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There is no simple answer to the title of this thread. Even today, the best of Indian doctors (like our engineers) come from public funded teaching hospitals. If you were knocked unconscious, your best bet of surviving may not be in the adjacent private hospital that refuses to accept unknown patients but the local public hospital that offers emergency services.

Many sectors in India are ailing, some could (as some believe) thrive if they were privatised. Not every sector can or should be privatised, health is one of them. As a doctor, my prime responsibility is to treat the patient as per clinical needs and not based on their ability to pay. Private healthcare thus in itself creates an ethical conflict. Ethics aside, no developed country has a satisfactory private healthcare model - US healthcare is in shambles despite a 15% of GDP worth money spent on health.

I can write reams on NHS and EU models, especailly the purchaser-provider model, but will not do so for want of time. It would be academic anyway, as if our health ministers were keen they would have snapped it up long ago after repeated jaunts to West on study tours.

Rather we can simply focus on how much we spend on health in India. On paper we spend a healthy 6% of our GDP (UK spends about 8). So what is the problem? Less than 1% comes from Govt funds and 5% is out of pocket spot purchase of expensive services provided for a significantly small minority of Indians who work all their lives saving for the bypass surgery (or the like when they hit 60).

The first step if we hope to reform our health and social welfare is to start a mandatory National Health Insurance scheme (no, not private - those interested may study US failings in their own time). Let every one pay 10% of their salary and employer pay 10% in addition in to this fund (over and above usual tax).

When I say the above will actually fetch year on year a large pot of money, the bog standard answer is - but a very small proportion of Indians are earning money enough to hit tax brackets. Well, on average only 30% of EU population pays taxes!!

Last year IR collected Rs 1,47,197 crore in taxes. India's budget for health is Rs. 16,534 crores in 2008-2009 (yes, the states contribute similar such petty amounts). One can imagine that very easily a massive corpus can become available for reforming the ailing health sector through a mandatory national insurance scheme.

Sadly, one needs to only compare these figures with amounts spent on less than 100 million people in 6 metro cities. Compare the above budget with the estimated loss of revenue through tax sops to SEZs (companies that do not need tax sops are milking the system - India needed to get rid of license Raj, investment flows where there is a market, tax sops or not). 

Again, I must end as an insider who informs, privatisation is not the answer - one needs to be a doctor to know how corrupt the private health sector is (it beats public sector hospitals in this regard many times over). As for Medical Council of India, the less said the better.

ASJ 

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Karnataka boasts of Medical Tourism as one of its most ambitious tourism attractions.  It is catering for the novea rich and local 'haves'.  But 'have nots' and government employees themselves have no faith in their own health care systems that are lacking in money, man power, infrastructure, life saving drugs, corruption, exchange of babies for gains, the list is long.

- What people want is minimum possible health care and emergency services during that 'golden hour' and when the sirens are blaring and rushing madly to save the life of the sole bread earner of a family.  These simple needs of aam aadmi are not available even after he reaches government hospitals.  To carry the sick person inside on a stretcher needs greasing of palms.

-  Administrators wake up and start rubbing their *eyes* for identifying some means to combat an incurable disease only after it has hit the BPL/Slum areas, some dead bodies are lying around etc. 

- Instead of letting the people die unnatural deaths due to medical negligence or lack of infrastructure by the service providers in government maintained hospitals, despite collection of taxes from people, it will be better to close down these 'Narakas', allow private hospitals to treat  people with qualified doctors and para medical staff with a sense of service, regulate fees and operation charges for identified sections of the society, open more and more peripheral/ essential services from government funds like, diagnostic, scanning, x-ray, drug stores at subsidised rates, elders homes, creches, orphanages, etc.

- Prevention is better than cure does not exist in Govt's dictionery.

Medical tourism for ordinary people in Bengaluru/anywhere, is like "ootakke illada uppinakaayi..."

- Anybody listening?

- Vasanthkumar Mysoremath

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The government instead of investing in healthcare facilties (apart from the absolutely necessary ones like isolation facilities, etc) should concentrate on providing universal health insurance. The investments made into this bleeding organizations could instead be used for paying the health insurance premiums for the needy people. Let the private sector take care of the treatment based on the insurance. And since the insurance companies will be involved, they will ensure that private organizations do not overestimate on the treatment charges. The sucess of "Yeshasvini" scheme introduced by the karnataka govtment is prrof that this concept might work.

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Thanks Doc for that input, incidentally i saw Micheal Moore's documentary "Sicko" over the weekend and i cant agree with you more. I didnt realize the fact that insurance companies can act in ways as they do in US (well Moore could have over stated the problem, but i am sure he is correct to some extent). Probably a government managed universal health insurance is the way out. Apart from the contributions from individuals and companies, revenues from taxes on cigarettes and liquor (atleast some of it) could be put in this fund.

But the question remains, how can govt hospitals be made more accountable and how can we improve their services. The state govts do spend considerable amount of money on health care and yet it is in such a bad state. It is very saddening to see how poor people are treated in these facilities. Incidents of fake drugs being used and treatments being denied is very common in hospitals here.

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The point is that capitalism has had its succes because of free democracy, these countries are democracies first (not capitalists as being tried to make out). Free democracy killed feudalism (not capitalism).

And anyway what is the point, its so out of context. Bottom line is that significant number of capitalists (if that is what you want to call them) countries have huge investment in socialist agenda.

ASJ

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