The healthcare industry is virtually run by “big money” pharma companies and manufacturers of modern equipment. Doctors are mere pawns in their hands. A new series on solutions for the ailing healthcare industry
Aamir Khan has stirred a hornet’s nest, by exposing the malpractices in India’s healthcare services. Personally I am surprised by the sharp reaction of the medical associations and their intention to sue him or to boycott all his programmes. I thought he presented a rather balanced picture; the cut-practice, unnecessary investigations and operations, etc are issues that are discussed almost everyday by the media. What is more important is to find out what is ailing our healthcare services and what can be done about it. As a doctor, I feel that the least we could do is to stop the “blame-game” and the clamour to “punish doctors who misbehave”. Are they really guilty? If so, to what extent?
Even the most well-informed and well-placed intellectuals have not understood the complexities of our healthcare system. There are two distinct streams to this service. The state provides “public healthcare” for essential services to benefit the maximum population. The importance given to public health services and the amount of money spent on it by the state varies from country to country. India spends hardly 0.5% of its GDP (gross domestic product) on health, which accounts for just around 26% of the total amount spent on healthcare; the remaining 74% comes from the pockets of Indian citizens. Even though the importance given to this section is enormous and primary health service is so neglected that a survey by some social institutions found that 80% of the people opted for private services for their primary health—despite abject poverty. Moreover, it found that less than 20% of the MBBS doctors were involved in primary health care—private or public. This is because the union and state governments seem to be inclined to leave health services primarily in the hands of the private sector.
While the private sector dominates healthcare services in India, barring a small section of general practitioners, it consists of nursing homes, hospitals and specialists. The hospitals are turning high-tech and people end up spending three times of what the state is the spending for their health. Unfortunately, the private sector offers only the lucrative ‘cold’ work and modern high-tech services and thrusts all uncomfortable or non-profitable services on to the public sector—the poor, destitute, old people, tuberculosis, leprosy; even emergency services are a headache to them. “Health is the responsibility of the state” is a convenient argument.
WHY? Though George Bernard Shaw warned society a hundred years back, the people have steadfastly refused to accept that the (private) healthcare sector is an INDUSTRY—a highly profitable industry because of extremely low consumer resistance. Worse, now it sells attractive healthcare ‘products’ at profitable rates. Profit gets priority and healthcare becomes a subsequent objective. Hence, actual “health service” becomes a by-product and the proportion of its availability depending on the moral concepts of individual doctors. In just around 10% of the cases one gets miraculously good results and the patient is gifted with some extra and valuable years of good life. By then, the remaining 90% suffer so much economic loss that nearly a crore of Indians are being pushed below the poverty line every year because of crippling medical expenditure. Who is at fault and what needs to be done to correct this situation?
The medical industry is virtually run by “big money”, “ably aided” manufacturers of modern equipment and by big pharmaceutical companies. The media is cleverly used, first to create panic about every illness and then to glamorise new technology or a new ‘miracle’ drug/ invention which will save you from a ‘deadly’ illness. Doctors are mere pawns in their hands. The cost of research, PR and advertisements needs to be covered and the doctors must then earn money for the industry chain to make a profit. How can all this come cheap? The overuse of costly investigative and treatment modalities is further increased by:
a) lack of knowledge and expertise in specialist doctors
b) ever-increasing expectations of patients and
c) growing intolerance in society towards any untoward consequences during the management of treatment.
Earlier, there was a lot of emphasis on close observations and other clinical methods for diagnosis but now, due to the need to avoid ANY MISTAKE, the trend is towards “Objective Diagnosis”. Less you know, more you depend on technology. Less your expertise, more you need precision equipment to perform. The costs escalate, doctors are blamed, “internal trading” is suspected—and confirmed even without any evidence. But the fact is that many doctors are now totally dependent on these costly modalities; they are crippled without these aids for reasons mentioned. “Cut-practice” is but a small aberration for additional gains and merely indicates the same degree of corruption as is prevalent in the society in general. Totally unindicated misuse just for making money is an unpardonable crime. It does exist but I cannot judge the percentage of such unethical practices—could be 30% or so!
But overall, are you better off than previously in terms of your health-care? Facts are stranger than fiction. Average life expectation at birth is a useful indicator of the health of the community. Sri Lanka and Thailand have a much better lifespan than for Indians (more than 71 years compared to 64 for us). Reason? Those governments depend more on public healthcare, spending more than 50% of the total health expenses. And there is more attention to primary (and secondary) healthcare needs as indicated by a much better ratio of nurses in those countries, despite less number of doctors per 10,000 population. Mumbai fares the worst. It has 20 doctors, all sorts of specialists and all sorts of modern facilities, yet a Mumbaikar lives just around 58 years. This is universal; small town people have a much healthier life than those in metropolitan cities, all over the world. MODERN TECHNOLOGY DOES NOT OFFER YOU A BETTER HEALTH CARE EXCEPT SPORADICALLY. Mr Aamir Khan, don’t blame the doctors, blame the market, blame faulty medical education.
(Dr Sadanand Nadkarni, 80, is the former Dean of Sion Hospital, author of several books, a serious thinker of medical issues and hugely respected for a series of path-breaking ideas on improving the delivery of medical services to the aam aadmi. His book “Management of the Sick Healthcare System” is among the first to speak out about medical malpractice and other issues).
The path of least resistance is higher
The market is behaving as if it wants to head...
