Complexities in the healthcare sector can be solved mainly by concentrating on primary care and evolving the system of family doctor with the help of technology
The Indian healthcare system has become highly glamorised with growing demand for skilled and specialised treatment while crucial primary care system is been ignored, says experts from the healthcare services.
“When primary healthcare can solve 90% of the medical problems, at times, there is no system in place to provide it. Earlier the concept of family doctor played an important role, but it is slowly diminishing. Complexities in the healthcare sector can be solved mainly by concentrating on primary care and evolving the system of family doctor with the help of technology,” says Gautam Sen, chairman, Healthspring Community Medical Service, while speaking at an event to discuss healthcare services in India.
Panellist discussed at length the need and importance of primary care and the role of the private healthcare system and rising out-of-pocket expenditure on medical facilities. While host of speakers including Ashok Ganguly, a member of Rajya Sabha and former chairman of Unilever, BK Goyal, professor of Cardiology (Mumbai University) and Dr Sanjay Oak, director- medical education (BMC) were present at the event, only two – K Sujatha Rao, former health secretary and Dr Satyanand Shastri participated in the discussions. Other panellists, apart from Dr Ganguly, who just spoke informally for a while, were not present.
Ms Rao, former principal health secretary and member of Public Health Foundation of India, said, “Primary care system in urban areas is collapsing. Rural areas at least have some basic infrastructure like primary healthcare and community centres. Over the years, our policy has failed to consider lifestyle diseases like asthama, hypertension and diabetes. Government asked private sector, by incentivising them, to place a system for treatment. While the private sector is growing, at present, there is no mechanism to regulate them.” She is also a member of planning commission committee on health insurance.
Explaining the role of primary care, Dr Shastri, medical director, Johnson and Johnson Medicals, said, “If general physicians are able to give good primary care, then most of the medical problems can be solved.”
“I know a patient who was given wrong treatment for six years after consulting his doctor for vomiting blood. While just drinking alcohol once a week, he was branded as alcoholic by his doctor. The subsequent doctors did the same without resolving the issue. The real problem was not detected for many years and he had to undergo many wrong treatments,” added Dr Shastri.
According to Ms Rao healthcare system in India is full of marker failure. “About 70%-80% (around 84 crore) of the population spend out-of-pocket on healthcare. If there are corporate hospitals in urban cities who contribute to this failure, some agents present in rural areas, who are hand in glove with pharma companies, have damaged the system. Many a time wrong drugs are administered.”
Lambasting the government for spending just 1.2% of the GDP on healthcare, Ms Rao said it should be increased in the 12th five year plan. “When National Urban Health Mission kicks in, the challenge for government would be to see if they can recognize the importance of primary care community centres, and then provide them financial assurance. Incentivising and providing financial assurance would be fine, but insurance model is just not the solution,” she added.
CDS norms were originally scheduled to be operationalised from 24th October, but the RBI deferred it to give market participants like banks and other financial institutions more time to clarify details on documentation and operational aspects
Mumbai: The Reserve Bank of India (RBI) today operationalised new guidelines on credit default swap (CDS), directing market participants to report such trades within 30 minutes to the Clearing Corporation of India’s (CCI) online repository, reports PTI.
“It is advised that all market makers shall report their CDS trades in corporate bonds within 30 minutes of the trade to the CCIL trade repository CCIL Online Reporting Engine (CORE) beginning 1 December 2011,” the RBI said in a circular.
CDS provides credit protection to corporate bond buyers, as the sellers of the swaps guarantee the credit-worthiness of the product. Thus, the risk of default is transferred from the holder of the fixed income security to the seller of the swap.
The RBI observed that the objective of introducing CDS on corporate bonds is to provide market participants a tool to transfer and manage credit risk in an effective manner through redistribution of risk.
In October, RBI issued a formal notification specifying that CDS is a derivatives instrument.
The apex bank had finalised the guidelines in May to allow corporate entities including insurers, FIIs and mutual funds to hedge against the risk of default in the corporate bonds to which they subscribe.
The RBI had said a credit event (a default on a previously agreed financial obligation) will cover restructuring approved under the Board for Industrial and Financial Reconstruction (BIFR), including corporate debt restructuring and corporate bond restructuring.
“Since CDS have benefits like enhancing investment and borrowing opportunities and reducing transaction costs while allowing risk-transfers, such products would increase investors’ interest in corporate bonds and would be beneficial to the development of the corporate bond market in India,” the central bank had said.
The RBI guidelines come at a time when the quantum of bad loans in the banking system appears to be gradually building up.
The guidelines take effect after a delay of over a month.
They were originally scheduled for 24th October, but RBI deferred it to give market participants like banks and other financial institutions more time to clarify details on documentation and operational aspects.
The users of CDS include commercial banks, primary dealers, non-banking finance companies (NBFCs), mutual funds, insurance companies, housing finance companies, provident funds, listed corporates and foreign institutional investors (FIIs).
RBI had announced in its second quarter review of the monetary policy in October 2009 that it would introduce a plain over-the-counter single name CDS for resident entities.
Following this, it had appointed an internal working group to finalise the operational framework in consultation with market participants.
The final report of the working group was presented to the RBI in February, following which it sought public comments.
As part of measures to enable more financial market reforms, RBI also increased the period of short sale in government securities from the existing five days to a maximum of three months.
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