“Transform India With Modi”

State of Healthcare Industry – Issues, Root Causes and Solutions

Background
The healthcare industry of India is in need of reforms. Healthcare in India needs to become more accessible, affordable and transparent as an industry. The 160,000+ strong “Transform India with Modi” online citizen community has come together to collectively identify the Key Issues, Root Causes and Solutions needed to improve the State of India’s Healthcare industry. The citizen community expects that the whitepaper will be reviewed by the Government Leadership and actions will be taken on the identified Solutions at the very earliest.

Issues Identified:
1. Medicines and medical tests are getting expensive day by day
2. A nexus has developed between the hospitals/doctors and the path labs
3. Hospitals prescribe costly medicines which are never given but only billed
4. They charge for very costly tests which are either not necessary or not done & false reports generated by computerized forgery
5. The surgeons overcharge
6. Many surgeries are done by trainees under a senior doctor’s name
7. No standardized rates displayed in hospitals for the services offered
8. Doctors don’t prescribe generic medicines which are much cheaper
9. Generic medicines are hard to find in the market
10. Lots of cases of fake medicines are being reported
11. Absence of senior doctors from government hospitals
12. Patients are misbehaved with in government hospitals
13. Entry and exit formalities are very poor in government hospitals
14. No complaint redressal mechanism in government hospitals
15. Prescribed medicines are available only in the nearby stores and not around the city
16. Hospitals run their own Pharmacy & make it is compulsory for indoor patients to buy medicines from there
17. Reimbursement of medical bills by insurance companies is another big issue
18. Patients are prescribed unnecessary tests to get kickbacks
19. Modern treatment facilities are not available in public hospital
20. No Transparency in treatment
21. Patients are kept in ICU for getting higher room rents
22. Treatments are extended for indoor patients for keeping the beds occupied and maximizing returns
23. If a patient has mediclaim, he is charged extra compared to a patient without insurance cover
24. Unhygienic conditions prevail in most clinics/ hospital complexes
25. Dubious clinics still carry out unauthorized organ selling, surrogacy, abortion of the girl child, etc.
26. All health centres and Super specialities are in cities. Rural population cannot afford these
27. Banned drugs continue to be available in the market
28. Little or no medical facilities in most villages
29. Red-tapism in the CGHS system
30. Uneducated and untrained Doctors are a big problem

Root Causes Identified:
1. There is no governmental control on drug prices
2. No laws to govern the working of path labs
3. There is no rule to govern the rates of medical tests across path labs
4. Private colleges charge a hefty donation for admissions. Doctors hence use alternate ways to earn and get return on this investment
5. Doctors try to make extra income by tying up with these path labs
6. Doctors get perks from the pharma companies for prescribing their medicines
7. Hospitals want to make more and more money from the patients
8. Surgeons are allowed to decide themselves how much they want to charge for surgeries, depending on their seniority
9. Generic medicines have a lesser margin and hence chemists don’t like to stock them
10. The huge number of people who turn up at the Government hospitals make the Doctor’s/Staff’s job very tough
11. Insurance companies try to find the smallest flaws in the application to be able to reject claims
12. Doctors don’t want to work in villages since they lack infrastructure
13. Not enough awareness among general public about medical practices
14. Not enough good medical colleges in the country to produce the required number of Doctors
15. Medical practitioners in general lack humane attitude and use their expertise only for earning money
16. Anti-competition laws are ineffective

Solutions Identified:
1. Better cleanliness and hygiene should be maintained in government hospitals
2. Emulate British health care system where every citizen has to contribute a part of the salary as social benefits and money is distributed for state and central healthcare system
3. A low premium based Health Insurance Policy covering all citizens of the country and the drive should be in line with opening of bank accounts Jan Dhan type
4. Nationalise all private medical colleges and pay professional salaries and campus residence for all professors and teaching staff
5. More government medical colleges should be opened
6. Affiliation of the colleges charging donation should be cancelled
7. Consultation fee of the doctors should be fixed by the government
8. Medical representatives visiting the doctors should be made illegal. They should be handled by the admin staff
9. The price list of different medical procedures should be displayed in the hospital premises
10. The working of all the path labs should fall under a common law
11. All Medical tests should have maximum standard rates for every state which needs to be approved by a standard govt. body and displayed in every hospital and clinics as a mandatory rule Increase in prices should be allowed only through some governmental body and its approval
12. The licences to the Public Analytical Laboratories should be given after thorough scrutiny and so also their renewal should be thoroughly audited
13. Generic medicines should be easily available on counters
14. A social campaign should be created to educate the masses about medical practices
15. .A regulatory body for Professionals (Doctors in this case) beside IMA which is just like Cricket Association leaving no scope for Government to directly intervene
16. Time frame & timely settlement of health insurance claim which may include negligence of Doctors, wrong medicine prescription etc.
17. There must be master agenda to upgrade the overall status of the rural and suburban hospitals/health-centres. This will also help the crowd to stay away from the crowded cities
18. Proper supply and honest distribution of free medicines/supports in the hospitals must also be duly taken care of
19. Negligence should be treated sternly
20. Encourage the big business houses who can afford the huge expenses of running the medical colleges
21. Give free tuition to 50% students if they agree to work for 5 years in rural India on stipend after passing out

