public Hospitals
in India

Dr.
Shriniwas
Kashalikar


Since the public services and especially public health services, affect most of us, it is essential to find out the root causes of their deficiency and try to deal with them. This is one of the intellectual measures of stress management and benefits every individual concerned.

The causes of degeneration of quality of public health services in public hospitals in India; is the prevalence of the two concepts on which these institutions work. These concepts are, free medical care and economic dependence of these institutions on the government revenue and donations.

FREE MEDICAL CARE
The free medical care gives rise to parasitism, beggarly tendency, meekness and irresponsibility towards personal and public health amongst the patients.

The free medical care creates a special and extremely favorable situation and golden opportunity for the powerful, rich and famous individuals to exploit the government revenue and tax payers’ money.

The free medical care leads to zero returns and subsequent deterioration in the facilities given to patients and employees.

The free medical care associated with perpetual absence of returns leads to unjustifiably low salaries, delay in filling the vacancies, excessive working hours and duties, and delay in promotions.

This state of affairs demoralizes the sincere and dedicated employees and promotes irresponsibility, lethargy, absenteeism, corruption etc.


ECONOMIC DEPENDENCE OF THESE INSTITUTIONS ON THE GOVERNMENT REVENUE AND DONATIONS
The public hospitals are not self-sufficient and do not have any productive/commercial projects to support them. Naturally since there are no returns either from patients or from any other source, for what is spent, the public hospitals are always in loss.

This has lead to inadequate progress in terms of inadequate facilities, inadequate salaries, inadequate employment in terms of number of employees in almost every category, protracted duty hours, worsening working conditions, worsening of staying conditions for the employees and crowding of patients due to huge patients/employee ratio.

All these factors have lead to deterioration of the quality of medical care. In fact because of this a large number of lower middle class and even poor patients turn to private practitioners, consultants and hospitals.

This deterioration can be overcome by trying to make the public hospitals self-sufficient. For this, the concept of free medical care has to be replaced by more just system of payment. This would bring adequate revenue to ensure progress in terms of adequate facilities, adequate salaries, appropriate employment which could ensure normal duty hours, improvement in working conditions, improvement in staying conditions for the employees and preventing excessive and many times [because the services are free] unnecessary crowding of patients.

One may raise the objection that this is difficult to implement in case of very poor, helpless, unsupported patients.

It is very true that no sensitive and sensible individual would think of doing it as well. These patients who are in agonies, in emergencies, or helpless etc. should be made exception and a separate arrangement can be made for them. But in most other cases the problem can be overcome by making provision for payment through “services” or soft loans.

Another way to make the public hospitals self-sufficient is by buttressing them with productive / commercial projects. One can think of more innovative plans as well.

This is important because:
A] it would inculcate a sense of responsibility towards one’s own health, towards public funds, towards public services, amongst everyone including the patients.
B] it would generate the sense of accountability, satisfaction and fulfillment amongst the employees
C] It would ensure optimal progress in medical care especially in terms of holistic approach
D] It would improve the lives of patients as well as employees
E] It would make the revenue hitherto squandered on free medical care available for other developmental work thereby facilitating national progress.
F] it would reduce the corruption born of out of injustice
G] it would reduce the crowding and degeneration of private medical care.

DR. SHRINIWAS KASHALIKAR