Dr. Nirmalya Ray
1) Different Health Districts to be designated under individual medical colleges.
2) All primary health centres to be supported by the designated medical college virtually by telemedicine; Virtual Portal to be staffed for 24 hours by PGTs of individual departments.
3) Incorporation of telemedicine in the undergraduate as well as post graduate curriculum at all medical institutions.
4) All hospitals to have current bed status available online all the time.
5) The main issue of inadequacy of beds is due to inappropriate and delayed discharge. This needs to be managed with aggressive monitoring via individual heads of departments.
6) Two main deadly diseases- Hypertension and Diabetes. Free distribution of Amlodipin for hypertension and Metformin for diabetes from all radal centres like PHCs. Such intervention has been shown to have significant reduction in health complications and thereby reducing health care burden.
7) Availability of ECG, CT, MRI, X-ray, USG and Echo at all district hospitals. These studies can be read by a centrally located radiology centre. This will reduce the need of radiologist, at every location physically.
8) Here a task force comprising of senior faculties from individual departments. These doctors will be given the responsibility of monitoring the performance of respective department at all levels throughout the system. The task force will also formulate guidelines for everyone to follow for that particular department.
9) All health district level headquarters to be Trauma Centres.
10) Aggressive implementation of Central Government Schemes like Ayushman Bharat and Indradhanush. I think it may be prudent to start a vaccination program for adults to reduce the burden on the healthcare systems.
11) All health care centres including PHCs to be connected by internet PHCs to be able to seek expert guidelines from tertiary centres designated to them.
12) Increase in number of colleges and training institutions for paramedical staff. The numbers gradually should be more than required, so that some of them can be catered to hospitals all over India and even abroad. Health policy is aggressively followed in countries like Vietnam and Phillipines. They do not export doctors like India, they export nurses. Addition of Spoken English classes for nursing schools may be a very advantageous endeavour.
13) Strict rules to be implemented to curb ony nexus between doctors and pharmaceuticals or diagnostic centres and hospitals. Any connection will be dealt with Permanent Cancellation of License to practice.
14) All private hospitals to render 20% discount to senior citizens (> 62 years) and to charge a premium rate for non Indian citizens. Foreign Citizens paying the same rate as citizens is almost same. .
15) Private hospitals calling themselves ‘Research Institutes’ need to be reviewed. Is there any proper research or this is purely a ploy for tax evidence.
16) Starting air ambulance from remote locations to tertiary centres. We can have a total of 5 air ambulances for the entire State.
17) Getting all these done will require a lot of funds-
How to raise funds-
(a) Donations from business houses in exchange of naming of blocks, wards, OTs
(b) Setting up a fund from donations from doctors and all citizens particularly Bengalees settled abroad.
If funds are used properly, this method can raise a huge amount from doctors abroad.
18) Associated health measures- (that have indirect impact)
Encouraging all jobs at malls and restaurants and even petrol pumps to be for women. Lack of proper toilet is big problem for women workers. Also, enforcing proper toilet availability for all employments employing women.
Serious measures to be taken in controlling Dengue and Malaria mosquitoes. A clean environment is the most important step towards proper health care.
19) The very important road block in delivering quantity health care to rural areas is getting doctors to join a job there. The only way to solve this problem is by dividing the partings into three hierarchies- Rural, Semi rural, Urban.
A rural posting should be rewarded with a 4oK stipend above and over the salary and a semirural posting to be rewarded with a 20K stipend. Also all post graduate seats should be made available after 3 years of service. No matter how dramatic this may sound, there is no other way of solving the healthcare paradox in West Bengal.
20) We have excellent doctors and excellent healthcare facilities. There should be a massive impetus from the governor in promoting healthcare tourism from all over South-East Asia to Kolkata. This can be a source of employment and a sizeable foreign revenue earning for the country.
Promoting health tourism will also indirectly promote tourism and hospitality industry in the State.
21) A long neglected field is dentistory in the rural areas. We should try to provide proper dental care delivered at the PHC level if possible. This will also provide ready job opportunity for young dentists graduating from different private and government dental colleges.
