Dr
Arun Mitra
A
lot of debate has been generated not only in the medical circles but also the
civil society whether healthcare is a business or a profession. Anything that is termed as business is for
profit only and could therefore be ruthless, apathetic and self-centred. The
business has to compete in the market and follow the rules thereof and lacks
empathy and compassion. About four
decades back healthcare was a profession where one would earn by serving. But
the scenario has undergone much change now and medical profession too has
started following the rules of market. There are several reports of
overcharging and unnecessary interventions by some health providers. The
infamous case of Fortis hospital charging exorbitantly from a child who had died
of dengue fever is not too old to be forgotten.
Many
of these hospitals have taken land on lease from the government at throw away
prices. They are thus bound to give free healthcare facilities to a stipulated
number of patients from poor economic groups. But this hardly happens in
practice. Even the doctors and other staff see such patients with contempt.
This may be because of pressure from the management or apathy that they have
developed in the system they have been working for long.
The
process of shift in values in medical profession started by the 1980s when the
policies in South Asian countries began to be influenced significantly by the
Bretton Woods institutions, specially the World Bank. The developing countries
had to accept structural adjustment policies (SAP) under the corporates-driven
one-way globalization which served the interests of the international finance
capital. The governments in the developing countries changed laws in favour of
multinational corporations and the local elite while denying the basic
fundamental rights to the poor strata of society. Rights to hold protests and
unionise were curtailed. Subsidies to the poor were taken off. Job security was taken away and employment generation occurred
in the form of contract labour with very low wages. This happened not only in private sector but
even in public sector. The priorities in agriculture production also shifted
from the basic food to produce that was to be used by the elite in these
countries. All this further resulted into increase in the problem for the lower
income groups leading to fall of health determinants.
There
occurred a policy shift that treats health as ‘techno-dependent and amenable to
commodification’. The shift in concept is evident in the WHO itself when in
1996 it proposed a behaviorist model, which stressed more on the individual
effort for better health rather than social responsibility. The WHO started
working under the influence of international monopoly corporates and took
position to increase privatization and partnership with multinational
companies. So the emphasis shifted to address only population control and some
selected communicable diseases at the cost of its earlier broad-based approach.
As a result the institution which was supposed to work for inclusive healthcare
policies took lead in destroying its own agenda set at Alma Ata.
There
were serious implications on medical education in our country. More medical
colleges opened in private sector than in state sector affecting the very concept
of social service in the medical training. During 1947-2017, 251 private
colleges were setup as against 214 new medical colleges setup by the government
and 9 by government led society.
This
is the time when the patent laws also changed under the new patent regime of
the WTO. The local pharmaceuticals industries suffered. As a result, prices of newer drug increased.
After a lot of hue and cry from the public the government appointed a committee
to go into the drug prices vis a vis trade margins, that is the difference
between the price of the drug when it
comes out of the manufacturing unit and the maximum retail price i.e at what it
is sold at retails. The committee pointed out startling figures of the trade
margin to be the tune of even 300% – 5,000% in some cases. The committee
recommended capping of trade margin so that the cost of drugs to the patients
is streamlined.
The
committee also pointed out that in case of bonus offer the benefit should go
the consumer not the retailer. For example, if there is a bonus offer of 1+1
then trade margin should be halved.
The
market system also pushed practices of cuts and commissions for referrals and
freebies to the medical professionals by the pharmaceutical companies. This
corrupted even the doctor. The time has come now to think whether health
services are to be treated as business or they have to be retained as a
professional service and restore its glory and nobility. (IPA Service)
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