#dnaEdit: Unhealthy trends

The disquieting news coming in from the health-care sector points to a dangerous slide that must be stemmed before it is too late. Evidence of apathy, corruption and unethical practices are massing up but none of the stakeholders — government, Medical Council of India(MCI), hospital managements and doctors —  are taking corrective or preventive action. In Delhi, a city woefully short of hospital beds, work on two super-speciality hospitals initiated in 1998 costing Rs150 crore is far from complete. Last month, an Australian doctor David Berger writing in the prestigious British Medical Journal blew the whistle on doctors and medical institutions living in an “unvirtuous circle of referral and kickbacks that poisons their integrity” and noting that ‘investigations and procedures are abused as a means of milking patients”. While some like eminent gastroenterologist Samiran Nundy have concurred with Berger’s findings, the Indian Medical Association’s attempts to ban referral cuts have run into rough weather with many doctors’ associations slamming the move and an IMA state unit termed the BMJ article as a conspiracy to defame India.

The health-care sector’s need for an effective regulator has never been more pressing. The private sector and corporate groups have stolen a march over the government in setting up hospitals and profit motive has quietly trumped public and individual welfare. Only recently, a Mumbai hospital affiliated to a top industrial group acknowledged that it promised general practitioners Rs1 lakh for referring 40 patient admissions per year, Rs1.5 lakh for 50 admissions and Rs2.5 lakh for 75 admissions. Media reports also point to patients being charged twice and thrice the actual price of medical devices like stents and pacemakers and being subjected to unwarranted medical investigations at hospitals in lieu of hefty commissions for doctors and medical suppliers. The MCI, despite being a statutory body, has failed in its mission. Reforming the MCI — staffed entirely by doctors and dogged by allegations of irregularities — must become top priority. Without giving representation to civil society, the MCI will not be able to do justice to either patients or honest doctors struggling to uphold medical ethics. Most sectors like banking, securities, telecom and even the pharma industry have regulators to monitor and enforce norms which has greatly benefitted consumers.

Doubts over the MCI’s regulatory ambit over private hospitals, medical consultancy fees and sale of medical devices have been compounded by its inaction on complaints of unethical practices. The new health minister, Harsh Vardhan, a prominent medical practitioner in Delhi, is best placed to rectify these systemic flaws that endanger public health. But reforms will work only through winning over doctors and hospital managements; a confrontational approach might lead to agitations and incidents that divert attention from the real issues. The challenges are many; they range at the macro-level from expanding public health services to evolving problems like antibiotic overuse in which India tops global consumption. The 2014-15 Union budget indicates a fascination with big-ticket ideas like starting five new AIIMS institutions with a paltry Rs500 allocation. But the spending on health care has seen a marginal hike of just 1.4 per cent from 2013-14. In contrast, the 2013-14 budget had an 8.24 per cent hike from 2012-13. Though the public expenditure on health is just 1.4 per cent of India’s GDP, rural and urban households spend up to six per cent of their monthly household expenditure on health care. The governance deficit that Narendra Modi campaigned on encompasses such gaps in spending and regulation. He must bridge them now.