The government aims to shift focus from ‘sick-care’ to ‘wellness’ by promoting prevention and well-being. It intends on gradually increasing public health expenditure to 2.5% of the GDP. Plans are afoot to strengthen health systems by ensuring everyone has access to quality services and technology despite financial barriers. The policy proposes increasing access, improving quality and reducing costs. It proposes free drugs, free diagnostics and free emergency and essential healthcare services in public hospitals.
These are some of the aims which are part of the health policy presented by the Central government as part of the national health policy. What about Goa, is the business of healthcare attractive to help the residents of this State aspire to something similar to what is being promised by the Centre.
There are certain realties in Goa which cannot be ignored. As the chairman of the Alcon Group, Victor Albuquerque, said “The first challenge faced in setting up a Tertiary Hospital in Goa is the question of numbers. Goa is a small State with a population of approximately 1.8 million and there are innumerable nursing homes and small hospitals to cater to the primary needs in medical care and health. As a result you will find that hospitals like Wockhardt have closed down. Secondly all medical treatment is free at the Goa Medical College Hospital which may have been set up to cater to the under-privileged and not so privileged. However all take advantage of this hospital since it has all the specialties and is free. Now in view of the Govt setting up the DDSSY scheme and with most hospitals empanelled with the Govt under this scheme, there is an increase in business in the other hospitals. But since the overheads are very high in a tertiary hospital it is not much of recompense. Even small hospitals and nursing homes have specialised consultants/ doctors and hence the patients see no need to go to higher end hospitals unless there is an emergency and the specialized treatment is not available in the small hospitals”.
Ajoy Estibeiro a healthcare professional with over 25 years experience agreed with the assessment but also added that the absence of corporate insurance meant those who had insurance had it at an individual level. These numbers were just not adequate in the State. He said “There should be an effort by the banks to popularise their schemes. The third party mechanism can guarantee healthcare. Non insurance is a big problem in healthcare.”
Another senior executive in the healthcare industry in the State, Girish Babu Bommakanti, unit head, Manipal Hospitals said “It is very expensive at existing rates to operate a hospital in the State. It is a very difficult job to operate a hospital in Goa in the private sector. In the last couple of years three hospitals were shut down. No private investment is coming into health care in Goa. The cost of operation increases by 40% every year. The hospital needs water, electricity 24×7 and the charges are pretty high. Then there is the small matter of all the equipment which has to be maintained and new ones purchased”.
Another executive at a smaller hospital who did not want to come on record said “It is important to remember that Goa does not have a health policy. The government ensures a certain level of health service which is provided by GMC and its ilk. The State government does not promote GMC overtly nor does it care about corporates setting up hospitals over here. There is no policy on this front. Remember if tests are not available at the GMC, they are provided by the private sector which charges a fee which can be substantial for some. Then there is a ruckus created, which can be avoided. The private sector can step in. Insurance should be made mandatory, so payments are guaranteed. The healthcare standards will improve and more hospitals with modern facilities will be established.”
Another senior executive said there were stringent quality standards for private hospitals but none for GMC which meant ultimately the patient suffered.
When asked if setting up a hospital in Goa made business sense, Victor Albuquerque said “No-however depends on who is setting it up. If it’s a tertiary care hospital, there are not enough numbers in Goa to justify any returns. However in case of small hospitals or nursing homes which are doctor driven, the case may be different, otherwise we would not have had so many nursing homes set up all over the State. It is also possible for small nursing homes to be viable as their overheads are much lower.”
He went on to say that he did not visualise the situation improving in the next five years. He said “I cannot see much improvement in the setting up of tertiary hospitals as the numbers cannot increase drastically in Goa over the years. It only can improve if the hospital sets its sight on medical tourism which can be a revenue earner but then it would require Govt. support and proper marketing of the Hospital. Goa has all it takes to become a medical tourism hub but no concerted effort has been made either by the Govt or by private players to attract medical tourists.”
Corporate hospitals will be needed in a couple of years as the demography of the population slowly changes. Yes, it is a young population but the number of older folk in need of specialised medical assistance will only increase.
