In 1924, the Madras presidency of British-India rolled out the Subsidised Rural Medical Relief Scheme (SRMRS), which was about providing temporary annual subsidies to doctors choosing to settle down and practise privately in villages specified by local boards.
The scheme was then reckoned to be an economical way of expanding health-care access in rural areas. The economic depression of the 1930s brought this scheme to a complete standstill, and an initiative named Honorary Medical Scheme (HMS) received impetus.
The web of private sector –
- As early as in 1938, only 23% of doctors were in the public sector with the rest working in the private sector, predominantly in single practices.
- Post-Independence, perpetual sub-optimal investments in public health allowed the private sector to capitalise, flourish, and increasingly gain the confidence of the masses.
- The private sector went from having about 1,400 enterprises in 1950 to more than 10 lakh in 2010-11.
- The dominance of the market, bespoken by the simple fact that the private sector has over 70% of the health-care workforce and 80% of allopathic doctors.
- Due to such privatisation, the larger chunk of Indian health care (and health workforce) could not be brought under a “national system” having some form of overarching state control or involvement to pursue the goal of healthcare for all.
- Over time, a culture of exploitation and profiteering gets cemented, and the system gets locked in a trajectory that becomes difficult to alter. It is little wonder that in such systems, doctors require hefty incentives to stay motivated.
- The medical profession attracts more of those with an ambition to earn riches than ones with an aptitude for medical service, thus leading to a generation of doctors who become the apologists of a profiteering system.
The ethical way –
- A system founded on the concept of equity (which, while remunerating doctors well, is able to separate incomes from patient care decisions by and large) cultivates a totally different culture of patient care.
- Doctors manufactured under its aegis cherish a spirit of service and hanker less for extravagant incentives.
- Things such as professional satisfaction and success come to be measured by a different yardstick, and there exists a different kind of motivation towards work, which is then bequeathed to the forthcoming generation.
Source – The Hindu
QUESTION – Public health has been increasingly concentrated in private hands. Discuss the ethical dilemmas that plague the public health services and suggest a way forward.