vaccine matters, and data implications do have consequences. Never before have we as caregivers in India, been more aware of the true nature of the problem, the disease antecedents, the environmental factors, and yet felt more helpless in controlling the effort to address it.

In the coming years, the major factors, which will tip the scales in India, are whether the caregivers’ voice will find its place in determining health policy, whether the ecosystem for startups will gain acceptance within the larger health ecosystems, whether public health will be given its due importance and whether attempts to standardize care, follow protocols, and use technology as a true aid to patient care will succeed.

At this juncture, policy makers need to adopt a ground-up and holistic approach, and medical associations need to come out of the largely social mode into a proactive policy influencing one.

I, for one, am optimistic as I believe the need for change and clarity of perspective has already dawned on the profession and policy makers. 

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