Insurance Based Medical Treatment Is Unsuitable For India : 5000 Tehsil Polyclinics with 5 Authorised Doctors In Big Villages and Jan Aushadhi Shops Is A Better Model
Rajiv Upadhyay 
India is aping the western insurance based medical treatment and adopting it like in schemes like Ayushman card . It seems good now . But in West with fifty years of experience ,it has shown its unsuitability for poor and middle class families . It starts failing because
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- Hospital infrastructure and Doctors salaries are very high and commercial return cost on investment makes the treatment very expensive .
- In Delhi , where it has been in use for many years strains are already showing . It first lead to private hospitals increasing the bill by adding number of days of indoor treatment , prescribing extra tests and consultants . Insurance companies got wiser and added ceilings and packages . It lead to patients being discharged without full recovery and pushed into paid out door treatment.
- Serious patients were admitted to ICU and kept on ventilators very long just to increase the bill. As an example it is said that about sixty five percent of deliveries in private hospitals are cesarean while in government hospitals eighty percent of them are natural . Monetary considerations are forcing doctors to prescribe un necessary costlier treatment and drugs.
- Worst however comes from court cases . Lawyers working on percentage of compensation basis , file criminal neglect cases on doctors and hospitals and get unnecessarily high compensation for clients . This leads to doctors insuring themself . Ultimately it increases the medical insurance costs so much that ordinary treatment goes beyond the reach of poor and middle class .
- This model is clearly not suitable for India .
- Alternatively we can consider a Mixed Govt / Private model .
- Government should set up a polyclinic with a Sr. doctor, pathology lab , X Ray and Ultra sound facility in every one of five thousand tehsils in India . It should also have a Jan Aushadhi shop attached and one technician and nurse .
- Each polyclinic should have five MBBS doctors in big villages and a multi skilled health worker in every village who could also be a primary teacher. It would be better to introduce a three year diploma course in medicines like old Engineering diploma . These could be posted in villages as college educated doctors may not stay in villages for the whole day.
- These Tehsil doctors should be connected via internet to the Tele Medicine centre of District multi speciality hospitals for daily fixed time consultation slot. Similarly village diploma doctors should be connected to Tehsil doctor via internet. It will help in higher level medical attention being available to tehsil and villages .
- For the more affluent class an authorised fixed charges paid consultant should be available in Districts and big hospitals say in the evening slot.
- Private hospitals and doctors should continue as now but with legal protection against genuine mistakes or experimentation in critical cases. Deaths or diseases are not always possible to be detected and different doctors can have different opinion on suitable treatment . Some doctors and some patients may misuse these provisions but it is un avoidable. Ideally each big district or several smaller districts could have a private multi speciality hospital.
- Jan Aushadhi testing facilities should be available in every state where any patient can get medicine tested for contents on payment.
- AIIMS standard Large Super Speciality hospitals should be available in both government and private sector preferably one for every fifty lakh population .
- The idea is to insulate the poor and middle class from greed and exploitation inevitable in private sector and yet support the superior facilities being available on payment basis in the country. This model is more suitable for India than a just Insurance Based model.
