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With a population of more than 125 crore, contemporary India yearns for another opportunity to become a global leader. Looking at our credentials of democracy, diversity and tolerance, many look upon us as the future of the world. But the rural-urban divide and non-inclusive, lopsided development remain a matter of concern. While Silicon Valley in USA thrives upon the innovative minds of Indians, back home, the country has no credible research and development (R&D) and innovations to boast about. Similarly, Indians constitute 5% of the doctor workforce in USA (and 20% of its International Medical Graduates). Indian health workers are also the pillars of medical services in the Middle East. In contrast, in India we continue to struggle with health challenges. With a massive population load and gross national income per capita of $3,900, India spends just 4.1% of its national budget on health. It has one doctor for 1700 citizens (WHO says the optimal number should be 1:1000). Cuba has 6.7 and America has 1.5 doctors for their 1000 population. With its gross national income per capita of $54,000, USA spends about 18% of its budget on health. However, this is not to say that everything is in perfect shape in USA. In fact, many experts feel that the American health system is ‘broken’ due to its inability to provide health care to millions of uninsured people.

With this background, let us study the basic health care delivery models that are prevalent in the world.

The most prevalent service model is ‘Out of Pocket’. In India, we may not have any problem in understanding this concept: You are responsible for footing the fee and bills to the doctor and/or hospital. Well, many will say, the government does provide free universal health care to all its citizens. That is true. India claims (unlike USA, as we shall see below) that anyone can visit a government healthcare facility and avail treatment literally free of cost. However, in actuality, the government health facilities are dilapidated, over-crowded and dysfunctional thanks to poor work ethics, chronic absenteeism and corruption, thereby limiting the access for a large chunk of population.

Contrast this with Britain’s National Health System (called the Beveridge Model). Here, the government provides health care through its government doctors, clinics and hospitals. The private medical sector is negligible. Everyone is eligible to choose a General Practitioner (GP) who is your primary doctor and avail medical care free of cost (the care is free at the point of use).The government will pay your bills. In communist Cuba, hailed by many as the successful model for a developing world, the same system is seen in extreme form: the whole health care system – be it clinic or a pharmacy- is owned by the government. No doctor is allowed to have a private practice.

Canada also provides a universal health care to its citizens, but in a different way. The government provides every citizen a health insurance (National Health Insurance model). The patient can choose to go to a private clinic or a government doctor or facility.

Germany has a slightly different system. The government mandates a health insurance for everyone, and that is provided by the employer. The employee also contributes a part of that. But the whole system is created not to make profit and must cover everyone, even if unemployed.

The above models are typical examples of what we call Socialised Medicine, where the government pitches in to provide subsidies through taxation. In other words, these are public-funded health care programs.

When it comes to USA, the concept of universal health care becomes fuzzy. According to the Institute of Medicine, USA is an exception among the developed countries that does not provide a universal health care. Here the government hardly runs any health care centres (except a few county hospitals administered by county governments. One famous example is Cook County hospital in Chicago). For a majority of people, health care benefits come through their jobs. In other words, your employer will buy you a private health insurance. You also pay a portion of that premium per month, though. The companies that issue health insurance are called Health Maintenance Organisations (H.M.Os) and they are for profit. But if you become unemployed or operate your own business, you have to buy your own private health insurance. However, for army men, the government provides health care through government–owned and operated facilities (Department of Veteran Affairs). For senior citizens (more than 65 years of age), the government runs a Medicare insurance scheme and thus bears the costs of their medical bills (Canadian system).

Thus it is obvious that India has a mixed system where the government pledges to provide health care, but is unable to meet the demand. The private health sector is robust, but the poor and needy may not be able to use the services for want of money. How do we strengthen the health care system in India, then? We need to increase access to affordable and quality health care for everyone. India needs to increase its budget share on health, particularly preventive and primary health care. In addition, we must produce more doctors and para-medical forces. Instead of running the health facilities itself, the government will do well to broaden health insurance to its citizens and put good regulations in place so that through the private sector, it can provide much needed health care to its citizens.


