Tag Archives: healthcare india


24 May

I had mentioned in my last article that we have a strong case against consumer protection act being made applicable to the medical profession. This is that strong argument, and I believe it will work if properly put up. But before that, let me tell a past incidence.

Mr. Madhav Gadkari was the editor of Loksatta–a Marathi news-paper. He was very out-spoken -to a fault. Once he wrote an article stating that the High Court Judges are most negligent. One judge sleeps while the advocate is pleading, and wakes up only when he has finished. Another judge gives a favourable judgement when a particular female lawyer pleads because she is very beautiful. Yet another judge is partially deaf and uses hearing aids. But whenever he is bored, the said judge removes his hearing aid and dozes off. Obviously the judges have already made up their minds without hearing the opposite side. An article so brazenly accusing the high court judges was bound to invite “Contempt of Court” proceedings against Mr. Madhav Gadkari and the Loksatta newspaper. The High Court bench demanded an unconditional apology, but both of them refused to apologise. Instead, Mr. Gadkari asserted that he was telling the truth; he can prove his statements with concrete instances against each of the judges and therefore it is not a case of contempt of court but it is a right of the media to inform the public about the actual facts of high court proceedings. He pleaded that he may be allowed to bring his material and his witnesses to prove his point.

Strangely, (or appropriately?) the high court bench refused to give him such an opportunity and gave a verdict against him. The supreme court, on appeal, upheld high court judgement and Mr. Gadkari was punished with a token fine. The judgment, in effect, said that the citizens of the country have strong faith in the judiciary and its impartiality. This faith of the citizens is the strongest pillar on which the entire judicial system is based and accepted by the people. If this faith is eroded, the people coming to the court for justice will start doubting each and every judgement and the whole judicial system will collapse. Even if it is presumed that a few judges are defaulters as mentioned by the article concerned and even if Mr. Gadkari had sufficient proofs to prove, it is extremely unsafe to allow these facts to be brought to light as the whole judicial system will collapse as mentioned earlier. TRUTH CANNOT BE ENOUGH WHEN THE FATE OF THE WHOLE (JUDICIAL) SYSTEM IS AT STAKE.

The same argument can be applied with equal force to the health service provided by qualified doctors. In most ordinary illnesses, it is FAITH THAT HEALS. The prescriptions of the doctor help but they are not the actual healers in most instances. Even in major illnesses, faith contributes a lot in healing and helps substantially more in allowing doctors to take decisions. Therefore, the whole system of clinical practice  will collapse, if the Faith of the people in Doctors is lost. And that is exactly what is happening after the Consumer Protection Act has been made applicable to the Medical Practitioners. The health- care system has collapsed and  therefore TRUTH CANNOT BE ENOUGH  TO PROSECUTE THE DOCTORS WHEN THE FATE OF THE (HEALTH-CARE) SYSTEM IS AT STAKE.

The consumer Protection Act was enacted to protect the consumers who purchased goods or services from being cheated by the shopkeepers. It was then claimed that the act was not applicable to medical services as there was no contract  nor any promise of result. The argument was first rejected by the Kerala High Court; the Honourable judge insisted that it is a contract between the doctor and the patient. But we can insist that it is a contract essentially based ON FAITH. In most illnesses, it is the  faith that heals. If faith is excluded, and it becomes a mere contract, the clinician has to work fool-proof. He cannot take the slightest risk. If a patient comes for chronic headache, he has to advise a C.T. Scan and a fundoscopy before declaring that it is due to psychological reasons -which he knew anyway in the first place only.  A cardiac condition has to be ruled out by E,C.G.,2D Echo, and angiography, for a patient with pricking pain in the chest, before he is relieved by Antacids. Clinical judgement, based on general circumstances and other symptoms could be fallacious. The doctor would not take any risk, even if the patient was poor. “Let him refuse” will be his response.

Thus, the C.P.A. is contributing to the collapse of the health-care system, even if it may not be solely responsible for it. Nor is it  helping the real sufferers. There is no punishment for the doctor. He has to only pay compensation which he now collects from all his patients through higher charges to pay for his indemnity insurance. Actually, C.P.A. can only be compared to the “Blood Money” law in Pakistan wherein a murderer is let free by paying the victim’s family a defined amount of money.

