The Hindu Business Line : Healthcare in India — Caught between a rock and a hard place

MR DESHPANDE was in the Military Engineering Service for over two decades before he opted for VRS last year to start a business. A communication centre near the Bandra Kurla Centre ran well for a year, but was washed out in the July floods.

They say bad news rarely comes in isolation. He was diagnosed with cancer of the colon a few weeks ago. He took the news of his illness with a stoic calm. This helped his family as they could now concentrate on the treatment. The family had an advantage — Mrs Deshpande was a senior nurse at a government hospital and, as per service rules, her husband could get subsidised treatment at another government Hospital. After two days of standing in long queues, they decided the trouble was not worth it, after all.

"First I had to wait in a line to get the admission form/case paper. Then it was another long wait to see the doctor. I was then asked do a series of investigations, for each of which I had to wait in a line, just to make the payment.

"All this just set me up for yet another appointment with the doctor — which would happen only the next day. The fortitude I had built up to face the deadly disease dissipated by end of that one day," said Mr Deshpande. The Deshpandes were forced to take a decision that they previously had not considered. They decided to go for a costlier but `easier on the patient' private facility. The fortnightly chemotherapy treatment that is likely to last months has begun. They know it is going to be a costly process that will erode their savings. .

The compromise the Deshpandes made has come by way of a decision to put off their daughter's marriage by a couple of years.

While this instance is a reflection of the ills of the public healthcare system in the country, it is not as if everything is hunky dory in the private hospitals.

If it is slow treatment that is dogging public healthcare, it is `over-treatment' that is the bane of some of the leading hospitals in the city, according Dr K. Sanjay, a consulting orthopaedic surgeon.

"Everyone knows that private sector healthcare is a big business. Like in retailing or consumer durables, it all boils down to how you are able to market your wares.

"The onus is on doctors to convince the patients to go in for, say, a joint replacement or a spine surgery. The patient may be able to get on a while longer without it, but the question is whether he can afford it. Once it is clarified that the patient has sufficient medical cover or other means of making payment, it is time to talk business," says Dr Sanjay.

According to him, if a doctor who works in a `five star' or `seven star' hospital is to hold on to his star billing, he needs to bring in surgeries on a regular basis.

And this becomes possible, says the doctor candidly, only by way of frantic networking at the grassroots level.

"The smart surgeon nowadays has his web cast far and wide. He connects at many levels in his search for potential clients but none are as effective as that with the friendly neighbourhood family physician.

Just as in any other business deals, here too, some gratis is paid to those who throw business your way," Dr Sanjay explains.

Thus, the Deshpandes anguished over the slow treatment, and were quick to switch to the private hospitals. But it may be time for many of us who insist on speedy treatment to make sure we actually don't over-treat ourselves.

Positioned somewhere between these two extremes — the snail-paced public healthcare system and the rat race that characterises at least some of the private hospitals — is the kind of healthcare the country could do with.

These are the days of public-private joint initiatives in many sectors and perhaps such a venture in healthcare could deliver the goods.

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