Context

There is a need to empower primary health care providers to make crucial health decisions in India.

Problems with Indian healthcare

• In India a hospital-oriented, technocentric model of health care took roots. 

• Building urban hospitals through public investment enjoyed primacy over strengthening community-based, primary health care. 

• A private sector with a rampant, unregulated dual-practice system flourished. 

• This influential doctors’ community saw a lucrative future in super-specialty medicine and buttressed the technocentric approach. 

• This had an enormous impact on the present-day Indian health care.

Focus on hospitalization

• Preference for ‘high-tech’ medical care has trickled down to even the poor sections which cannot pay for such interventions. 

• Health insurance schemes like Ayushman Bharat based on providing insurance to the poor for private hospitalisation are influenced by the popular demand for high-quality medical care.

• Medical Council of India came to be dominated by specialists with no representation from primary care. 

NMC – community health care provision

• The current opposition to training mid-level providers under the NMC Act 2019 is an example of how the present power structure is inimical to primary health care. 

• Evidence proves that practitioners of modern medicine trained through short-term courses of a 2-3 year duration can greatly help in providing primary health care to the rural population. 

• Such medical assistants and non-allopathic practitioners have been written-off as ‘half-baked quacks’ who would endanger the health of the rural masses. 

• Nations like the U.K. and the U.S. are consistently training paramedics and nurses to become physician assistants or associates through two-year courses in modern medicine.

Way ahead

• Countries such as the U.K. and Japan have incentivised general practitioners (GPs) and designed a system that strongly favors primary health care. 

• It is imperative to reclaim health from the ivory towers called ‘hospitals’. 

• We need to find a way to adequately empower PCPs and give them a prominent voice in our decision-making processes pertaining to health care.

• No one should be allowed to bypass the primary doctor to directly reach the specialist unless situations such as emergencies so warrant. It is only because of such a system that general practitioners and primary health care have been thriving in the U.K.’s health system.

• Bhore Committee report (1946) highlighted the need for a ‘social physician’ as a key player in India’s health system. 37 years after the report, PG in family medicine is a reality.

Best case – Japan

• For the early part of Japan’s history, hospitals catered only to an affluent few. 

• The government limited the funding of hospitals, restricted them to functions like training of medical students and isolation of infectious cases.

• Reciprocal connections between doctors in private clinics and hospitals were forbidden.

• The Japanese Social Health Insurance was implemented in 1927, and the Japanese Medical Association (JMA) as the main player in negotiating the fee schedule. It was headed by Primary Health Care providers.

• Japan Managed to contain the clout of specialists in its health-care system and accorded a prominent voice to its primary care practitioners (PCP) in decision-making processes.