Is Indian Healthcare Moving Towards the UK Model?

The ongoing changes in Indian healthcare are readily apparent. It's evident that the Government of India is adopting increasingly impactful policies in Indian healthcare. The 2024 budget allocation reflects a trend of increased healthcare expenditure, though still falling short of the actual need, but nevertheless moving towards uplifting healthcare delivery.

The primary focus of the Indian government seems to be on reducing out-of-pocket expenditure for Indian citizens. This shift from prioritizing primary healthcare is notable. The government appears more interested in advanced healthcare delivery alongside primary healthcare. With consideration for non-communicable diseases, often chronic in nature, the government is also emphasizing the digitalization of health records, allowing every citizen to maintain longitudinal health records digitally. In this regard, the government has launched ABDM. To aid remote healthcare, crucial in reducing the cost of health delivery and benefiting our aging population who struggle to visit hospitals repeatedly, the government has initiated UHI. Additionally, to ensure the coverage of most, if not all citizens under some form of health insurance, IRDA along with NHA has introduced HCX. The new set guideline for the insurance sector henceforth is 100% cashless coverage. The government is dedicated to reducing healthcare costs by regulating insurance companies. These changes will undoubtedly have a significant impact on healthcare and will disrupt the healthcare industry. Healthcare professionals should prepare for these evolving times.

Changes in Healthcare Infrastructure:

There's also a noticeable shift in how government hospitals are functioning in India over the past few years, especially since the launch of the PM-Jay scheme. The coverage amount has been augmented from 5 lakhs per annum to 10 lakhs. Funding for government hospitals is gradually shifting from allocated budgets to the earn-by-service method. What this means is that now every government hospital is expected to enroll under the PM-JAY scheme and generate revenue from it. The revenue generated through this method is becoming a more significant component, reducing direct funding to government hospitals.

The number of government medical colleges is increasing. Alongside private medical colleges, almost every district headquarters now has one medical college, and in many cases, more than one. The number of MBBS seats in India has more than doubled in the last few years, and as for post-graduate seats, they have increased several times over. The NMC has relaxed criteria for obtaining permission for an increased number of seats in both undergraduate and postgraduate courses. This is not as challenging as it was in the past. It's not uncommon to find specialists in taluka headquarters and even government hospitals in taluka where specialists from various fields like MD general medicine, orthopedics, and general surgery are now working. While not everything is perfect, there are still issues to address.

Challenges Faced by Healthcare Professionals:

Similar to the UK model, in government hospitals, doctors are given targets to fulfill, such as a certain number of procedures to be done in a month. Of course, this is not very stringent, but heads of departments are answerable for not meeting the targets. This could be minimal, such as a certain number of cataract surgeries to be performed. The private sector will undoubtedly face competition from government sector hospitals in the near future.

Challenges doctors are facing:

The government is very much inclined to produce doctors, but at the same time, they are not keen on providing employment. The sharing pricing of the PM-JAY scheme is a reflection of this. For example, services like Hysterectomy have a package cost of around 10 to 12 thousand. The rule is that private hospitals should perform this without charging extra. However, if one tries to divide the cost of maintaining the operation theatre, hospital stay of a few days (like 4 to 5 days minimum), medicine cost, anesthesiologist cost, and surgeon cost, this is barely possible. Even the most efficient scenarios will exceed 25 thousand without giving any profit to the hospital at all. This shows that the government does not consider the doctors and healthcare providers who are providing the service.

In actuality, this amounts to exploitation of doctors in India. Even government hospital doctors are working on a contract basis; they are not permanent employees in many cases. They hardly receive a salary of about 50 to 60 thousand, even a CTVS surgeon in a government medical college is offered 70 thousand per month under contract basis. This is nothing but exploitation. The government is not keen on providing employment for doctors. The trend of doctors becoming unemployed will be the norm in the near future unless government policies are adjusted in this regard.

In private corporate hospitals, the scene of exploiting doctors is no better. Many doctors who are working do not receive their professional fees regularly. A couple of my friends who are part of corporate hospitals said some corporate hospitals don't pay for certain procedures at all. Those who are working for a salary, for example, a urologist, was offered a 60 thousand salary. This is also exploitation.

Conclusion:

The government should have concern even for doctors and healthcare professionals while making policies. Here, I am mentioning harassment part of healthcare professional. The medical professional act, which is meant to protect doctors, needs to be implemented and protect the healers.

These changes in Indian healthcare, while moving towards the UK model in certain aspects, also bring about unique challenges and opportunities. It is imperative for policymakers to consider the well-being of healthcare professionals and ensure that the evolving healthcare infrastructure meets the needs of the population while fostering a supportive environment for those working in the healthcare sector.