Journal of Emergencies, Trauma, and Shock
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Transforming health care in india: the real question


 Department of Neurosurgery and Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India

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Date of Submission09-Oct-2019
Date of Acceptance09-Oct-2019
 


How to cite this URL:
Agrawal D. Transforming health care in india: the real question. J Emerg Trauma Shock [Epub ahead of print] [cited 2021 Nov 27]. Available from: https://www.onlinejets.org/preprintarticle.asp?id=314954




India is a land of dichotomy with state of the art facilities in some private health-care facilities to abysmally poor infrastructure in most government health-care facilities, the extreme heterogeneity in care is taken for granted in this country. With health sector continuing to be a low priority for the state governments, the scenario continues to be bleak to say the least. Despite insurance coverage increasing to 14% in rural areas and 18% in urban areas in India,[1] for the vast majority, the out of pocket expense is more debilitating than the disease itself.[2],[3]

In an emergency, patients may have to go to the nearest health-care facility, which may not have the necessary equipment and resources. Stories of patients being turned away from various hospitals due to lack of ventilators/beds are all too common.[4],[5] An intensive care unit (ICU) bed (with ventilator) in India costs upward of Rs 25,000/day and averages around Rs 50,000/day in major corporate hospitals in Tier 1 cities.[4] The cost includes infrastructure, equipment, workforce, and disposables. What is not well known that the workforce (skilled doctors and nurses) is the cheapest part of the total cost. It is the high capital cost of equipment and disposables, which add to the burden on health-care providers, adversely affecting the bottom line of most health-care providers in India. Blindly aping the west and the lack of indigenous, innovative, and cost-effective products and solutions is causing tremendous harm to the people receiving health care in India, leading critics to label India's health-care system itself in need for life support.[6]

It is a matter of shame that despite having the best scientific pool on the planet, India has not produced an indigenous magnetic resonance imaging (MRI), computed tomography (CT), or even an ultrasound machine till date! This reflects the dominance and (undue) influence of multinational companies and lack of vision and effort by the Indian health policymakers. Whatever innovation has happened is at an individual level. Recently, we at All India Institute of Medical Sciences came together with a robotic engineer to make the cheapest ventilator in the world named AgVa.[7],[8] Innovations like these have the potential to change the way we provide health care to our citizens and show the world the path to cost-effective and affordable health care.

It is important that policymakers like Niti Ayog create a road map for government-funded or supported indigenization of key technologies such as central venous lines (surprised?), stents (both coronary and intracranial), ultrasound, CT, and MRI machines in a time-bound manner. These technologies should then be offered to Indian health-care companies to build and sell in a royalty-free manner. I believe this will transform the health-care landscape in India, similar to what has been achieved in the pharmaceutical space in India.

The pharmaceutical market in India has innovated and indigenized, leading to India having the cheapest medicine prices in the world. This has also happened because India made a number of policy decisions to keep drug prices low.[9] Although it is often argued that by these policy decisions, there is delay in introduction of new drugs in India, it may be a blessing in disguise, because we get to see the actual efficacy and side effects of the drug –before it is used on our citizens – and those conscientious and rich critics can always get themselves treated where the exorbitantly priced drug is available!

With indigenous ventilators already available at 1/10th of the current imported prices,[10] imagine having indigenous MRI and CT machines costing few lakhs instead of the current tens of crores, indigenous stents costing few thousands and an ICU bed (with ventilator) costing Rs 2500/day – It can only happen if we want it to happen. The question is – do we really?



 
   References Top

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Available from: https://thewire.in/health/whois paying-for-indias health.care. [Last accessed on 2019 Nov 03].  Back to cited text no. 3
    
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Available from: https://qrius.com/ indias-healthcare-life-support/. [Last accessed on 2019 Nov 03].  Back to cited text no. 6
    
7.
8.
9.
10.
AgVa Healthcare; 2018. Available from: http://www.agvahealthcare.com. [Last accessed on 2019 Sep 05].  Back to cited text no. 10
    

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Correspondence Address:
Deepak Agrawal,
Department of Neurosurgery and Gamma-Knife, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JETS.JETS_124_19





 

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