We hear this statement often in relation to policy discussions- this statement is misinterpreted to the core but happens only in India- the central government thinks that issues of health have to be sorted out by the states concerned. But what does it actually means?
-Health care is an issue to be handled exclusively by the governments, be it central or state – it is an issue which should never be handed over to the private enterprises. In USA it is 100% private and they do not even say health is a state subject; In India and USA are the only countries which are doing exactly the opposite of what is needed in health care-Now it’s almost 90% under the private in India. With the result the focus is on profit making business only, building state of the art five star hospitals under the private and busy building tertiary care hospitals in the government sector, besides promoting profit making avenues of AYUSH in the name of wellness.
At least public health is taken care of in USA, but sadly public health is a neglected orphan in India since we have eliminated those doctors with concern for public health. The most important doctors in the community for providing primary health care and working as the driving force for public health are family doctors or GPs which India has totally eliminated. Though the worst model of healthcare in the developed world is USA, even they have enough family doctors but are running private clinics under corporate agencies-working in the private sector. Wherever it is the private sector focuses on making profit from the patients who can afford to pay or those who have the so called health insurance-it’s ridiculous to call it health insurance- it’s only a disease care insurance. Health insurance is meant only for reducing out of pocket expenditure but the clever insurance companies deny claims on trivial reasons.
Kerala being state with maximum paying capacity naturally has more number of profit making private hospitals, and they are all making good profit. It’s only natural that the profit hungry business lobby from outside want to invest in the disease care industry in Kerala. Now they have taken over almost all the profit making private corporate hospitals in Kerala. It is absurd to say that such companies like Blackstone are attracted to Kerala because the Kerala health sector is very good. India should now think of reversing this trend by bringing health care completely under the government. Let us stop misinterpreting the statement – health is a state subject- let us understand that health care should be completely under the government. Let us also stop pampering single system specialists, super specialists, high tech private hospitals and the soft pampering of AYUSH. Let us from now on focus on bringing good quality primary care doctors. Dedicated competent and confident, trained primary care doctors will work as torch bearers and champions of public health; it’s no wonder public health is a neglected orphan in India, because we have eliminated the dedicated competent GPs. Neither the single system specialists nor AYUSH focus on issues of public health. Paradoxically even distributing money for treatment of rare diseases is seen now seen as an activity of public health. But in fact public health means is making available the following facilities accessible to all individuals
1. safe potable drinking water through pipes; (safe for drinking directly without boiling or filtering);
2. people being aware of handling their waste properly and we provide enough waste management facilities in a decentralised manner.
3. we should have excellent sewerage facilities and toilets for all
4. we should make sure that everyone knows what to eat what not to eat
5. people should be empowered to eat a balanced diet
6. we should ensure that people have enough facility for doing exercise in the open even without being aware of it by providing public places footpath cycle paths or open gyms.
7. all have access to free disease care with good primary health care doctors – family doctors
(Dr PK Sasidharan
Former HOD Medicine & Former Dean faculty of Medicine, University of Calicut
Former president of KGMCTA
Fromer President of API
Immediate Past president of Indian Society of Hematology)