The author is a a practicing Neonatologist in Chicago. This op-ed is an exclusive article in his series Musings from Chicago. You can reach out to him at e-mail ID: pedia333@gmail.com and on Twitter @drMunishRaizada.


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Photo by Wikimedia Commons

Killer Smog in Delhi.

Developed by the Indian Institute of Tropical Meteorology (IITM), Pune, a Decision Support System (DSS) that extends the ability of the existing air quality early warning system (AQEWS) to have decision-making capability for air quality management in Delhi-NCR was launched on Tuesday.

The website for the DSS (https://ews.tropmet.res.in/dss/) is designed to help the Commission for Air Quality Management for NCR and Adjoining Areas (CAQM) by delivering quantitative information about the contribution of emissions from Delhi and its 19 surrounding districts; the contribution of emissions from eight different sectors in Delhi; and the contribution from biomass-burning activities in the neighbouring states.

These information would assist in managing the air quality in a timely manner, a release from the Ministry of Earth Sciences said.

The need was stated by the CAQM, which was formed by the Ministry of Environment, Forest and Climate Change, during a meeting held in January 2021.

Recently, the Commission reviewed the progress made by IITM and had in principle approved the current version of DSS for air quality management in the Delhi-NCR. The IITM has also developed a new website for DSS with the entire system made operational, the release said.

Union Minister of State for Earth Sciences, Jitendra Singh, while launching the website for AQEWS on the occasion of 'Azadi Ka Amrit Mahotsav' week organised by the Ministry of Earth Sciences, said, "DSS is a significant contribution to 'Azadi Ka Amrit Mahotsav' on behalf of MoES and IITM and suggestions are invited on this issue."

The website also has a feature whereby the users can create their own emission reduction scenarios (from 20 different districts, including Delhi) so as to examine the possible projected improvement in air quality in Delhi for the next five days.

"This information would explicitly highlight the most important emission sources responsible for the degradation of air quality in Delhi and suggest possible solutions to ameliorate the same. With a plethora of quantitative data, the AQEWS integrated with DSS could become a user-friendly tool for air-quality management in and around Delhi," the release said. (IANS/JB)

Keywords: Delhi, India, Pollution, IITM, Ministry of Earth Sciences


Photo by GOI.

On the first day of the two-day meeting of BJP and Rashtriya Swayamsevak Sangh (RSS) leaders on Tuesday, discussions were held on important issues related to education and the National Education Policy-2020

On the first day of the two-day meeting of BJP and Rashtriya Swayamsevak Sangh (RSS) leaders on Tuesday, discussions were held on important issues related to education and the National Education Policy-2020. Apart from senior RSS leader Suresh Soni, representatives of various organisations associated with the Sangh Parivar -- working in the field of education -- were present in the meeting in New Delhi.

According to sources, Union Education Minister Dharmendra Pradhan, who attended the meeting on behalf of the government, shared information related to the National Education Policy-2020 and the government's policy on important issues related to the education sector. Pradhan also shared details of the efforts being made by the government in the field of education.

Discussions were also held regarding the impact of the situation arising out of Corona and how much it has affected the education sector. In the meeting, the RSS leaders asked several questions and provided suggestions to the Union Minister regarding the education policy of the government.

According to the sources, RSS wants the policy to be implemented expeditiously. All aspects related to the policy were discussed in Tuesday's meeting. On the second and the last day of the meeting on Wednesday, special issues related to education will be discussed in which representatives of various organisations of the Sangh, Union Ministers and several BJP leaders will be take part.

Meanwhile, in order to convey its point of view to the government on various issues, the Sangh keeps on calling such coordination meetings related to specific issues, in which RSS representatives -- working in that particular area -- provide feedback to the government. (IANS/JB)


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