Changing politics of Uttar Pradesh or just a groundhog day

Now when dust has settled on the election results, I would like to present certain observation from the heartland of Indian politics. This election has been different for certain reasons, some positive and some negative. Lets see how?

Positive Trends:

1. Higher voter turnout: This election saw a turnout of around 60%, which is higher than earlier election. This can be attributed to the anti-incumbency wave against Mayawati, to pro-democracy campaign of Anna Hazare, to certain measures taken by election commission. EC has allowed political parties to carry voters from their home to polling booth in private vehicles. This helped the voting percentage a lot.

2. Developmental agenda: However tickets and other political calculations are still based on caste and religion but a welcome trend is that every party now recognizes that development is a main issue and nobody can neglect it.

3. Young CM: Everybody is excited about the prospects of Akhilesh Yadav transforming UP like Nitish did in Bihar. But in my opinion it is going to be a very tough road ahead for Akhilesh, even if he means what he is saying now. If he doesn’t mean it, then we all know how next five years are going to be like.

4. Violence free election: Kudos to EC on well-managed and violence free election.

Negative Trends:

1. Declining role of national parties: BJP and INC are becoming more and more marginalized in UP and politics of UP is heading in same direction as Tamilnadu, where two regional parties have national parties as their fringe supporters.

2. Short term memory loss of public: Public of UP seemed to forget the tragedies of last SP government. It is better not to say much on decision of janta-janardan.

3. Muslim reservation: However backward muslims groups are already been given reservation under OBC list, political parties are trying to make it an issue out of no-where. Issue would be remembered as the child of this closely fought election. Once the Jinn is out of the bottle, it is hard to contain it.

4. Rise of peace party: seemingly unnoticed event of rise in stature of peace party can be a dangerous trend for future. A party based solely on religious line can’t be good for future.

So all in all, this election has thrown up some solutions and some new problems. Only future will decide whether UP regains its lost honor or we are looking at a new Bihar of India.

Health Care in India

Health Care in India

Health care facilities and personnel increased substantially between the early 1950s and early 1980s, but because of fast population growth, the number of licensed medical practitioners per 10,000 individuals had fallen by die late 1980s to three per 10,000 from the 1981 level of four per 10,000. In 1991 there were approximately ten hospital beds per 10,000 individuals.

Primary health centres are the cornerstones of the rural health care system. By 1991, India had about 22,400 primary health centres, 11,200 hospitals, and 27,400 dispensaries. These facilities are part of a tiered health care system that funnels more difficult cases into urban hospitals while attempting to provide routine medical care to the vast majority in the countryside. Primary health centres and sub-centres rely on trained paramedics to meet most of their needs.

The main problems affecting the success primary health centres are the predominance of clinical and curative concerns over the intended emphasis on preventive work and the reluctance of staff to work in rural areas. In addition, die integration of health services with family planning programmes often causes the local population to perceive the primary health centres as hostile to their traditional preference for large families. Therefore, primary health centres often play an adversarial role in local efforts to implement national health policies.

According to data provided in 1989 by the Ministry of Health and Family Welfare, the total number of civilian hospitals for all states and union territories combined was 10,157. In 1991 there was a total of 811,000 hospital and health care facilities beds. The geographical distribution of hospitals varied according to local socio-economic conditions. In India’s most populous state, Uttar Pradesh, with a 1991 population of more than 139 million, there were 735 hospitals as of 1990. In Kerala, with a 1991 population of 29 million occupying an area only one-seventh the size of Uttar Pradesh, there were 2,053 hospitals. In light of the central government’s goal of health care for all by 2000, the uneven distribution of hospitals needs to be re-examined. Private studies of India’s total number of hospitals in the early 1990s were more conservative than official Indian data, estimating that in 1992 there were ^300 hospitals. Of this total, nearly 4,000 were owned ^a‘¹⁽d managed by central, state, or local governments. Another 2,000, owned and managed by charitable trusts, received

partial support from the government, and the remaining 1,300 hospitals, many of which were relatively small facilities were owned and managed by the private sector. The use of state-of-the-art medical equipment, often imported from Western countries, was primarily limited to urban centres in the early 1990s. A network of regional cancer diagnostic and treatment facilities was being established in the early 1990s in major hospitals that were part of government medical colleges. By 1992 twenty-two such centres were in operation.

Most of the 1,300 private hospitals lacked sophisticated medical facilities, although, in 1992, approximately 12 per cent possessed state-of-the-art equipment for diagnosis and treatment of all major diseases, including cancer. The fast pace of development of the private medical sector and the burgeoning middle class in the 1990s have led to the emergence of the new concept in India of establishing hospitals and health care facilities on a for-profit basis.

By the late 1980s, there were approximately 128 medical colleges—roughly three times more than in 1950. These medical colleges in 1987 accepted a combined annual class of 14,166 students. Data for 1987 show that there were 320,000 registered medical practitioners and 219,300 registered nurses. Various studies have shown that in both urban and rural areas people preferred to pay and seek the more sophisticated services provided by private physicians rather than use free treatment at public health centres. Indigenous or traditional medical practitioners continue to practice throughout the country.

