Thursday December 13, 2018

How govt can provide better healthcare system to more than 125 crore people in India

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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.

A MK

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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Oracle Witnessing Double-Digit Growth in India For Past 3 Years

The Oracle Autonomous Database now has the capability to automatically scan for security threats and apply security updates while running to help prevent cyberattacks and data theft

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Cloud major Oracle, which is seeing high demand in the Banking, Financial Services and Insurance (BFSI), telecom and manufacturing sectors in India, has witnessed double-digit growth in the country for the past three years, a top company executive has said.

Start-ups and small and medium businesses (SMBs) are fast adopting Oracle’s Software-as-a-Service (SaaS) in the country.

“We are seeing double-digit growth (on an average) in the country. In fact, that’s both in our NetSuite business as well as our enterprise business.

“The India Cloud business is really booming. Overall, the double-digit growth has been there for the last three years in the country, which has been the best-performing region in the Asia-Pacific for us,” Shaakun Khanna, India SaaS GTM Lead, Oracle, told IANS in an interview.

The company competes with major Cloud players like Amazon Web Services (AWS), Google Cloud Platform and Microsoft Azure and provides services such as SaaS, Platform-as-a-Service (PaaS) and Data-as-a-Service (DaaS).

According to Oracle, as a corporation, the firm is on track to become the top SaaS company in the world.

The company offers innovative and proven Cloud suite of SaaS applications that enable customers to transform their business with the latest intelligent technologies such as Artificial Intelligence (AI) and Machine Learning (ML).

“From a perspective of completeness of our enterprise applications, there’s no one who can compare with us. So, that’s pretty much our objective and vision in India as well,” Khanna added.

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According to the company, going “autonomous” gave it an edge over rivals in the country.

Larry Ellison, Co-Founder and Executive Chairman of Oracle, in October unveiled the second generation Oracle Cloud with autonomous capabilities, improved security and upgrades for enterprises at the company’s annual user conference “Oracle Open World 2018” in San Francisco.

According to Khanna, autonomous is probably the biggest thing because, with autonomous, the ability to engage technologies like AI, ML, UI-UX, is there.

“I think the other advantage is our diversity, because if you look at it, we are the only company of our stature in the world that has everything — it’s not just the applications that are ours, the hardware, the infrastructure, the database, everything is Oracle,” Khanna noted.

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The Oracle Autonomous Database now has the capability to automatically scan for security threats and apply security updates while running to help prevent cyberattacks and data theft.

“If you look at the way Oracle built its first set of Cloud infrastructure is very similar to how Google built it, how Amazon built it, how Microsoft built it, almost everyone built it and we are doing exactly the same.

“Larry and the other founders who started Oracle — they were working for a CIA project and then they came out and started Oracle. So we understand security from our DNA,” said Mitesh Agarwal, Vice President, Key Accounts, Oracle India.

“Almost all of our competitors have never managed to move an enterprise workload to the Cloud — not a single one of them. They all have peripheral applications that have moved to the Cloud. That’s still only about 5-6 per cent of the workloads in the world,” Agarwal informed. (IANS)