About three months ago, I was asked to talk about the biography of the founder-chairman of the group of hospitals I work in. This was a day before its official release. The biographer was a noted columnist of Newsweek and some important western dailies. I believe, one of the reasons of my being there was, that the chairman having related his story in so many interviews and queries, himself wanted to know how he had been caricatured, and how an ‘odd one out’ like me would interpret it. He is a man, as some of us call him, of multiple and tremendous instincts!
As I heard myself speak, before the hospital faculty, the chairman and the celebrated biographer beside me on the dais, on an important biography read overnight, I realized I was speaking a truth I was never aware of. I said that this book was not a book on Dr Zhivago, not on Dr Kotnis, certainly not on the Mother Teresa mission. I was quite clear that the framework of working in making this big a hospital chain was more like a biography of Donald Trump, Richard Branson, Henry Ford. Medicine, I realized, had to run somewhere close to the principles of an enterprise,
Yes, the way the biographer chronicled it, it was all about getting a government sanction, bidding on a piece of land where luckily the tender opened favorably on the amount, beyond which there was no money in the kitty. It was about allocation of cement and steel and excise concessions on medical equipment coming for the first time in the country. It was about knocking the door of every joint secretary concerned, and arranging for guarantees for loans from banks.
The concept of ‘corporatization’ of medicine was budding in what was euphemistically termed a ‘developing’ country, a bit more than three decades ago, when Indian presidents would line up on the appointment lists of the celebrated Prof Denton Cooley! No need to mention lesser mortals. They were perceptibly mortal! Certainly, controversies were taking rounds if running medicine as an enterprise was a way of making money out of others’ miseries! I would not be surprised if that indeed was the major issue.
This chain of hospitals grew to be the largest in Asia in three decades. It was a template for many others to follow. The message I heard myself reason and listen to was that ‘corporatization’, (meaning public shareholding, listing on the stock exchange), was perhaps one viable method, among others, to make a hospital run in ‘profits’. A textile mill may fall in debt, a major studio may close down, but a hospital closing down due to losses is a social catastrophe. In today’s economics, that makes a lot of sense.
I am writing this in the backdrop of popular measures being announced in changing quite a few practices that have ensnared the health systems in the country — the resurgent, and rather appropriate urge to ‘clean up’ the system. Nothing could be more appropriate and timely. I have no doubt that the common man should never be cheated, and the rich man never give up his wisdom and patience. That’s how society, systems, and nations run.
The Indian health structure, pharma included, has largely grown despite the government, rather than a policy-based governance. Beyond the laudable ‘firsts’, as AIIMS, PGIs, the initial state-run medical colleges, the system did not catch up with the growing needs of healthcare, an unbridled population growth, and the threshold changes in medical science. In this circumstance, private initiatives had to set their camps. Some were well-regulated, where there were well structured by well meaning industrial houses, corporate hospital chains as I have had some insight into, and nursing homes of repute run by senior faculty attached to teaching institutions.
Along with this came, much to the respite of physicians and surgeons in mid and even small towns, not to mention the metros, near adequate private investigative infrastructures as CT scan machines, MRIs, nuclear scanning, and pathological work-up labs that can deliver some intricate tests in some of the remotest corners of this country in a span of a day or two. This was service as I would see it first, and to run it there came a business like structure. Why the governments could not install and maintain such facilities, for at least half of the population, is a question that probably has easy answers. One may say the government did not have enough funds, or that private participation was believed to be more competitive to the consumer, or for other reasons one may not like to state.
I am aware all patients, all doctors have to resort to support from this easily accessible infrastructure, that is prompt, has competitive rates. The reasons are again rather obvious. To take a shot at oneself, there could be doctors’ interest, perhaps these investigation centers announce packages to the patients, and patients of their own declare their intentions to avail themselves of that. Quite often, there are third parties employed that may influence a patient, which could be a family kin that has a holding, and become a decision maker. Despite this, I am ready to agree that some methods have gone much beyond control. To sum up the sum, money transactions, whether it be currency conversion, credit card usage, ticketing, all run on mutual or even benefits across the chain. Call it the grease and oiling, call it muck.
The one essential message here is that in a flight of righteous chauvinism, regulating agencies have to realize that this system still delivers, though in many ways is now becoming destructively unethical. There should be a well-thought policy how to replace the practices methodically by what are fair business practices that are viable and more importantly acceptable to the common man that he is not being cheated. It’s like refuelling a plane midair. One has to catch up to the speed and space, and there should be no jolt while the process is on. The clean up may include transparency, definition of what are acceptable practices, deterrence where it should be used, and activating government-run centers, again by private participation if that be so. The wisdom of bringing about changes in a system that grew on its own to provide services, that thrived more because of need and subsequently runs on greed, will require mostly common sense, deciding what are reasonable charges for such services, and defining what may be called as ‘crossing the limits’, knowing just that slight difference of what makes the horse run, and what are the advantages, if any, of flogging a tired horse.
With further opening of markets, investments, particularly FDI in insurance, there is a need to improve systems by all means, even by providing more medical benefits and social security to the common man, but so is the need to keep the Indian medical houses healthy enough to compete with any foreign players. The corrective measures need not flog them into dormancy; on the contrary make them cleaner and more competitive. It is a subtle wisdom, how to keep your house intact, even while replacing what has become unwanted. Because it is your house, and you live in it.
This one from Ghalib —
“Tere waadey pey jeey ham, to yeh jaan hamne jaana, / Agar aur jeetey rehtey, yahi intezaar hota”
(I lived a life on you promise, but in case I lived longer, I would still have waited)
DISCLAIMER : Views expressed above are the author’s own.