The medical science and its application in clinical practice has progressed a great deal through “trial and error”. What was considered “The Latest in Management” has often been discarded as junk a decade later. Noradrenaline was considered a miracle drug a generation ago but is now considered a very dangerous drug. This progress is achieved through relentless discussions and critical analysis of the treatment protocols/drugs continuously through years.  The critical specialists continuously find faults with the present practice in their clinical meetings in medical colleges and scientific conferences. The C.P.A. has put a virtual full-stop to such free and frank discussions even in the closed-door meetings. The news that “something went wrong, the treatment was faulty” would leak out in no time. There are press reporters amongst the very doctors attending the meeting! So, the meetings avoid being critical and conveniently push the blame on “lack of modern equipment, modern facilities or paucity of technical staff”. Thus instead of any efforts to improve the personal skills or improved understanding of the subject, the whole medical profession is prefering to fall into the hands of the manufacturers of high cost modern equipments. These manufacturers are already aggressive in their marketing, trying to impress that their new product will definitely reduce the errors. Time and again these claims have been proved wrong; but  the manufacturers come-out with a new product. The ultimate sufferer is the Patient who has to bear the additional costs, often without any additional benefits. C.P.A. has contributed a lot to this decaying  process by abolishing all resistance of the conscientious and socially oriented specialist doctors. If the act was made non-applicable to the medical profession, it is distinctly possible that the movement against abuse of high technology and costly treatments would revive as it is the need of the country. Even the rich developed countries like U.S.A. and U.K. are finding it difficult to meet the expenses of the health care and their leaders are desperate to find ways to reduce the costs.

Therefore looking at the disastrous effects on the doctor patient relationship, some alternative method of compensation needs to be evolved. It is also necessary that  grossly defaulting doctors be suitably punished.

The Finance Minister had recently announced a 5% tax on all hospital bills of air conditioned hospitals with more than 25 beds. This would have gone to the coffers of the central government. Instead, the medical profession could agree to a 5% tax to be collected from each and every hospital/nursing home/diagnostic centre but this would form a Reserve Fund for compensating the aggrieved patients. The same medical centre could be allowed to use upto 50% of the amount it has deposited while the remaining 50% could go to the common pool. In this system, there is no discussion or dispute about the guilt or otherwise of the doctor or the hospital. Only those patients in whom the complications or death was mostly unexpected would be compensated. It would also be possible to compensate families where the earning member on whom the family was mostly dependent, gets crippled or dies due to an acute illness-even if there was no accusation about his/her treatment. If CPA was made non-applicable to health-care services, such a scheme would be widely accepted  by  the society and it  will not disrupt the faith of the society in  doctors. This idea was proposed by Dr. R.D. Lele but was not considered seriously by the fraternity.

In addition, the medical fraternity could offer certain noble concessions to the affected family, if and when unexpected complications occur. It can be stipulated that the family will have to bear the additional expenses upto Rs. one lakh or two and half times the original estimate whichever is higher but after that the doctor/s would charge  a nominal fee or nothing  for his visits, and the hospital will also collect minimum [cost]charges for all services, investigations, and medicines etc. Such a step, taken by the association and publicly announced, as Professional Ethics, will go a long way to soften the public opinion.

But it would be unfair not to keep the doctors answerable for their conduct. As shown earlier, the C.P.A. has hardly achieved this objective. It would be better if the Govt. evolves a regulatory authority and the fraternity accepts it. The concerned authority will not question the decisions of doctors but certainly will examine whether the protocols were properly followed or not. The government has already passed “Clinical Establishment Act 2010” and accreditation is already on the cards. All the establishments can now be accredited as 1) Convalescent home 2) Day Care Centre 3) Nursing Home 4) Mini Hospital 5) Hospital and 6) Five Starred Hi-Tech Hospital. [This is just an arbitrary classification to emphasise the categorisation of the establishment that will define vaguely the types of cases the centre can take up, depending on the facilities and the staff therein.] Similarly, display of charges for various services, including the fees of the specialists, was made mandatory by MCI but was not being followed. This rule can be strictly implemented. The medical council is already making it compulsory for the doctors to attend refresher courses before re-registering them. Good clinical and hospital records should be made mandatory which must include good clinical notes, the final diagnosis with staging and the time of the visit of the specialist and his findings and management advice. Committees could be appointed in each district and each metropolitan city to look into the complaints and take appropriate action. The rationale of the specialist’ advice cannot be questioned, as each specialist is an “Expert” even in legal terms. Therefore he is entitled to take his own decisions.

These regulatory mechanisms, if strictly implemented, will regulate the conduct of the doctor and the hospital far better than at present. The interests of the patient will be sufficiently safe guarded. It is in the interest of every one that the C.P.A. should be made non-applicable to the medical profession because it is a contract with faith as its main ingredient and because the whole health care system is collapsing under the weight of C.P.A. If these facts are repeatedly highlighted through the media and the medical conferences and if a P. I. L. is lodged in the high court, I feel confident that the courts will reverse their present decision.

