High out of pocket expenses on health is impoverishing some 55 million Indians annually, with over 17 per cent households incurring catastrophic levels of health expenditures every year, according to a World Health Organization (WHO) report from March 2022.
What can be done to decrease this load? Many Indians are worried as the Covid epidemic cost them dear. However during that very epidemic the owner of a small nursing home pointed out that admission in his set up would cost much less than the big structures that have come up.
The Government has set the ball rolling with the generic drugs initiative. The public unfortunately ignores this thinking that the products are of low quality. They are not because a chemical remains the same whether generic or under a brand name.
The Right to Health Act of Rajasthan envisages increased role of the public sector infrastructure in health. It will seek to improve the quantity and quality of clinics in the Government sector.
It was in Rajasthan that an exercise in prescription audit was carried out in government hospitals that revealed more drugs were being prescribed than needed. There is also the issue of irrational drug combinations. These add to the costs without much benefit and are associated with adverse effects.
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Currently many governments are trying to provide health care at a lower cost. The hospitals under the AIIMS banner are providing good care at a very low cost. However the long lines to claim the benefits deter patients. This can be done away with by a system of bank transfer.
Even with all of this there is a problem; the huge rush in the government hospitals. The sight of patients queuing up from the previous night is common.
To really reduce costs the flow of patients must be reduced instead of trying to serve the sick population.
Thus there is need to think about keeping people healthy. More thought must be given to this neglected aspect. There is no dearth of knowledge as to what ensures health and what does not.
There is also the need to take care of patients at home through neighbourhood doctors. This tribe is disappearing. A group of doctors are reviving the family medicine practice. It needs encouragement. The family practitioner must ensure good health instead of attending to sick people.
The major part of family health expenses is expenses on medicine. Thus there is need to think about drugless approaches. Naturopathic practices and herbal/ kitchen remedies must be integrated.
Before the era of specialized doctors, the MBBS practitioners were known for their reluctance in prescribing medicines. They rarely prescribed. They realized the value of acute diseases, nutritious food, getting rid of addictions and lifestyle changes. They knew how the body worked to keep itself healthy. They preferred to facilitate this process rather than medicating and increasing the chronic disease burden. They had the same medical education but they had not lost their common sense or the sense of responsibility towards their patients.
The very high cost of medical education drives medical cost as the pass outs will seek returns. The private medical colleges are a great challenge. Medical education must be state sponsored and heavily subsidized. The curriculum must be thoroughly examined from the perspective of health and wellness. It should reflect the ongoing research and be freed from the influence of the industry and its lobbyists.
There are many ills in society, many hindrances to health that can be tackled with willpower only if the value of good health is realized and becomes the objective. The disease and medication approach allows the hindrances to remain unchecked. The current system of medicine feels that prescribing medicine is the one and only route. It has lost touch with reality.
It is good that many states are now waking up to the value of holistic systems. There should be more budgetary provision and better monitoring of the facilities available. As I keep on stressing there should be investment in the herbal resource that is key to the holistic approach.
The dominant system must get over its animosity towards the healing methodologies. Currently just talking about health and wellness raises heckles. Why should it be so?
Thus the remedy in a nutshell is;
- Reducing the quantum of sick people by focusing on health
- Teaching people to be healthy by disseminating knowledge on the basics of good health
- Ensuring health of populations through drugless measures
- Kitchen and herbal gardens for all possible households
- Integrating holistic systems into the healthcare system
- Improving the government infrastructure to have low cost services as well as medical education
- Introducing mandatory courses on medical ethics and patient rights
- Encouraging small nursing homes
- Introducing the system of family medicine. The culture of MBBS doctors should return
- Introducing audit of prescriptions and processes to eliminate unnecessary medical tests/ interventions
- Providing more stress on generic medicines and eliminating irrational drugs
The above process requires conscientious doctors and an awakened civil society. Mercifully the number of such doctors is increasing and the public is slowly realizing what goes on.
The perception that health cannot be ensured by medicalizing the process has been there since Ivan Illich pointed it out with his informative writings. It is time to put into practice the ideas which can truly benefit the common mass. They need help.
Jagannath Chatterjee is a Health & Human Rights Activist from India. This article was originally published on The Current Health Scenario.