AGENCY for HEALTH CARE ADMINISTRATION Operational Audit Form

Thanks for asking me, ‘Which country's healthcare system can be emulated in India? ‘.I was in the Govt service (Defence) for more than three decades before I entered the private health care. With experience in both the sectors, I think I am qualified to answer this question.Before I discuss which system is better for India, its better to start with a brief history of health care in India to give orientation and ground for appreciating the ground reality.The first medical institution in India was founded in 1664 by the British East India Company, and it stands today as the proud Govt General Hospital (GGH), Chennai. Surprisingly, this hospital is younger to Taj Mahal by about 30 years only.Govt General Hospital (GGH), Chennai. ( Source: Google)The first medical college in India was started in Calcutta (1835) followed by the Madras Medical College (1835).BTW, I want the readers to know that the 2nd oldest Eye hospital to establish in the world after London, is Eye Hospital, Chennai, and not in Germany or France or America!!!These two medical colleges-Calcutta and Madras- formed the mother colleges to provide instruction in modern medicine, and their alumni went on manning the future medical colleges established gradually in various cities across India over a period of time.In the hospitals attached to the medical colleges, treatment was always free and till the early sixties, higher specialty treatment was available only in the medical college hospitals. Mighty MGR was treated in Govt.General Hospital (GGH), Madras, when he was near fatally shot at. Medical treatment in private was confined to only OP cases.This brief introduction is meant to let the readers appreciate that even the rapacious colonial masters considered health care is the responsibility of the state. The policy of free treatment has been in continuation till now albeit in such a diluted fashion that now the health care in govt hospitals is considered a mere tokenism.It will be of interest for the readers to know that in British India, there were two classes of doctors- The Indian Medical Service( IMS) on par with the ICS in status with even higher remuneration, and the lower qualified licentiates. Dr. Ronald Ross of malarial Parasite cycle fame, the second to win the Nobel Prize (NL) in the category of Medicine and physiology (1902), belonged to the Indian Medical Service (IMS). ( We for some unfathomable reasons do not count him among the NLs from India though the Nobel committee records him from India, officially ( born in Almora).The Bhore Committee:Abhorred by the discriminating two types of quality in medical care, in 1945, the Bhore committee strongly recommended to abolish the licentiate system and bring in uniformity in medical education across the country such that the basic medical qualification for practice of modern medicine remains only MBBS. This committee also recommended primary health care centres and secondary care centres at the district headquarters, and various other reforms that paved the way for expansion of healthcare, medical colleges and district hospitals and various specialties immediate post-independence.Till 1975 the products of these institutions were treated on par with the British qualified doctors, and the doctors qualified before 1975 could straight away register with the General Medical Council (GMC) of great Britain without exam (PLAB) and could practice anywhere in the commonwealth. Following introduction of bridge courses to grant MBBS to the graduates of integrated system ( ayurvedic and other licentiates) and ever falling standards, the GMC derecognized Medical Council of India in 1975. Instead of improving the standards we retaliated by derecognising diplomas of Royal Colleges (FRCS & FRCP), the craze for which only increased after that.The Deterioration of Govt Hospitals:The high quality medical manpower thus produced also has a flip side. After the mid-sixties, when the medical institutions started showing signs of deterioration due to failure of administration to improve the infrastructure commensurate with time, and poorer remuneration of doctors ( purchase power of doctors salary reduced nearly 10 times by the sixties compared to 1917), these highly competent doctors found themselves not fitting into the dated hospitals and started to see greener pastures away from govt. service. Slowly but surely many ambitious and talented doctors started quitting the govt. service to enter lucrative private practice. This is the beginning of flourishing of private practice. It gradually started to acquire commercial tones from the early eighties while the government hospitals showed further decline in the scope and quality of medicare both due to lack of leadership at the helm and over crowding with patients who could not afford private care.Importance of InvestigationsWith rapid strides in medicare and introduction of new gadgets and investigations, the domain of clinical medicine has gradually receded back giving way to objective investigation dependent diagnosis and medicare. This is one of the causes for growing trust deficit between doctors and patients. But patients