Learning the art of doing business from the hardworking and smart Lebanese businessmen. The 51st part of a series describing the unknown triumphs and travails of doing international business
As we entered the fag end of 1969 and having spent some six months in the Lebanon, we settled down well. We met a lot of Lebanese people of different walks of life and realised how hardworking and smart the businessmen were in being the conduit for promoting sale of goods from various countries to Saudi customers, who, in order to beat the heat came in thousands to live in the mountains of Lebanon with their families. Likewise, many came to spend their holidays to have fun in the snow-clad Cedar Mountains.
Yes, I came to know that Lebanon was one of the few countries in the world where one could live in the plains in the city, feel the mild and enjoyable winter climate and yet, in a couple of hours drive reach the mountains to enjoy the beauty of snow. The cedar tree, an important symbol in the centre of the Lebanese flag, I was told, had a religious reason too, in that Jesus Christ was crucified on the cross made of cedar wood! There were some rains too in winter in the city, but, tourists, who flocked to take advantage of the climate, would swim in the Mediterranean, enjoy the sun, and travel back to the mountains so that they could skin the next morning!
Saudi and other Arab countrymen would come down to Beirut with their families and enjoy their summer vacation, instead of going to Europe and facing the unpleasant truth of not knowing the language, whereas, in Lebanon, they were at ‘home’ and enjoy the hospitality at comparatively cheaper cost. It is at this time the Lebanese agents would also travel up to the mountain resorts and sell their wares. A lot of business was thus concluded, very often, we were able to meet the Saudi and Gulf buyers in the city when they came down from the mountains to do their shopping. The Lebanese businessmen had the advantage of being able to speak fluently both French and English, and acted as the ‘tarjuman’ or translator into Arabic, thus concluding business and pocketing a commission.
Many seasoned exporters, who stopped over at Beirut, en route to UK and Europe would invariably take the assistance of these agents to conclude business. Thanks to the arrangement made by Lakshmipathy, my predecessor, they would stay in the Commodore Hotel, get a special discount, as being members of the Council, and walk it up to our office in the Commestra Building. After my taking over, I continued this practice, and became friendly with all the folks at the front desk so that our exporters did not have problems. Though the Lebanese food had a number of vegetarian items to choose from, for the diehard Indian, we were able to guide them to visit Sirena Restaurant, owned by Bisham Verma and his Lebanese wife. Sirena was also catering to Air India.
Thanks to the support received from the Indian Embassy, and spearheaded by Ganga Lal Casewa, the world’s first All-Women Indian Cooperative Society was established in Hamra Street, Beirut, with Pushpa Dewan as president and Pratibha Patel as the secretary. This was the first point of cultural contact between the Lebanese and Indian women where a lot of cultural activities were organized.
We had regular visitors from Syria, who were keen to get supplies of agricultural implements, diesel engines, auto parts and a few other items for the construction industry. The problem, however, was the payment, as the Syrian government was not permitting direct imports, and most of the goods were routed through government organisations. They, however, permitted the imports, provided there was no outflow of foreign exchange. Merchants, being what they are, devised ways and means to short circuit the process by arranging for 365 days credit, and arranging for the remittance from Lebanon, which had no exchange control regulations.
The labour supply in Lebanon came mostly from Syria; thousands of workers would cross the Masnaa Border everyday by bus and share-taxis, work in Beirut on agricultural lands, return back once a week or so. The earnings, in Lebanese pounds or lira, were locally converted into dollars, etc, and this was bought at a premium for remittance to meet such imports. This practice was known to all, but as there was no objection for receiving remittance against exports effected,
The Reserve Bank of India (RBI) apparently did not make any ruling.
Our joint venture committee, meanwhile met regularly and other Indian expatriates like Capt Bedi (representing LN Thapar), Fakir Chand Karani (king of pearls who had a jewellery factory), Zaveri and Lalwani keenly watched the progress. I was able to get some good contacts and advice from these people, which I was able to use to advantage.
Beirut also boasted of the successful running of the AUB—the American University of Beirut, where a large number of students from Lebanon and from all neighbouring Arab countries were admitted. The faculty was both American and Arab and a number of businessmen had their wards here from Saudi Arabia. For the Arabs in general, for education purposes, they either chose the AUB or the Cairo University for higher education.
It was only through the regular visits of PD Patel of Sigil India, Kanthibhai of KB Thaker & Co and Muhammed of Kirloskar Oil Engines I was able to get a lot information and support in our attempts to gather knowledge of the Syrian market, which was practically closed due to centralized imports and exchange controls. We did have a bilateral trade with them, like we had with so many others.
As the market was developing, I was more and more in contact with exporters who were stopping over at Beirut. I gathered the importance of establishing a working relation with Saudi Consulate.
Although I had established a long working schedule for myself, averaging some 12 hours a day, working six days a week, it really became a nuisance when some exporters would stop over for a couple of days, have no contact with me or the Embassy, and then barge into the office and demand service on Saturday evenings. I tried my best to meet their requirements most of the times; but, eventually, decided that I will be out of circulation on Sundays at least to be with my family and kids. Yet, it was only much later that we could take them on site-seeing of places like Grotto or Jeita. Or, for that matter, Mamaari Castle, which was built by a Lebanese engineer and generated its own electric power by the artificial forced flow of water. The other picnic spot was Damour, where a small tributary of Dog River passed by, and from where we could see the Israeli soldiers in the occupied lands.
Lebanon was and is a great place to live with its wonderful people, as long as one kept away from religion or politics, which anyway was the keynote for success in peaceful living in this part of the world.
(AK Ramdas has worked with the Engineering Export Promotion Council of the ministry of commerce and was associated with various committees of the Council. His international career took him to places like Beirut, Kuwait and Dubai at a time when these were small trading outposts. From being the advisor to exporters, he took over the mantle of a trader, travelled far and wide, and switched over to setting up garment factories and then worked in the US. He can be contacted at [email protected].)