Doc, take a stand, break the nexus

In September this year, Fortis Hospital in Gurgaon created news by excessively charging for the treatment of a six-year-old girl, who had Dengue and who unfortunately died. In November, Max Hospital in Delhi was in a big soup after it wrongly declared a baby as dead. In early December, Income Tax raids on several diagnostic centres in Bengaluru revealed that doctors were paid for referring patients. In the last week of November, villagers ransacked Holy Cross Hospital in Kalyan, when a 22-year-old youth died of chest pain. In Karnataka, some 30 patients died as thousands of doctors went on a strike against a law intended to curb malpractices in healthcare.

These, and several other incidents, have rattled the entire community of doctors in the private sector. A few doctors were perplexed when most of their colleagues came down heavily on the proposed amendments to the KPME Act, despite the outrageous incidents that made them necessary. The medical fraternity claims that only a few doctors (2%) are black sheep. But there is enough evidence, from a public health point of view, for regulating the private sector. For example, the second major cause of debt in rural India is expenses towards healthcare. Data from the 60th round of the National Sample Survey, conducted in 2004, had shown that 70% of out-of-pocket expenditure is on medicines. The Health in India report shows that in rural India, 25% of patients relied on "borrowings" for hospitalisation expenses and 68% on household income and savings.

The media did not support the medical fraternity, either. They blamed doctors for the death of several patients while the doctors were on strike. The politicians enjoyed their usual routine – with those in the ruling party insisting that they were trying to help consumers, and those in the opposition party trying to pacify doctors, claiming loudly that they would never allow the government to bring in such a law.

In the midst of all this, the private doctors' lobby proclaimed that it was the government-run public health system that needed to be strengthened. This statement from the doctors was long overdue. The World Health Organisation (WHO) says that 5% of GDP should be allotted for health, but the Indian government allots a meagre 1.2%, which is much less than what many poor countries spend on healthcare for their citizens. With the public health system becoming weak, the private healthcare sector has boomed. India now perhaps has the largest unregulated private healthcare sector whose main aim is profits. With this have come the corporate hospitals, with huge investments and, very often, political clout. Thus, healthcare has been hijacked by 'for profit', politically-connected corporates. Doctors had to either jump onto their bandwagon or be isolated.

But there was indeed a third route. Unfortunately, they missed it. It is worth recalling that the word 'doctor' is derived from a Greek word that meant "to teach". One is not sure if this meant that doctors taught people to stay away from illnesses, but over the years, the word came to be used globally for one who treats the ill. So, it is time doctors reclaimed their lost glory, firstly by stating the urgent need to strengthen the government public health system as well as by campaigning for Universal Health Care (UHC).

The UHC model has earned much attention from Thailand which has since 2002 provided healthcare access to over 48 million out of its 66 million population. The number of households falling under poverty line due to health impoverishment reduced from 2.36% in 2007 to 0.34% in 2015. Thus, a reduction has been seen in catastrophic health expenditures. It is mainly funded by tax revenue. There are also models of robust government public health systems in India itself in the states of Kerala and Tamil Nadu that could be emulated by other states.

Secondly, private doctors should set up district redressal committees consisting of a few senior doctors amongst them, along with some eminent people from the community, and they should invite representation from aggrieved healthcare consumers.

Thirdly, doctors should take the lead in promoting generic medicines. Globally, and in India, the 'pharma-doctor' nexus is well known. The medical fraternity should come forward to break this. No act or legislation can undo this nexus until and unless doctors themselves initiate the action. A beginning in this direction has been made by a few doctors under the banner 'Alliance of Doctors for Ethical Healthcare'.

Fourthly, doctors should bring out treatment guidelines, especially for antibiotic usage.

There are many more such initiatives that doctors can start to retrieve their moral standing and win back the confidence of people. The KPME Act may or may not help the consumer, but initiatives undertaken by doctors themselves will surely help the people at large.

(The writer is president, Drug Action Forum, Karnataka)



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