Monday, 19 January 2015

National Health Policy: IMA demands equity and scientific practices

Now 13 years after the last National Health Policy, the Ministry of Health has brought out a draft new national health policy, which is in the public domain for discussions.

As per IMA  it seems that not enough homework has gone into preparing the draft policy and is reflected in the fact that the policy lacks clear directions and more importantly no clear-cut targets or objectives; unlike the previous policies.

The Indian Medical Association (IMA) feels that the policy, should give greater focus for preventive and rehabilitative care in context of rising burden of non-communicable diseases.

Commenting on the policy, IMA National President Padma Shri Awardee Dr A Marthanda Pillai and Its Honorary Secretary general Padma Shri Awardee Dr KK Aggarwal said that the policy has a reluctant and hesitant approach towards enhancing GDP for health – a mere increase to 2.5% proposed whereas the policy itself acknowledge that only if we govt starts to spend 4 to 5% of GDP, a real impact can be made in the health sector.

The policy is almost silent on many things including improving the family planning program, or on how to improve medical education, on health education in the schools. Over all the policy lacks any measurable objectives apart from some statements.

A large part of allocation of funds is spent on pay and allowances, pensions, transport and establishments. Funds for actual expenditure on health and medical care needs to be more specified. There should be a permanent mechanism to monitor the utilization of funds and to ensure that funds reach the targeted population with the intended purpose. There is need for inculcating better managerial skills; an Indian Medical Service just like the IAS, IRS is needed.

Govt policy seems to give undue importance to corporate sector forgetting the fact that majority of health care in the country is still delivered by small-scale institutions, and these small players move the national health indices.

Some of the policy statements expose the lack of in-depth knowledge of Govt reg the role of the small and medium hospitals in delivering health care particularly to the poor and in remote areas. Govt policy should aim to sustain and promote these own-account-enterprises (OAEs) so that affordability and accessibility is not affected.

Govt should consciously discourage the corporate culture in health care, which will definitely push up the cost of treatment and affects accessibility because all the corporate hospitals are city centered.

Under this policy, poor shall still depend on quacks. There is no clear-cut policy on Health Human Resource Development. The lack of any clear policy direction, may lead to uncontrolled, unregulated expansion as has happened so far, with Health Professional Education institutions proliferating in already saturated geographical regions rather than in the ‘unreached’ areas?

In a place where the private sector provides care for 70 percent of the population, it is un-wise to sideline the private providers. Income tax, luxury tax and service tax in hospitals and VAT on drugs goes contrary to the government policy of making health a fundamental right. Government policy should influence and encourage private health care establishments by exempting them from the purview of income taxes and providing subsidies to these institutions. Govt in turn can demand at least 15% free care in these institutions for poor patients. This will reduce the cost of care eventually avoiding catastrophic health expenses. Government also should provide water electricity and basic amenities at reduced rates for hospitals. This model will be cost effective compared to heavy investments required in health insurance systems. Failure of American model insurance driven health care provisioning should be a lesson while framing the policy

Considering private hospitals as pure industry is entirely misleading and it contradicts the Govt policy of making health as a fundamental right. When the Govt demands that medical ethics need to be followed and considers it as a service sector, branding clinical establishments in private sector as an industry exposes a contradiction in Govt policy. The need for standardization and quality health care services is understandable, but the mechanism to ensure it thru Clinical Establishment Act will be counter-productive. A process of voluntary and incentive driven accreditation is the best practical option. The pre-conceived notion that private sector always is profit-driven and ignoring it in the over all structure of health delivery and allowing it to run parallel to the Govt sector rather than promoting them to compliment is unbecoming of a health policy.

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