The two main forms of traditional medicine practiced are the ayurvedic (meaning science of life) system, which deals with causes, symptoms, diagnoses, and treatment based on all aspects of well- being (mental, physical, and spiritual), and the unani (so- called Galenic medicine) herbal medical practice. A vaidya is a practitioner of the ayurvedic tradition, and a hakim (Arabic for a Muslim physician) is a practitioner of the unani tradition. These professions are frequently hereditary. A variety of institutions offer training in indigenous medical practice. Only in the late 1970s did official health policy refer to any form of integration between Western-oriented medical personnel and indigenous medical practitioners. In the early 1990s, there were ninety-eight ayurvedic colleges and seventeen unani colleges operating in both the governmental and non-governmental sectors.

The Indian constitution charges the states with ‘the raising of the level of nutrition and the standard of living of its People and the improvement of public health’. However, many critics of India’s National Health Policy, endorsed by Parliament in 1983, point out that the policy lacks specific measures to achieve broad stated goals. Particular Problems include the failure to integrate health services With wider economic and social development, the lack of Nutritional support and sanitation, and the poor participatory involvement at the local level.

Central government efforts at influencing public health have focused on the five-year plans, on coordinated planning with the states, and on sponsoring major health programmes. Government expenditures are jointly shared by the central and state governments. Goals and strategies are set through central-state government consultations of the Central Council of Health and Family Welfare. Central government efforts are administered by the Ministry of Health and Family Welfare, which provides both administrative and technical services and manages medical education. States provide public services and health education.

The 1983 National Health Policy is committed to providing health services to all by 2000. In 1983, health care expenditures varied greatly among the states and union territories, from Rs.13 per capita in Bihar to Rs.60 per capita in Himachal Pradesh, and Indian per capita expenditure was low when compared with other Asian countries outside of South Asia. Although government health care spending progressively grew throughout the 1980s, such spending as a percentage of the gross national product remained fairly constant. In the meantime, health care spending as a share of total government spending decreased. During the same period, private sector spending on health care was about 1.5 times as much as government spending.

In the mid-1990s, spending on health amounts to 6 per cent of GDP, one of the highest levels among developing nations. The established per capita spending is around Rs.320 per year with the major input from private households (75 per cent). State governments contribute 15.2 per cent, the central government 5.2 per cent, third- party insurance and employers 3.3 per cent, and municipal government and foreign donors about 1.3, according to a 1995 World Bank study. Of these proportions, 58.7 per cent goes toward primary health care (curative, preventive, and promotive) and 38.8 per cent is spent on secondary and tertiary inpatient care. The rest goes for non-service costs.

Medical Tourism In India

'No force on Earth can stop an Idea whose time has come' -- Victor Hugo

Insurance companies in USA & the NHS in UK do not underwrite health-care expenses incurred overseas – unless an already-insured person needs emergency-care while traveling abroad. But Medical Tourism Companies like  Panacea Overseas began to come up when finally, in 2006, an Insurance & Finance company called Union Group Programs in Boca Raton, Florida, USA, convinced 40 of their Corporate Clients to opt to send their employees overseas for surgical procedures (Newsweek International, 30^th Oct 2006). They broke the taboo! The fundamental reason to do so:save up to 80-90% of what it would cost in USA.

Medical Tourism is something everyone knows about but very few understand. Medical Tourism is an established industry in other countries like Thailand, Malaysia & Singapore. Even Brazil, Turkey, Israel &Lithuania are competing. The Government of India & the Ministry of Health & Confederation of Indian Industries began to promote it actively. External Affairs Ministry set up the provision of issuing Medical Visas on priority to Westerners seeking health-care in India. According to the study conducted by the Confederation of Indian Industry and McKinsey consultants, in 2005 some 150,000 foreigners visited Indiafor treatment. And it is growing fast. Like any growing industry, it’s all about Demand, Supply & Quality-Assurance.

   

Demand exists because :--

1.       In USA ,

·         Rising Health-Care Costs & commensurately rising Health-Insurance Premiums are critical today.

·         16% of America’s GDP is spent on Health-Care, in 5 years it might be 20%.

·         Millions of workers in the 18-33 years age-group do not enroll for Health-Insurance.

·         46 million Americans have no Health-Insurance at all.

·         Another 30-to-40-million Americans have Inadequate-Health-Insurance.

·         Industry & Businesses are suffering the burden of Employees’ Health-Insurance.

·         50% of Domestic bankruptcies & major Corporate Failures like Airlines & Steel industry are grim evidence of    the severity & magnitude of the problem.

2.       In UK & Canada , though the government delivers free-health-care, the Waiting Lists for important surgical procedures  are so long that people are compelled to suffer. Immediate surgery in Private hospitals being exorbitantly expensive, they have no choice but to seek treatment overseas.

3.       In Africa , medical technology has not yet reached & infrastructure not yet developed – so even money cant buy it   there – and so they flock to other countries.