About the Author:

Dr. S.V. Nadkarni

Ex. Dean L.T.M. Med. College,
Sion, Mumbai,
Email: sadanadkarni@gmail.com,
Tel: 09320044525 / 022-24468633,
Website: www.healthandsociety.in
Suraj Eleganza II, Mahim (W)-400016


Physician Practice in India’s Emerging Healthcare Environment

29 Oct

Date: 29th October 2010

Author: Louis Pavia

About: President, CareCompanion Inc.
CareCompanion is an international research and management consulting organization. Our strategy is to work closely with the leadership of healthcare organizations to develop innovative approaches to capitalize on opportunities and solve problems and be a catalyst to accelerate your success.

There are tremendous opportunities for physicians as healthcare in India continues to evolve, but there are also risks

Healthcare is changing rapidly, creating both new opportunities and threats for physicians. The population is becoming more health conscious and better informed about the benefits and value of primary and preventive and well as specialised care. As the middle class expands, health becomes a higher priority and health-related spending increases. Lifestyle-related diseases are also becoming more prevalent than traditional infectious diseases. While there is a shortage of trained healthcare professionals, physicians are already concentrated in urban areas and are not well organised or differentiated from the myriad of less qualified providers. Patients are becoming better informed and more sophisticated consumers of healthcare, but they do not know where to turn for high quality care.

Over one million additional hospital beds will be required by 2012 just to attain a ratio of 1.85 beds per thousand people (comparable countries like China, Thailand, and Korea have a ratio of over 4 per 1,000). In response, hospitals are becoming larger and more corporate. Corporate hospital companies are also developing narrowly focused specialty hospitals, competing with traditional physician owned nursing homes.

The Clinical Establishments Bill will give further impetus to the institutionalisation of standards and clinical protocols. Emerging clinical management, patient billing and reporting requirements are driving the need for administrative infrastructure in the physician practice. Medical technology is an increasingly important part of the diagnostic process and is moving out of the hospital and clinic to stand alone and retail centers. Apollo has created over 60 franchised physician clinics offering facilities for specialist consultation, diagnostics (e.g. lab, imaging, radiology, and nuclear medicine), preventive health checks, telemedicine and 24-hour pharmacy, all under one roof.

Health insurance is reaching a critical mass already covering 10 per cent of healthcare expenditures and growing at more than 20 per cent per year. This is increasing awareness about the importance of healthcare and providing a vehicle to help finance these services. Corporations are recognising the importance of healthcare for their employees and offering programmes for them. The Government strategy is shifting from providing care to offering insurance. State and local Governments are instituting a variety of schemes to improve access to healthcare for the lower income population. Rashtriya Swasthya Bima Yojana (RSBY) is expected to cover 60 million BPL families by 2020 and other jurisdictions are copying and improving on this concept.

We are beginning to see the inevitable next steps in the evolution of healthcare and insurance in India. With claims exceeding revenues, insurers are beginning to negotiate or dictate payment rates for services by hospitals and physicians, analyse healthcare costs, expand coverage to lower cost non-hospital settings, promote preventive care and early detection and institute administrative requirements in order for providers to collect reimbursement. Governments and independent third parties are collecting information on quality and cost. Large corporate hospitals are positioned to effectively balance the inevitable power of the insurance companies and meet the growing administrative requirements, but independent physicians are at high risk of losing access to patients and their ability to set prices.

One strategy to strengthen and grow the private medical practice is to create an ‘Organised Physician Association’ (OPA) that balances the flexibility and control of an independent practice with the leverage and efficiency of an organised group. This strategy has proven successful in the US as the insurance market evolved through a similar phase. These organisations should be owned and governed by physicians and have professional management to capitalise on opportunities, respond to market requirements and remove barriers to success. This enables independent physicians to build the critical mass necessary to compete effectively for patients and protect their income from erosion by larger and better organised hospitals and insurance companies without losing control of their individual practices.

OPAs are owned and governed by physicians, have a sustainable business model and provide services and support to the owners and participating physicians to strengthen and expand their medical practices. They are likely to include a cross section of well trained and qualified primary and specialty care physicians in close geographic proximity interested in expanding and improving their practices. The power of the group would be used to gain the economies and efficiencies necessary to attract and treat more patients and improving the health of the patients and increasing the income of the physicians.

