Welcome to the Friday Loose Bloggers Consortium where Anu, Ashok, Conrad, Delirious, Gaelikaa, Grannymar, Magpie11, Paul, Maria the Silver Fox, Rummuser , Will Knott, Shackman and I write on the same topic. Please do visit the linked blogs to get different flavours of the same topic. This time my husband Prof N Natarajan takes on the topic!
Health care means maintaining good health and restoration to normal health when something goes wrong with it. The causes can be many. Smoking, drug addiction, bad eating habits and alcoholism are self inflicted causes. Others are due to hereditary factors or societal /work related factors or diseases contracted by immunity deficiency, by contact or aerially spread or water borne and food borne diseases. For a woman, conception, child delivery and post delivery period are critical events having impact on her health and logically health care must cover these periods.
Medical care kicks in when health fails or in the case of accidents and health deficiencies from birth. Maximization of health care will lead to minimization of medical care. Thus the two are inversely interrelated. Medical care does not necessarily mean restoration to good health. In a large number of cases medical care is more concerned with prolonging life, without delivering substantial quality to it. Today chronic pain and suffering is simply managed medically by administration of palliative drugs on a life-long basis. Often surgical interventions too are followed by prolonged medication as are blood pressure and diabetes,.
Any informed debate on ‘National vs Private’ must recognise the above distinction between health care and medical care. One is preventive in nature while the other is corrective or palliative. For health care, the biggest responsibility is that of every grown up individual himself. He has to look after his own well being, health-wise and fitness-wise, to enjoy a reasonable quality of life. He has to refrain from abusing his body and to be able to listen to its needs, complaints and protests. He cannot afford to take his health for granted. As regards children initially their well being is in the hands of their parents. As they grow up, gradually the responsibility for their health shifts to themselves and finally they have to take full ownership of their health.
While an individual and the family unit must have primary responsibility to maintain themselves the secondary responsibility for good health of the citizens devolves on the state and the society as a whole. The responsibility cannot be abdicated to profit motivated private enterprise. The state has to ensure clean and safe environments, free from noise, dust and toxic pollutants. It must provide safe drinking water supply, sanitation and drainage. It must ensure that garbage and waste disposal system is effective and that there is no stagnant water. It must frame building regulations for a healthy environment and ensure strict compliance. It must also constantly educate the community about the best practices for maintaining a clean and healthy environment.
When the family and community individually and collectively ignore their responsibility and also fail to elect a responsible municipal administration capable of good governance and fail to pay taxes and rates honestly, it results in a multiple organ failure of the society. This is what is increasingly happening in many of the urban settlements in India and many other countries. Instead of reflecting upon the root causes listed above and addressing them effectively, the municipal Administration and society tries to find escape routes to duck admission of failure through privatization of health care. The problems are palmed off to profit driven third parties, whose primary concern is for the health of their business! This solution is expensive without being effective.
Bad health care management transfers the burden to medical care management. For example contaminated water supply results in wide spread diseases. The dictum, ‘prevention is better than cure’ finds its uppermost relevance in the case of health and medical care management. When it comes to medical care, unfortunately affordability is a big problem for economically weaker sections of a society, even as the cost of medical care is soaring to the sky. Medical insurance has only aggravated the problem.
Opacity is a big problem in the medical care industry. It all starts with very high prices of drugs, on the pretext that the manufacturers of patented drugs have to recover their research cost. Generics are blocked by IPR. This creates monopolies, where medical companies prefer to make astronomical profits by selling a very limited quantity of their product at a huge margin rather than putting in efforts to manufacture more.
Corporate hospitals too charge steeply for their services on the pretext of providing world class medical care. In line with such high charges the physicians and surgeons are paid high fees. Many expert consultants are lured by the assured high compensation. Increasingly, most patients have come to the state when they cannot afford the high cost of medication and treatment in corporate hospitals. This opened wide the concept of health insurance. But it has not worked.
Neither private medical insurance, nor government sponsored insurance has worked. It has created a nexus between insurers, hospitals and doctors and in some cases the patients are also unfortunately part of the unholy alliance in the belief that he is getting all the treatment free, never mind the adverse side effects. Unnecessary medical investigations are ordered, expensive avoidable surgeries are performed, unduly expensive medicines are prescribed, even when cheaper generic substitutes are available in the market.
In countries such as India, the Government has virtually stopped building good hospitals to treat the poor. The excessive reliance on the private hospitals has made medical care unavailable to the majority of the poor. Private medical care alone will never be the solution. It is absolutely necessary to set up a large number of government hospitals.
My conclusion: Health care must firmly in the domain of the national sector. Medical care may be shared by the government and private sector, with the Government playing a dominant role.
Prof N Natarajan