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Apr-Jun2001-9(2)
LETTER FROM
CHENNAI
Government gifts to corporate
hospitals
Thomas
George
Come election time and the government's mind turns
to thoughts of the people's welfare, or at least to the appearance of it.
A perennial favourite of every government that wishes to show its commitment to
the people's well-being is health care. So it is not surprising that the DMK
government in Tamilnadu has a flurry of health camps. Also, the Corporation of
Chennai, which it controls, has announced an increased outlay for health in this
year's budget. But how deep is the commitment? Very shallow, one
fears.
As states go, Tamilnadu is one of those whose
health indices are better than the national average. But how much this is due to
efforts on the part of this or previous governments is a moot point. One can say
for certain that we are nowhere near attaining the Alma Ata goal of Health for
All. It is also true that severe disparities exist not only in the provision of
basic amenities that make for healthy living, but also in curative services.
Since the 1993 World Bank report gave 'intellectual' or 'theoretical' sanction
for the withdrawal of the government from any but the most basic curative
services, the Tamilnadu government has been quietly downgrading its services.
This is done in a subtle fashion. Official policy is not to turn any patient
away, and not to refuse any service. But the reality is that many elective
services are simply not provided, or provided after such long waiting periods,
that the patient just goes away. It is exceptional for a patient to get a total
hip replacement in a government institution. The cost to the individual and the
nation of having so many unhealthy or barely healthy people is incalculable. For
the politicians, however, such long-term considerations have no value. After
all, as the famous economist John Maynard Keynes said: "In the long run we are
all dead." They prefer the health camp: numerous doctors descend on a village
with some political flunkey in the limelight and 'screen' patients. Having
discovered that so many need cardiac valve replacements or whatever, they refer
them to the nearest medical college hospital, which, as everyone knows, hasn't
done one for years! By the time the patient discovers this, election time has
come and gone.
****************
From the 1980s, the corporate hospital has been the
buzzword among medical entrepreneurs. Fired by the success of the Apollo group,
many others jumped on to the bandwagon. A lot of them have been unable to
replicate the financial accomplishment of Apollo. The closure of the Tamilnadu
Hospital on the outskirts of Chennai is symptomatic of the predicament that many
others find themselves in. Sadly, a lot of public money is in these institutions
in the form of loans, notably from the beleaguered Indian Bank and from ICICI
(Industrial Credit and Investment Corporation of India). It says something about
the priorities of the government that lending institutions controlled by it give
soft loans to these hospitals which are solely for those who can pay well, while
the government does little for the underprivileged. It is not unusual to find
public sector institutions and banks gifting expensive equipment to private
institutions. For example, this month the State Bank of India donated an
expensive ophthalmic laser to a private hospital. It would seem that a
government hospital would be the more appropriate place for such largesse. The
only reason that seems plausible for such donations is that the institution
concerned offers some concessional treatment to the employees of the donor
organisation. But is it right for a public sector enterprise to divert part of
the profits for the private gain of its employees? It is also a sign of
the complete shift of the middle class to the private sector for medical care.
What this has meant is that the sovereign, socialist, democratic republic of
India is witnessing ever more stratification of its citizens. Government
hospitals are filthy, poorly equipped and unresponsive. Instead of improving
them, we have abandoned them to the voiceless poor. Surely it is a sign of a
sick society that its citizens care so little for each other, and are so little
involved in civic affairs that they do not understand or are unwilling to fight
for basic services. This is the syndrome of: "If there are power cuts get a
generator, if the phone service is poor get a cell phone," and so on.
Unfortunately, once in a way along comes a plague or an earthquake to remind us
all about the importance of good infrastructure as a basic right. Equally
unfortunately, we do not seem to have learnt the lesson yet.
And the politicians think that a camp once in a
while will bring in the votes.
Dr Thomas George, 114J,
Rostrevor Garden, Railway Colony, Chennai, 600018. Email:george@medicalethicsindia.org.