State of Healthcare in India – A few citizen posts and comments:
1. I agree that healthcare has become an industry nowadays. This week CII is holding a convention in Delhi about ways and means to increase domestic demand of medical technology to three times the current value. And FICCI Heal has the same agenda. There is nothing wrong except that the healthcare CEOs are trying to extract maximum revenue from the small percentage of people who can afford to pay. They should expand the market to cover a higher proportion of the country – Sumit Ghosal

2. An online evaluation/ ranking system for the doctors to be done based on the success rate, cost of treatment to be developed which will integrate with all the hospitals and pharmacy which can bring some amount of Transparency in the current system – Sampath Shetty

3. All issues mentioned are real. Need some complaint system directly with State Medical and District Medical/Central medical authority linked to our PM Modiji – Dr. Ramesh Maheshwari

4. The root cause of present day miserable condition of Health care system in our country is mainly due to indifferent attitudes of our Governments-Central as well as state governments, towards it – Prakash Rai

5. As a doctor l am more worried above all these issues mentioned is that there is too many brands for a same medicine and pharmaceuticals is a pure business now. There are laws and establishments to check the quality of medicine but not functioning or to my knowledge bribed to such an extent that we can’t imagine – Dr. Manesh Mohan

6. A large population is getting affect due to no coverage of Out-of-Pocket expenditure on OPD (Out-patient) costs. This amounting to a major chunk and also creating a scenario of patient being refused to get admitted in the hospital – Tarun Goel

7. A comprehensive health care system like the NHS in U.K is needed in India – Anand Rao

8. The root cause for this all practices start from the point of admission into MBBS - usually one has to pay 20-50lacs of rupees to get admission in medical college, there after another 20-50 lacs for PG, this makes investment of about 1Cr to become doctor, so when he start practice at age of 30 he need fast money to repay debts and earn out of investment, this makes him greedy to get money via unethical roots like - clinical test / operations and hospitalisation - this has to be check at very first step to start cleaning of system – Achal Kumar

9. Drug companies exert pressure on the Doctors to prescribe their medicines to the sick required / or not and extend favours to the Doctors at the cost of sales made by such Doctors. Doctors involved in such inhuman acts should be stripped of their Medical Degree – Ajit Kumar Bhargava

10. Once a claim is made to insurance company for a disease, insurance companies exclude that disease from future insurance. This creates a problem for people who have a recurring problem – Misha Tandon

11. In Govt. Hospitals, the best of medical facilities are for the elitist class like top govt. officials, bureaucrats , politicians, MP's ,ordinary citizens are given third rate facilities or are never entertained the best doctors come out to treat only the well-heeled and elite class who are well connected , rest are left to trainees and nurses to be handled. I had first-hand experience at LNJP, Delhi where i lost my mother as i had turned bankrupt after her extensive and expensive treatment in Private Hospitals – Dheeraj Kocchar

12. Why not Doctor's Licence be renewed after 5 Years - So that they don't leave in a Paradise of their own , once acclaimed the doctor Licence - they forget the oath taken at the time but remember the donation paid for the entry of Medical Colleges - Every Doctors Clinic should have a Complain / Suggestion Box to be locked / opened once a month by CMO - Hence it would work for evaluation of Doctor's deeds in 5 year – Paras Berlia

13. Day to day activity should monitor and people awareness drive should be done often – Ramesh Kumar

14. Professional Ethics of Doctors coming down nowadays – Sundararajan M

15. The root cause is training of d doctors& management of these doctors. We have enough n more doctors in South India. But there is shortage in other parts.one more aspect is to abolish DNB system of d national board run by health ministry.as it has miserably failed to achieve any of d purpose for which it was started. And now corruption has also crept into it. It is better to persist with d md/ms system without diploma courses – Baswaraj Kollur

16. The best way to fight this war is to have authenticated network of very confidential candidates who are willing to perform the tasks and have every information of the drugs used that are already banned and more than that, a strong disciplinary approach towards appropriate action to be taken against such complaints – Sharad Chauhan

17. The root causes of the state of Health industry in India are due to the craziness to mint money. The pharmaceuticals are also offering good commissions for the medicines sold/prescribed.The insurance companies are cheating the policy holders at the time treatment/reimbursement whereas they adopt super tactics to sell their policies. There is no corrective system with the government to control such violations by insurance companies. There is no active supervising body either in the hospitals or in the Health Department to find out the culprits in this field - Krishan Shanmukhan