Monday, September 21, 2009

Welfare State on the Death Bed

Today, for I had the "fortune" of visiting the largest and supposedly the best government hospital in Kolkata. I had gone there with my wife to visit one of lab assistant's who works in her college. While she went to meet and enquire about the condition of this person, I was walking about on the ground floor emergency ward. What I saw shocked me. This was the first time that I actually have been to a government hospital and the condition was simply deplorable. It was dirty, with paan stains all over the place, overcrowded with people, with patients lying on stretchers on the floor, and with a disgusting and nauseating smell emanating from every corner. If this is the condition of the "best" hospital then I shudder to think what is the state of the other more ignominious ones!

This got me thinking about the concept of a welfare state - a haloed concept popularized in India by the founding fathers of our country. The problem I, and a lot of pragmatists like me, have with it is that the welfare state is not able to fund itself. The government cannot run any institution of quality unless in the long term its economically viable. If it tries to do it, like in India, the quality suffers drastically. That is pretty evident in every sector where government institutions are a monopoly. Be it hospitals or schools or transportation or industry. The pathetic state of affairs in each of the areas mentioned are a testament to the fact that a public body is not the best mechanism of service delivery.

So, what are the solutions to improve government hospitals in India and turn them into centers of excellence? To answer that question, we need to first ask what are the problems that plague these institutions. They key problems are:
1. Doctor/Nurse to patient ratio (overcrowding)
2. Lack of physical infrastructure (number of beds)
3. Very little modern medical equipment
4. Revenue to cost ratio on a standalone hospital basis

The solutions are also possible, but needs political will to push through. Solutions could be:
1. Increase medical and paramedical colleges to increase the availability of doctors, nurses, paramedical staff
2. Pay market rates to doctors for working in government hospitals
3. Tie-up with large generic pharmaceutical companies to supply drugs at a bulk rate. Ensure that drugs are always available or can be procured quickly in times of need.
4. Most government hospitals are spread out on large tracts of land. Vertically increase the capacity on the same land. That is, make multi-storied hospitals in the land where the current one/two storied buildings are.
5. Get better equipment and train staff to use them effectively.
6. Tie-up with medical insurance companies to educate people about the need for medical covers. Sell medical insurance covers to people. This will increase the reach of the insurance companies and also a lot of poor/ middle class people will be able to afford them if they are educated adequately.
7. And finally, charge people reasonable rates to cover costs.

The last point is the most crucial. Unless, costs can be recovered adequately, everything else will fail. I strongly believe if people are educated about the benefits of medical insurance, a lot more of them would opt for it and then they would be in a position to pay for the medical treatments.

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