22) Development of stable small scale laboratory facility at every PHC level including-blood TC, DC, Haemoglobin, Glucose, Sodium, Potassium, TSH, Creatinine, R/E urine.
This tests can be done at a minimal cost and does not need to be free.
23) A proper cost structure for all investigation by private set up. For e.g. a maximum retail price like model to be set up for CT, MRI, X-Ray, USG and all other radiologic and laboratory investigations after a proper cost analysis. No one should be allowed to charge more than the maximum price set by the government. If any centre wishes to charge less, they are more than welcome.
District – 23
Health District – 28
North 24 Parganas
South 24 Parganas
Bankura / Bishnupur
Rampurhat / Birbhum
Nandigram / East Madinipur
2-3 PHC / Block (13-16) Panchayat
District (4 Subdivision)
In the current COVID-19 pandemic situation, the citizens of this country is fighting two pandemics at the same time. Firstly, COVID-19 and Secondly unbelievable corruption in the medical field. This is a very appropriate time to address this problem that has been perplexing the healthcare system for last many years. Addressing this issue, particularly at this time, will be highly welcomed by the population. People will held the government in very high esteem if a proper of medical corruption is conducted during this COVID-19 era.
Different facets of corruption in the medical field in India and their remedies.
1) Absence of any ceiling price for medical investigation. So medical centres can charge whatever they want. This is particularly detrimental to admitted patients who often pay erronomical charges for CT / MRI / USG etc. when admitted in the hospital. This does not happen in the ward where the charges for individual services are stipulated.
2) Medical representatives peddling drugs to doctors. A very big racket of kick back from pharmaceuticals is creating havoc in the medical system of this country.
Only way to control this would be exemplary punishment for both pharmaceuticals and recipient doctors. A few such instances will stop this practice largely.
3) Unnecessary investigation from doctors. This is purely due to commission from the investigation centres. This is also a big problem in the country and can be controlled with some exemplary disciplinary . Cancellation of license and jailing of the involved parties will set the standards very clearly.
4) Completely unnecessary device implementations like pacemakers and . There are very high commissions from the makes of these devices for the doctors implanting them.
This is also an area where the only solution to the problem is very serious legal action against all doctors and any other involved parties if found receiving any kick-back.
It is understandable that it is impossible to monitor all doctors in the country. But all that is necessary is a sting operation with comprehensive proof and absolutely laws and disciplinary measures against a few.
5) From the doctor’s standpoint it is often a different situation. Many a time he or she cannot continue to practice without prescribing unnecessary investigations and referral. He will be asked to leave the medical centre as he is not generating enough profit. He has no option but have his own clinic to practice honestly. This can be a very cost prohibition affair for many.
6) A very important corrupt practice that goes on without any check and balance is indiscriminant usage of ceaserean section for birth of a baby. According to some data 90% of this operation is unnecessary and harmful in the long run. There are ample data to show that the birth of a baby is best through normal delivery. Vut C-sectuion is often a doctor’s choice as it is much less time consuming and is paid much more.
7) A very new corrupt problem that has started in the last few years is that medical students getting their medical degrees abroad which is equivalent to MBBS in India, starts writing MD against their name. This need to deligitimised immediately. This will discourage students from going abroad and substantial amount of foreign money will be saved. Rather they will then try to go top private medical shops in India.
8) Another form of corruption is peddling baby food to children at a very young age. There are huge volumes of literature which shows that this is a very dangerous practice and breast milk is the best source of nutrition for babies till age 2 years.
9) A very big problem in the field of surgery. There are a lot of surgeons who get paid cash. Suppose a particular surgery is paid Rs.8,000 by the insurance. Now the hospital will take maximum amount and then give a small amount to the doctor for example, Rs.8,000. Now the surgeon will say to the patient that I charge Rs.25,000 and you have to pay Rs.17,000 in cash. That means the patient has to pay out of pocket despite having insurance.
10) A common problem with private medical practices is cash payment without issuing a receipt. Thus this money is completely unaccounted. The government is a huge amount of tax this way. Patients are often uncomfortable asking for a receipt. Ideally the medical practice should give a receipt anyway. The way to solve this problem is nondating Creditor debit and payment for all private medical practices.