Physicians that recognise and understand the coming changes in healthcare and insurance and position themselves to capitalise on these changes will not only survive in this new environment, but will thrive. Change is scary and difficult but the status quo is doomed to decline. Effective change must not only address the changes in the market but also consider the objectives and requirements of the physician. Requirements for success of an OPA include:

  • Vision: An understanding of both how the market is changing and where you need to be positioned in the near future to be successful in that environment.
  • Balance: Equilibrium between physician autonomy and organisational effectiveness.
  • Leadership: Physicians willing to help shape the vision, passionate about achieving it, effective at communicating it to other physicians and able to motivate others to participate.
  • Market Sensitivity. Research-based definition of customer expectations and requirements and competitive conditions.
  • Differentiation: Set apart from competitors in terms of clinical quality, service, convenience and efficiency.
  • Strategy: A well-defined plan of action to achieve the vision based on an evaluation of options.
  • Measurement: Clear and measurable objectives that are monitored and reported regularly to leadership.
  • Continuous Improvement: Regular adjustments to strategy and enhancement to differentiation.

This process for creating the organisation would include the following steps:

  1. Identify core group of physicians interested in the OPA concept.
  2. Define the vision and purpose for the organisation.
  3. Delineate potential features and characteristics of the business through a series of expert lead, information based brainstorming sessions.
  4. Delineate the business model and value proposition. lInvite additional primary and specialty physicians to join.
  5. Devise a strategy and detailed business plan.
  6. Structure the organisation.
  7. Implement the plan.

There are tremendous opportunities for physicians as healthcare in India continues to evolve, but there are also risks. Those physicians that capitalise on the lessons from other markets and adapt them to the unique environment in India will not only advance their own practice, but also the quality of care in their community. Solo and small groups of physicians will be at a significant disadvantage in access to space and patients as larger and better organised groups improve efficiencies in business and medical practices. Organised physician groups enable physicians to maintain the autonomy of their own practice while capitalising on the advantages of a large group.

Those Doctors interested in the OPA concept can take a survey here:

Louis Pavia with his associate Dr. Ajit Dhavle, are looking for interested Doctors to for the first such OPA in India.

Using The Internet to create Informed Patients

26 Oct

Date: 25th October 2010

Author: Nrip Nihalani

About: CEO, Plus91 Technologies (www.plus91.in)
“Using The Internet to create Informed Patients” by Nrip Nihalani at the Putting Patients First Conference in Mumbai, India on 20th October 2010

Putting Patients First Conference – 20th Oct, Mumbai

16 Oct


9.30AM – 1.30PM

In order to improve healthcare, we must be sick and tired of being sick and tired.

Engaging patients is not easy; yet, it is fundamental to achieving better outcomes in consumers’ healthcare.

Patients and doctors need to trust and respect each other. The better the doctor-patient relationship, the better will be the amount and quality of information about the patient’s disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient’s knowledge about the disease.

Doctors need to work in partnership with patients by providing Information Therapy – which is something we seek to incorporate in the process of delivering the best medical care to patients.

A well- informed patient is a satisfied patient.

The conference is open to everyone. Participation is free. We would like to listen to your inputs.

The conference will be broadcast on the Web, to ensure higher visibility !

Conference Partners:

help logoplus91 logoPEAS logo

HERO – Helpline for Emergency Response Operations

8 Oct

Date: 08th October 2010

Nobody expects a health emergency. A heart attack, an accident, an infection that turns deadly.


In a crisis, as those precious seconds slip away, knowing where the nearest vacant ICU bed is or how many blood bottles of the required type the nearest blood banks have can mean the difference between life and death.

However no service that provides such crucial real time information exists  in India – information that would be invaluable during natural disasters, terrorist attacks and public health epidemics.


Mumbai needs a centralized automated network geared to provide real-time, updated information regarding the availability of  ICU beds and blood bottles of the required type in the ICUs and blood banks  of the city;

24 hours a day, 7 days a week through phone, sms and a website.

Mumbai needs a HERO—Helpline for Emergency Response Operations.


For the people who have lost loved ones trying to find a hospital bed, or enough blood to live, and for those facing emergencies every day…We want you to be a HERO.

NGO ARMMAN along with our partners SNEHA, Municipal Corporation of Mumbai, technology partners Inscripts Ltd and Plus91 Technologies (our hospital counter software provider) will conduct a eight month pilot of project HERO in Sion Hospital starting in January 2011 and on successful implementation of the same will spread to all the ICUs and blood banks of the city.


But to get this ambitious pilot project off the ground, we need your support.

Every 10 dollars (Rs 500) you donate will help 4 patients requiring an ICU admission or 12 patients requiring blood in an emergency.

Reach Out. Make a Difference. Be a HERO.

To learn more and find out how you can help, please visit us at http://beahero.armman.org.

To donate, please visit: http://beahero.armman.org/donate.

Every rupee (dollar) counts!!!

To learn more about ARMMAN, please visit www.armman.org.

Help us help our city!!!!


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