PPP (Pretty Private Profits)

By Dr Oscar Rebello
05 August 2010 19:22 IST

Should health care be a social obligation or should it be purely a commercial enterprise? This is one question that befuddles the best of minds in the most sincere of environments and there never can be easy answers.

In the Goan context, let me try to wade through the swamp.

Broadly, there are two systems  of health care across the world.

1.    The     Socialist / Communist model: - the best example of this model is the one in Fidel Castro's Cuba. Though the docs there can't afford private yachts and holidays in Capri many believe that this is perhaps the most excellent health delivery system to the people of Cuba. In Michael Moores movie "Sicko", he shows how patients denied health care by insurers in good old capitalist U.S.A. smuggle their way into Cuba to get fabulous eye surgery done.

2.    The Capitalist Model:-  The dazzling example of this of course is the celebrated American model. Here you encounter brilliant health care, cutting edge research and the latest gizmos and drugs that tries to keep you alive and kicking forever (and then complain about global warming ). There is a huge caveat to this however, YOU MUST BE ABLE TO AFFORD THE DOCTORS AND THE HEALTH DELIVERY SYSTEM. If you can't afford to pay the insurance companies you could end up dead beef on the streets  or try to sneak into Cuba .

In Goa / India, as always, we choose to be deliciously schizophrenic. As in every other field , over the last 2 decades we have junked our socialist robes and all jumped gleefully on to the gravy train of cowboy capitalism .

So, Why should health be different?

India is witness to the mushrooming of world class pvt hospitals like the Apollo, Fortis, Reliance chains with truly fantastic medical personnel and facilities and you are also witness to the alarming speed at which Govt-run hospitals are crumbling due to lack of infrastructure, resources and manpower.

Hence the equation in Goa/India is very simple if you can afford it, you will continue to access the best health care possible and if you can't afford it (after blowing your entire salary on dal/rice) you could be crushed to death in the bursting mass of people outside any GMC OPD.

Live by the capitalist sword and die by the Socialist one. Wiser words were never spoken before.

Make no mistake about this. If it wasn't for the ceaseless, untiring and valiant services of the Doctors in Govt hospitals, who have to handle hordes of patients daily, teach students, spend time on research, conduct beside clinics attend  night calls/surgeries  and be the bashing board of Govt officials and citizens alike our socialist model of health care (the PHCs , CHC, District Hospitals and GMC) would have completely collapsed long ago. If not for them, then most patients in Goa would have been at the mercy of the private lobby (who can charge you a Govt. Doctor's monthly salary for a single appendicectomy).

So logic would tell you that as health care becomes increasingly more expensive and unaffordable for the vast majority of Goans/Indians the socialist, public health care system would need to be strengthened by the Govt certainly NOT the private capitalist health care system which by its very definition must be left to its own rules, regulations and fate without any Govt intervention or bailouts.

But in Goa logic it seems is always in short supply. So instead of bolstering the Govt health systems, we have a peculiar predicament wherein crores of rupees are spent on specialized health care in the PVT sector via the Mediclaim schemes and now this infamous sweet heart deal with Elbit (an Israeli company who will put up its first tertiary care hospital in India) that again seeks to put public health in a favoured Pvt hand at tax payer cost putting all other super speciality hospitals in Goa to a significant  unhealthy disadvantage.

The common argument put forth by the health Dept is that you just can't get super specialists into GMC, so how does one go forward?

Let me list the super specialists in GMC that are doing heroic , exemplary work. Neurosurgery, Urosurgery, Plastic surgery Endocrinology, Paediatric surgery, GI surgery, Neurology, Nephrology.  The list is endless . Given the right salaries and incentives  (a fraction of the outgoing Mediclaim) all other departments can also attract talent that is abundantly available if properly sourced. (most of these superspeciality departments have been initiated due to the remarkable efforts of the current health minister).

Elbit and other private hospitals love the Health Department primarily for the Mediclaim facilities it generously doles out. They will not do anything gratis for the love of people of Goa. Also the Mediclaim schemes   will ultimately have to crack up it simply because it is unsustainable at the pace it goes and the cost over runs it incurs

SOLUTIONS:


A)    Let all private players have a level playing field. The best talent will attract the highest number of patients. The cardinal rule of Capitalism, No Sweetheart PPPs.

B)    Phase out Mediclaim and use those funds to upgrade facilities and salaries for high end, high tech work at Govt hospitals.

C)    Necessarily strengthen and motivate PHCS/CHC,s. It is completely unfair for a patient from Valpoi to travel all the way to G.M.C to avail treatment for a common cold.