have to understand that early diagnosis is lifesaving often and it is sometimes intense investigation dependent. By the time the diagnosis of cancer stomach can be made clinically, the patient has passed beyond the stage of operability / cure. Only sophisticated investigations offer hope of early diagnosis and pave way for effective treatment.Since the answer is becoming too big, I will rather try to be more concise.The National Health Service (1948) in the UK is considered one of the ideal health care services on the earth. More patients have trust in the NHS doctors and the services than those who decry them.It offers stratified health care where a General Practitioner is the entry level medicare provider and the patient gets referred if the disease/ condition falls outside the GP’s expertise. A specialist cannot be approached by walking in, like in India. Patient has to patiently wait for his/ her turn for treatment/ procedure while emergencies are immediately attended. The waiting for knee replacement can run to months while it can be fixed in less than a week in India.Though the quality of care is high, this waiting time for procedures can be frustrating. ( One Indian family known to me returned back to India when the waiting for a D&C was told six months).The doctors in UK are well paid and fall into the 2nd highest social strata with such income after entrepreneurs and business houses. But these days many NHS doctors find the job highly stressful and I heard from friends in NHS expressing frustration at the working conditions due to ever increasing complexity of managing of patients in advanced years with multi co-morbid diseases, and lack of say in the matters that affect the doctors. Yet NHS continues to be popular. Private healthcare though exists in Britain, its not the main player and only the rich can afford.The American system is highly evolved in so far as providing treatment with cutting edge technology is concerned but quite costly to the point that patients sometimes choose to suffer the disease rather than go to a hospital. Without insurance, it’s difficult to bear the costs of American medical treatment. A profession of ‘billing’ has emerged from this complexity of American system, which, honestly I, an outsider, found too complex to bother to know about. The system is lawyer and litigation oriented. No prescription comes without extreme investigation. No one wants to miss any and that ‘you-never know-syndrome works to the hilt.I have seen their hospitals. Simply superbly maintained and meticulously managed. There is a lot to learn from their attention to the minutest detail.Now coming to India. When the govt has failed to introduce such facilities as required and in demand, the private sector has evolved to fill the vacuum and take care of the needs of population. Many good hospitals have come up to provide contemporary medicare at a fraction of what it costs abroad. Be it liver transplant or bone marrow transplant India has the expertise widely available, if I may say, more wider and accessible than the America. No frustratingly long waiting lists unlike the West. India even started attracting medical tourism.But Indian private care suffers from the following.Lack of institutionalism. With rare exceptions, a consultant in private works almost unsupervised/ unaudited unlike in govt sector where the treating physician cannot do things the way he wants. This lack of scrutiny or overseeing has given rise to suspicion and dubious practices.Though insurance is becoming popular, most families end up spending from pocket and the burden can be quite heavy and sometimes almost make the patients bankrupt following the treatment of major diseases. This is not the fault of doctors. Medical equipment are imported and costlier than they are abroad and their maintenance is very costly. Gadgets become obsolete in about a maximum of 5 years.Many patients do not buy insurance or budget for medical treatment like they do for education and weddings etc. leading to despair, and find the doctors soft target to attack to vent out their frustration. Its no solution at all.Reforms in Govt HospitalsThe existing Govt hospitals are to be expanded with establishment of more peripheral treatment centres especially cancer centres across the nation and augmenting the strength of specialist doctors with built in performance based incentives.With the existing salaries and work culture of staff, quality in govt hospitals is a mirage. Hire and fire system and delegation of powers to the deans with autonomy only will bring in changes.The existing system is highly bureaucratic and inefficient to give desired results. The deans with supporting young hospital management guys as administrators shall be given powers and made responsible for omissions and commissions. And the selection of deans shall be confined only to those with outstanding annual performance reports and not based on seniority alone.The private hospitals shall have some kind of peer audits and regulation to check if they are following established norms of practice. Ethical and transparent billing shall become the norm.We are evolving but the recent move by the govt to introduce