Supply is assured because :-

4.       India offers the cheapest rates for all surgical procedures be they Cardiac, Spinal, Cosmetic, Orthopedic, Dental or  Transplant Surgery as compared to Thailand, Malaysia &Singapore.                                                                               

5.       The latest technological equipment is available in Delhi - be it a Flat-Panel Detector Cardiac CathLab system,   combined Gamma Camera/CT systems, a Brain-Suite with Intra-Operative MRI, a 3-Tesla MRI-scanner or even a   64-slice CT-scanner.                                                                                                                                                                  

6.       Delhi has ApolloHospital, EscortsHospital (International fame; 15,000 open-heart surgeries annually with 0.8% mortality) & MaxHospital – which are already receiving patients from developed Western Countries. State-of-the-Art Hospitals like ArtemisHospital & MediCity in Gurgaon (25 Kms from IGIAirport) will be , plan to be JCI Accredited by 2008-2009.

7.       Most of the Surgeons in these hospitals are qualified & trained in the USA or UK and gained experience there too.

8.       Delhi has excellent airlines connectivity with direct International Flights from New York, Newark,Chicago, Toronto, London & Manchester available almost daily.

9.       Overseas patients from UK & Canada can Avoid Waiting Lists altogether. They can undergo any major surgical procedure the very next day after arrival in Delhi as long as the Pre-Anesthetic tests are acceptable.

Quality Assurance

10.   JCI is the International arm of Joint Council on Accreditation of Healthcare Organizations(JCAHO), the same organization that certifies quality of health-care services in every medical establishment in the USA. JCI Accreditation is the gold-standard for Quality in health-care. Until now, Five hospitals inIndia have acquired JCI Accreditation:

·         Apollo Hospital, Delhi ·         Apollo Hospital, Hyderabad ·         Apollo Hospital Chennai

·         Wockhardt Hospital Mumbai ·         Shroff Eye Hospital , Mumbai

11.   Escorts Heart Institute & MaxHospital in Delhi are not JCI Accredited but have ISO 9001-2000 ratings. Escorts Heart Institute conducts 15,000 open-heart surgery annually & has a global reputation due to an amazing post-operative mortality rates of 0.8%. Max Devki Devi Heart & Vascular Institute has just started 3 years ago, but in Cardaic surgery they are getting so many international patients. Max Institute of NueroSciences has the 3^rd Brain-Suite in the world, which is the ultimate in technological advancement for Brain-surgery.

12. All these hospitals look like 5-Star deluxe hotels & have services & facilities to match.

Three factors hinder the growth & usefulness of the Medical Tourism industry :--

1.     There is no reliable database of all those who need major surgical treatment urgently amongst the 46-million Americans who have No-Health-Insurance at all OR even the 30-to-40 million Americans who have Inadequate-Health-Insurance. It is very difficult to identify & locate them & yet they would benefit the most from Medical Tourism. It is a problem for Medical Tourism companies to specifically identify the unfortunate patients in UK or Canada whose sufferings are compounded by long unbearableWaiting-Lists.

2.     Health-Insurance companies in USA are reluctant to embrace the very concept of Medical Tourism. A probable reason might be that they fear that in case something goes wrong, it would be very difficult to bring malpractice suits against the Surgeons & Hospitals in foreign lands, but it stands to reason thatan individual who can’t even afford health-insurance, would rather seek life-saving & life-improving health-care first and worry about litigation later. Fortune-500 health-insurance companies are, in any case, far beyond the reach of the millions of Americans who actually suffer due to the rising costs of health-care & rising health-insurance premiums. But these insurance companies lead the way and most of the other smaller companies try to emulate their success stories. 

3.     Acquiring JCI Accreditation is an expensive venture considering it is valid for only 3 years. A JCI accreditation would cost a hospital approximately US$ 60,000 - US$100,000. Typically, the accreditation process lasts for about 2 years and involves two surveys by a team of consultants from JCI who also educate the hospital staff about various standards and their implementation. But that is absolutely fair considering the basic fact that Medical Tourism exists on the assurance of excellence in health-care.

 However, the industry continues to grow due to sheer necessity. Until & unless there is a change in mind-set and policies within Health-Insurance Companies, Medical Tourism will remain a disorganized industry. Inspired by the Union Group Programs initiative, they are writing to all the Health-Insurance companies in USA to develop a product such as:--

·         A health insurance plan that would be priced significantly less than present plans

·         A plan that covers Primary & Emergency Care within the USA, but

·         A plan in which clients agree to undergo Major Surgical procedures in Foreign Hospitals

Medical Tourism companies in India can manage the entire process of getting Overseas Health-Care fromexpediting Medical Visas, to receiving the patients at the Indian airports, escorting our clients at every step, networking with the Hospitals/Doctors until the admission-formalities are completed, arrangingSight-Seeing tours -- all as a package deal -- to even arranging follow-up care from the original Doctor who examined and made the diagnosis for individual patient.

Outsourcing Healthcare overseas in India is an Option for Westerners’ who seek highest Quality Healthcare at much Less Cost -- which would be an all-round solution for the patient who is suffering in quiet dignity. By using the services of Medical Tourism companies, Americans would experience a seamless & carefree world-class experience in health-care in a foreign country