D)    Handsomely pay Govt Docs, specially those working in far flung areas and provide them all basic health equipments and drugs. Allow pvt practice after duty hours in a regulated fashion by all means and haul over the coals those doctors who indulge in gross dereliction of duty.

As health minister it may make ample to sense to pvt most health eggs in one private basket, at this point of time, but if this experiment fails, Elbit pulls out  and the govt hospitals (particulary GMC) in the meantime are allowed to float rudderless till they run a ground there will be plenty of egg on the face when the health minister one day becomes chief minister .

OH THOSE NUDES


It was pouring mercilessly the other day. As I looked out of my hospital window at the campal ground, I saw two young migrant ("Ghanti") kids  completely in the NUDE, wet and freezing in the rain.

My sensibilities were offended. So I dialed the Hindu Tan Suraksha Samiti , the Catholic Forum against the Gay Da Vinci and the popular Islamic front who chop chop Hands, for help.

They all refused point blank claiming they don't deal with cases pertaining to children of a Lesser God.

I was, of course, too busy counting my pennies earned on the plight and misery of another fellow human being so I postponed my conscience for tomorrow

And then the moment of epiphany.

The slimy local politician with white shoes arrived on the scene and covered the two ‘ ghantis" with a shawl and some clothes.

Whether he did it out of an act of kindness or to increase the size of his vote bank I'll never know but that smile on the faces of those two kids was the only moment of genuine sunshine peeping out from the clouds on that monsoon Monday...

Blogger's Profile

Dr Oscar Rebello

Dr Oscar Rebello is one of the leading social activist of Goa and a practicing doctor. He led the historic peoples’ movement in 2006-07 to get the anti-Goa Regional Plan scrapped and save Goa from total destruction of Goa’s ecology and natural beauty. He is a Goa-based leader of Aam Aadmi Party. He is also a columnist.

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Previous Comments

It's better late than never. We Indians have lost our heart and soul and the mind has become cruel. You may have the best doctors in the super-speciality field, but our system has rendered them heartless, because in order to reach that position someone has put in a lot of sacrifice and money, paid through their nose.

In any chosen profession, be it a medical doctor, or a literary figure, a lawyer a financier, with an eagle's view on things, will not condescend or lower to the level of gross humanity. Everything has a price or nothing happens. It has become a way of life.

So if you think that better payment to these doctors, improvement of facilities, spending more money, the politics, handling of finances and percentage commissions, are we not of the same stock as those who make money out of someones' ailments ? plight and misery of the common man children of the lesser god?

It is said that dictatorship or communism or democracy all can be equally good if everyone acts like a good citizen, a national, proud of his country and believes in the brotherhood of man in the larger, true sense.

- ludovico, old-goa | 01 st October 2010 14:37

 

Even revamping salaries and getting the best of equipment does not solve the problem. We have an education system which is by favours and not on merit. Everyone knows that the Directorate of Health appointments and Doctors promotions in Govt Hospitals are by bootlicking the politicians and not on merit.

So we will get the best MRI/CT scanner to be used by the average doctor/radiologist who does not understand even 50% of the physics or technology involved what is the point ..the whole equipment would be under used. Surely making more burden on the system by improper maintenance.

If we need to upgrade facilities or infrastructure then we need to make sure that the people/individuals involved and using it are up to the credentials and not any average doctor from GMC

- Amit, Goa | 10 th August 2010 09:31

 

Hem soglem vachun maka ek mhonnecho ugdas ieta - "Nakak dhorlear thond ukttem zata". Dotor Oscar tujem nak .....

- Nanvnam, India | 09 th August 2010 21:51

 

A good analysis by the good Doctor.

The health care system in a country like US, has failed and the common man never can afford any treatment in hospitals due to exorbitant insurance covers! If u are not insured u cant venture to go for any treatment in any Hospital as the fees are beyond the paying capacity of an average person. The cost of Insurance cover is also very high and beyond reach of a common man if he has to pay for it. And it is well known that President Obama is trying to revamp the whole system so that the common man can afford health care!

To follow the Western model would be dangerous and would mean heavily taxing the common man to meet the insurance companies profits and the rackets in Hospitals of prescribing superfluous tests when ever any patient takes admission!

The best would be to spend this money in upgrading the facilities in the Govt. Hospitals and paying the Specialized Doctors comparative salaries.

Paying the mounting bills to insurance companies for Mediclaim would end up in the same mess in which the US finds itself right now!

- Vishwas Prabhudesai, Loliem | 08 th August 2010 10:51

 

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