[dropcap]A[/dropcap] recent article written by an Australian medical professional in the prestigious British Medical Journal about corruption in Indian healthcare may well have opened up a can of worms. The news understandably has not gone done well with the Indian Medical Association who have alleged that the observations of Dr. David Berger which reads “the country’s (India’s) doctors and medical institutions live in an unvirtuous circle of referral and kickback that poisons their integrity and destroys any chance of a trusting relationship with their patients. It is no surprise that investigations and procedures are abused as a means of milking patients.”
State IMA president Dr Rajeev Ranjan Prasad said it was a conspiracy to defame Indian doctors. “We have been providing cost-effective and efficient treatment to patients. The US and other countries are worried about our advancements,” he said. However, Bihar State Health Services Association general secretary Dr Ajay Kumar said corruption was prevalent in every field in India. “It is there in healthcare too, but very less,” he said.Dr Berger also refers to his experience working as a “volunteer physician” in a charitable hospital in India. He writes “ A senior doctor in another hospital a couple of hours away was renowned for using ultrasonography as a revenue earning procedure charging desperately poor people Rs 1000.” The article also exposes the deep “corruption” in the pharmaceutical industry. “Tales are common of hospital directors being given top-of-the-range cars and other inducements when their hospitals sign contracts to prescribe particular antibiotics preferentially,” it states.
The article throws light on the huge gap in health care for the rich and for the poor. It states that India records the highest out-of pocket expenditure on health in the world. And while the latest technological medicines is available to people who can pay, albeit at a high price, its vast marginalized class of 800 million and counting have little or no access to healthcare.
AIIMS-Delhi’s senior gastroenterologist Dr Samiran Nundy has also written an editorial piece in the same issue of British Medical Journal, agreeing with Dr Berger’s views. “In five star hospitals of India”, there are doctors for whom “the temptation to do unnecessary tests like CT scan and MRI and unnecessary procedures was irresistible”, Dr Nundy wrote.
Dr. Nundy has also been critical of how it has taken the medical fraternity to wake up to the ‘shame’ after a non Indian doctor working in India revealed that her healthcare is suffering from kickbacks and patients are being subjected to unnecessary tests and examinations.
Healthcare even otherwise is highly susceptible to the corruption virus, and an estimated 10% to 25 % of global spending on public procurement of health is lost through corruption.The global spending on healthcare is over $7 trillion annually. Then again corruption takes on many forms and changes faces, depending on the level of development in the country and its health financing system and health policies. In the United States for example the loss in medical embezzlement was mostly related to its health insurance system …as much as $82 and $272 billion in 2011.
The truth is no country is exempt from corruption.
Patients across the board are vulnerable and easy targets when money is diverted to doctor’s pockets and away from priority services. But this ‘medical malaise” as it were has continued to elude and prove complex for the medical fraternity to address. Either this or the fraternity have chosen to turn a blind eye while some amidst them unscrupulously ‘enrich themselves’.
In India rampant corruption at all levels and the practice of paying bribes for services is double that found globally. The payment of bribes to just get that ‘little quicker’ attention or a little extra attention is suppossedly ingrained in people’s psyche. Something like money can buy everything …even life!
Dr Samiran Nundy in his editorial piece in the same issue of British Medical Journal, supporting Dr. David Berger’s views writes “resistance is often not an option for those working within corrupt systems”. David Berger’s experience of the Indian health system highlights how corrupt practices can steadily erode the trust and respect with which doctors were previously regarded.
India as it is lacks external accountability and oversight of both public and private health sectors. There is acute shortage of doctors. Those who are there work in underfunded and inefficient public sector but they remain there because of the security of the job and with time bound promotions and the job comes with little supervision from the headquarters. On the other hand those in better paid private sector jobs are incentivised to generate business for their employers by over-investigation and overtreatment of patients who are at their mercy both medically and financially.
Private medicine is said to have flourished in India because of a weak regulatory climate with no standards to monitor quality or ethics. Better governance requires rigorous legislation and functioning administrative mechanisms to provide fiscal oversight.
The almost missing general knowledge level amongst the public about sanitation and hygiene is another contributory factor that encourages the system to get corrupted. Patients put their lives in the hands of doctors and medical assistants without wanting to question the decisions which doctors take. Often this trust is misused by unscrupulous practitioners.
A simple yet powerful model for change is presented by the “transparency wall” that appeared in villages under the Mahatma Gandhi National Rural Employment Guarantee Act. Through information sharing, communities were empowered to monitor disbursement of funds under the scheme and prevent malpractice. Similarly, the Right to Information Act provides a powerful tool to bolster the involvement of citizens in government functioning and to hold public officials accountable.
It will be challenging for patients and doctors to take on a system mired in corruption. Simple and effective channels for complaints must be established, and appropriate legal support and protection provided to whistleblowers.
Looking deeper, underlying issues such as education and social justice must not be forgotten if the battle against corruption is to be sustained and eventually won.
Doctors have allowed sleeping dogs to lie for too long because of fear, lethargy, and complicity. It is time for the medical fraternity to wake up and put in corrective measures in place.
To heal another is a great gift to give. It does’ nt come freely nor easily. But even doctors cannot take this gift for granted. When that happens to a doctor he loses sight of the ailing man and his problem and is in danger for losing his gift to heal.
