Getting a fix on healthcare

The CEO of my home office developed a toothache while on a temporary visit to Bangalore. As the Chief Operating Officer of this two-member outfit, it fell on the hapless yours truly to scout for a safe place in an unfamiliar city to get the dental work done. The big daddies of dental healthcare, such as Apollo and Fortis were, of course, options. Then someone suggested the name of a hospital attached to a dental college in the city, that was well spoken of. So off we went.

The place was full, but the registration was quite fast and hassle-free. The ‘better-half’ was directed to the radiology department for a preliminary X-ray, followed by a 10-minute wait for the consultant to turn up. He diagnosed the problem as one that required root canal work, some dental filling and cleaning up of plaque; the whole process to be completed over two sittings. Though the consultant took charge, an equally efficient post-graduate intern took over the initial surgical procedure and the whole process was completed with minimal fuss. Together with the registration and other services, the bill was an astonishingly low Rs 120.

Worth the money

Now, a dental chair is not the most ideal of places to strike up a conversation with whoever is attending on you. But I have seen women, almost always, and some men, if the intern is pretty enough, manage snatches of it.

In the course of a a conversation with my wife, the intern casually slipped in the information that she had paid Rs 40 lakh as capitation fee for a seat at the college’s post-graduate programme in dentistry. It was expensive (costs have since gone up for a variety of reasons, not all of them to do with the rupee’s depreciation against the dollar), but the intern thought the money had been well spent. As she reasoned, the college had the reputation of turning out quality medical professionals who would command a premium in the market after graduation.

The college acquired this ability of charging a premium on those seeking admission because an internship gave students a deeper understanding of the finer points of dentistry than they would get even at the best government dental colleges.

Now, this is the interesting part. How does a college acquire this reputation? The standard of professionals employed as teaching staff and the pedagogy are no doubt important. Equally, the quality of students, ensured by a judicious trade-off between their ability to pay and possess a certain innate capability to absorb the knowledge imparted, is no less important.

Attracting patients

But none of these initial conditions in themselves can guarantee commercial success for the promoters of these institutions, unless hordes of patients throng the hospitals’ portals. While the dental condition for which my wife was treated was pretty run-of-the-mill stuff, this much can be safely said: The best guarantee of medical students getting an exposure to a diverse range of dental (or other aspects of health if we are talking of a general hospital) problems is in ensuring that the hospital attached to the college attracts a large number of patients.

This is not just a matter of cost. If that alone were the criterion, government hospitals would be the first place of choice even for the affluent. But we know that even the poor, if they had the means, wouldn’t be averse to paying for quality medical attention. So a combination of quality and modest fee structure thus completes a virtuous cycle of more patients thronging a medical facility, leading to better professional experience for their interns. A highly discounted cost for a set of X-rays and root canal treatment is a case of cross subsidy by the medical student to the hospital for the actual cost incurred for such treatment so that the intern gets professional experience in varied areas.

You may have the swankiest of buildings, the most expensive of laboratory equipment. But as a medical college aspiring to train students in the profession, it will go nowhere if it is not able to attract patients in vast numbers.

Rating output

The regulators have, thus, missed the trick by not emphasising adequately enough the final output of patients as the criterion for grant of recognition. In other words, the focus of regulation must shift away from the quality of medical education inputs (beds, testing facilities, buildings, and so on) to the market validation of patient output.

It is quite possible that unscrupulous elements among promoters of medical education might not be above rigging the patient turnout to continue to be eligible for recognition. But this is where the Government can come up with out-of-the-box thinking by co-opting voluntary social organisations to complement its own inspection infrastructure to ensure the output is measured under the most objective criteria.

State involvement

Moreover, the credit rating agencies which have acquired some experience in measuring and rating the quality of social services (education, real estate, and so on) offered by a service provider can be drafted in to rate these colleges for the quality of hospital infrastructure and their output. To ensure that the rating agencies are not swayed by commercial considerations, the fee for such services can be paid out of the resources of the State.

The State would have thus ensured that it plays a role in public health and medical education in society.

Critics of private participation in the social sector oppose the latter’s role in the mistaken belief that it marginalises the State’s role in vital areas of human capacity building. It is possible to identify objective criteria of output for permitting private players in a cooperative framework of partnership in other spheres of the social sector, such as secondary education and non-medical higher education.

Of course, in the changed scenario, there is no getting away from the fact that State participation, as has been traditionally understood, would become marginalised. In that sense, State vacates the space held by it hitherto in favour of private players.

But that should not worry the proponents of a greater public sector presence. The State will always occupy commanding heights in the economy of manufacture and vending of alcohol as some States have successfully demonstrated!

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