IMPROVING PUBLIC HEALTH CARE: DR. SHRINIWAS KASHALIKAR

Philanthropy and charity are necessary (as symptomatic palliative measures) only in diseased society. Conversely; the need and presence of philanthropy confirms the diseased nature of society.

Since the public services and especially public health services, affect most of us, it is essential to find out the root causes and remedies for their AILING that causes STRESS to most of us. This kind of exploration; is a part of Total Stress Management i.e. SUPERLIVING; i.e. blossoming of one and all.

The main causes of the degeneration of the public health care; is the prevalence of three points; on which these institutions work.

These are:

1. Free medical care
2. Economic dependence of these institutions on the government revenue (public money) and donations.
3. Sectarian medical care such as allopathy, homeopathy, Ayurveda etc.

FREE MEDICAL CARE

The ill effects of free medical care are:

A. The free medical care gives rise to unnecessary visits to hospital out patient departments, excessive crowding, parasitism, beggarly tendency, meekness and irresponsibility towards personal and public health.

B. The free medical care creates a special and extremely favorable situation and golden opportunity for the powerful, rich and famous individuals to exploit the government revenue and tax payers� money. The chances; of misusing the FREE services through irregular and illegitimate means; increase.

C. The free medical care leads to zero returns and subsequent deterioration in the infrastructure, maintenance, renovation, state of the art technology and facilities such as food and recreation given to the patients and their relatives.

D. The free medical care associated with perpetual absence of returns; leads to unjustifiably low salaries, delay in filling the vacancies, delay and/lack of promotions, excessive working hours and duties, substandard working conditions (such as inadequate toilets) etc.

E. This state of affairs demoralizes the sincere and dedicated employees and implicitly and often explicitly promotes irresponsibility, lethargy, absenteeism, corruption etc.

ECONOMIC DEPENDENCE OF THESE INSTITUTIONS ON THE GOVERNMENT REVENUE AND DONATIONS

The ill effects of economic dependence are:

A. The public hospitals are not self-sufficient and do not have any projects to support them. Naturally since there are no legitimate returns from patients or from any other source; for what is spent; the public hospitals are always in loss and the problems resulting from the FREE medical care; multiply.

B. Thus inadequate progress in terms of inadequate facilities, inadequate salaries, and inadequate employment in terms of number of employees in almost every category, protracted duty hours, worsening working conditions, worsening of staying conditions for the employees and crowding of patients due to huge patients/employee ratio; worsen even further!

C. The dependence of the public hospitals on government through sanctioning of funds; leads to colossal corruption while attracting funds and while undertaking any developmental activity. In fact; many individuals and institutions concerned with hospital; get obsessed by the thought of �how they can be �richer� rather than the development and improvement in services.

D. The corruption of the individuals in the public hospitals drives them to seek money in every possible way. Thus they may deliberately spoil the equipments so that newer can be purchased (and kick backs can be amassed), they may manifest other tactics; such as misbehavior, insulting behavior, delay or denial of services and thereby compel the patients to go to the private practitioners and consultants and get �commission� from them.

E. Large number of lower middle class and even poor patients turn to private practitioners, consultants and hospitals; out of helplessness; rendering the public hospital investment wasteful and counterproductive!

3. SECTARIAN NATURE OF HEALTH CARE
The Allopathy, Homeopathy, Ayurveda, Yoga, Unani, Naturopathy etc in isolation; have made us; doctor dependent, laboratory dependent, other screening tests (e.g. ECG, Angiography etc) dependent, drug dependent, helpless and vulnerable to all kinds of fear psychosis and thereby deception and exploitation.

We are miserable because of sectarian nature of health care.

This deterioration can be overcome by:
1. Abandoning the concept FREE services and charging fees and
2. Making the public hospitals self sufficient through other appropriate productive projects.
3. Evolving and implementing holistic medical care

1. The concept of free medical care has to be replaced by more just system of payment. This would make everyone involved; less casual, more sincere, more accountable, more responsible and more dignified, in seeking health care and providing health care. The arrogance and condescending attitude of the health care providers and meek and irresponsible attitude of the health care seekers would be transformed.

This would bring adequate revenue to ensure progress in terms of adequate facilities, adequate salaries, appropriate employment, which could ensure normal duty hours, improvement in working conditions, improvement in staying conditions for the employees and preventing excessive and many times [because the services are free] unnecessary crowding of patients.

One may raise the objection that this is difficult to implement in case of very poor, helpless, unsupported patients.

It is very true that no sensitive and sensible individual would think of doing it as well. These patients who are in agonies, in emergencies or helpless; should be made exception and a separate arrangement be made for them. But in most other cases the problem can be overcome by making provision for payment through �services� or soft loans.

2. Making public hospitals self sufficient by buttressing them with some productive income generating projects; such as plantation of medicinal herbs.

We can recapitulate and list the benefits of the �Health Restoration of Health Care� as follows:
A] It would inculcate a sense of responsibility towards one�s own health, towards public funds, towards public services, amongst everyone including the patients.
B] It would generate the sense of accountability, satisfaction and fulfillment amongst the employees
C] It would ensure optimal progress in medical care especially in terms of holistic approach and making health far more convenient, reachable, inexpensive and effective than ever before!
D] It would improve the lives of patients as well as employees
E] It would make the revenue hitherto squandered on free medical care available for other developmental and research work thereby facilitating national progress.
F] It would reduce the corruption born of out of injustice
G] It would reduce the crowding and degeneration of private medical care.

3. SECTARIN MEDICAL CARE

The sectarian medical care involving sectarian training, practice and research has to be evolved into holistic health care training, practice and research. Holistic health care implies; all that, which promotes holistic health; and heals/prevents disease. Gita calls such body of knowledge, practice and research SATVIK. This would make the health care; less alien, less expensive and hence; less crippling.

We have a great opportunity to verify; how universal practice of NAMASMARAN; inseparably associated with the conviction of individual and universal blossoming; empowers all of us to heal our public health care system!