[Answered] “We need to shift focus from a hospital-oriented, techno-centric health care model to make healthcare services better.” Discuss.

In India, a hospital-oriented, techno-centric model of health care took early roots. Building urban hospitals through public investment enjoyed primacy over strengthening community-based, primary health care. There is broad consensus that health-care focus must shift from hospitals to communities in the coming years with focus on primary health care centres. This approach involves the active maintenance of health, so that the consequent need for urgent hospital admission are lessened. In this way wellbeing is improved and the need for in-patient capacity in hospitals is kept to a minimum.

Issue of inefficient hospital-oriented healthcare system:

1. A private sector with rampant, unregulated dual-practice system (doctors practising in both public and private sectors simultaneously) is flourishing. This allowed doctors to constitute a powerful group held together by coherent interests rising the cost of health services.
2. The core purpose of a hospital is to deliver specialist care, and it remains a logical home for specialists, so long as they deliver care differently. Specialist care is costly and unaffordable.
3. Hospitals are involved in corrupt practices like over-stays of patients, unnecessary diagnosis, driven by financial incentives.
4. Healthcare insurance schemes like Ayushman Bharat that harp on providing insurance to the poor largely for private hospitalisation, when the most expenses are incurred on basic medical care. Thus focus on basic medical care is needed,
5. The public hospitals today face many challenges like deficient infrastructure, deficient manpower, unmanageable patient load, bad quality of services, high out of pocket expenditure making health services inefficient and poor.
6. Hospitals are far off from many places especially in rural areas, where lack of roads, unavailability of hospitals, electricity etc. lead to deaths.

What should be done?

1. It is important to set up local collaborative arrangements with general practitioners to make expert care available to those patients need specialty support.
2. Healthcare should be accessible to patients and situated in their community. Thus focus on primary health care centre is needed.
3. Mid-level providing primary health care should be trained to provide medical healthcare to needy. Training through short-term courses, like those of a 2-3 year duration, can greatly help in providing primary health care to the rural population.
4. Practitioners of indigenous systems of medicine, like Ayurveda, should be trained in modern medicine practices.
5. The task of making the primary and secondary level health institutions functional ought to be the utmost priority, such that people can access effective healthcare for common and easily treatable conditions nearest to their homes.
6. Urgent steps need be taken to provide working and living conditions in the peripheral areas that will encourage doctors and other health personnel to be willing for rural service. Family hostels should be built in the nearby urban centres to house the families of doctors and other medical personnel, while they are posted in remote areas.
7. All the vacancies for medical and paramedical posts should be filled promptly and the administrative procedures should facilitate speedier permanent appointments. There is little evidence to show that provision of ad hoc/contract appointments has led to a sustained availability of health personnel in rural areas.
8.  The capacity of peripheral health services should be expanded to absorb the large number of health workers as full time workers in the health services system. Private practice for any category of workers should not be allowed.
9. There should be regular programs organized wherein the senior doctors from the secondary or tertiary level health facilities and medical colleges should mandatorily go to the rural areas to help the peripheral health workers improve their knowledge and skills.
10. The local communities, peoples organizations, and representative bodies should be involved in the planning, organization, operation and control of primary healthcare, making fullest use of local, national and other available resources in the true spirit of the “primary health care”.

Many countries, including the U.K. and Japan, have found a way around by incentivising general practitioners (GPs), designing a system that strongly favours primary health care. India should focus on primary healthcare service to make health affordable and accessible.