bridge courses and allowing vaids of other systems to practice modern medicine is an ill-conceived move which will sure to destroy what little we have achieved in the medical care.Instead of exploring ways to increase the penetration of the available medical expertise through better infrastructure and performance based incentives, government is trying to tinker with the system, which can do irreparable damage to the health of profession itself. In the sixties integrated system guys were there who were later conferred MBBS and this half baked guys were the weakest links in the chain. I have known such guys and their below par competence.Accreditation of hospitals through agencies like NABL etc shall be made mandatory for all the corporate hospitals and NABH norms shall be applied for all the private and govt labs. Drug control shall be more stringent. These are the pressing needs not bridge courses to ayurvedic vaids and exempting exams to pathetically trained foreign qualified doctors who could not clear the national exam. Their pass rate at 7–13% speaks of volumes of their quality. Exempting them from examination amounts to promoting quackery on one side and killing the majesty of noble profession. If people have complaints about quality of doctors, to avoid them, they shall support quality measures.Politicians come and go but its the systems which remain in place and guie the society.How much it costs annually per head for free health care?It needs about 5–6 thousands per head per year to provide primary care for every individual in the society .And it can go up much higher if tertiary and quaternary treatments are added. The govt just doesn’t have that kind of money and for that matter no govt on earth can afford nearly 8 trillions rupees /annum to provide high quality free treatment for 1.3 billion people.My viewCulturally, Indians abhor long waiting and queuing up at the government clinics for minor ailments. Primary care for trivial ailments may be left as it is going on now- part private and part public with choice left to the patients.Secondary and tertiary care and trauma care require urgent attention. It shall be fully augmented at all levels in taluks and cities and govt shall ensure quality through new additional recruitment, implementing modern well established norms of management and adequate funding. While insurance base shall get expanded for those wanting private care.Quaternary care shall be such, part of the costs shall be borne by the beneficiary. If it has to be free, cost overruns will destroy the quality to make it dysfunctional. No govt can spend tens of lakhs of rupees per patient.

I’m really not sure. You might try the websites of Medicare, Health and Human Services, or Social Security. They all have fraud offices or departments that may check legitimacy. You might also do a web search on the company’s name. If you the company appears to be private, you can also check the state health regulatory agency, or the attorney general’s fraud section.

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Let me guess, you've been contacted via email by somebody you’ve never met. they've told you a story about being a deployed soldier. At some stage in the dialogue they’ve told you about some kind of emotional drama, sick relative/kid etc. They tell you that because they are in a dangerous part of the world with no facilities they need you to fill in a leave application for them. Some part of this process will inevitably involve you having to pay some money on their behalf. The money will need to be paid via ‘Western Union’. Since you havent had much involvement with the military in the past you dont understand and are tempted to help out this poor soldier. they promise to pay you back once they get back from war.if this sounds familiar you are being scammed. There is no soldier just an online criminal trying to steal your money. If you send any money via Western Union it is gone, straight into the pockets of the scammer. you cant get it back, it is not traceable, this is why scammers love Western Union. They aernt going to pay you back, once they have your money you will only hear from them again if they think they can double down and squeeze more money out of you.Leave applications need to be completed by soldiers themselves. They are normally approved by their unit chain of command. If there is a problem the soldier’s commander will summon them internally to resolve the issue. This is all part of the fun of being a unit commander!! If the leave is not urgent they will wait for a convenient time during a rotation etc to work out the problems, if the leave is urgent (dying parent/spouse/kid etc) they will literally get that soldier out of an operational area ASAP. Operational requirements come first but it would need to be something unthinkable to prevent the Army giving immediate emergency leave to somebody to visit their dying kid in hospital etc.The process used by the scammers is known as ‘Advance fee fraud’ and if you want to read about the funny things people do to scam the scammers have a read over on The largest scambaiting community on the planet!

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