27 April,2010

Health… is wealth?
These days, our State’s apex health institution the Goa Medical College and Hospital at Bambolim, bears the look of a construction site. Though the GMC campus is itself fairly new—it was built only in the mid-1980s, and part of it first utilised for the fledging Goa University—it is being renovated on a major scale.
It’s perfectly fine to want to keep up with the times, to expand and to grow more efficient. The problem is, however, that despite so much money being spent on building and maintaining the ‘infrastructure’, the average citizen of Goa still gets an abysmally poor deal with it comes to health-care.
Politicians like the double-FRCS former health minister Dr Wilfred de Souza presided over the construction and shift-over from the old GMC Complex in the heart of Panjim to Bambolim. Given the strong contractor lobby overactive in the State, it might not be fair to just blame our politicians alone, but a lot has indeed gone wrong. In recent times, health minister Vishwajeet Rane has come up with so many new—and some controversial—initiatives and plans. The question is: will this at all offer hope to the patient?
After spending many crores on concrete, and despite it (or because of it), the health system in Goa seems to be creaking. Much of the health budget goes into building structures and paying salaries. This is more than obvious from the fact that patients are made to bear a heavy bill whenever they fall sick. With the cost of medicine going up sharply in recent times—thanks to changes in the patent laws and other factors — this becomes extremely difficult on not just the poor but even the middle-class. What is the point of offering “free” treatment, if the medicines are so un-affordably costly?
Besides this, GMC and Goa’s district hospitals too clearly face managerial issues. Look at the long queues, crowded wards, difficult sanitation situation, and it becomes more than clear that Goa is being short-charged.
Another problem area is the manner in which Goa has been—or rather, has not been—building up its own skills and infrastructure. In recent years, the Goa government’s approach (regardless of which party has been in power) has been to promote the Mediclaim policy. If a particular line of treatment, or specialisation, is not available in Goa, then a patient can claim a reimbursement for treatment in hospitals outside the State.
So far so good. This almost seems to be a win-win-win situation. The patient gets the healthcare without paying for it. The government meets its obligation. And the insurance companies do their job.
But the situation is not that simple. Why should outstation hospitals benefit as the taxpayer’s money gets channelised via the insurance firms involved? More than that, such a policy has resulted in the neglect of Goa’s own infrastructure. In the name of claiming outstation treatment for free, nothing has been done to build up specialisations here—for treatment even of heart or cancer complications for instance. Beneficiaries of Mediclaim also drop hints about how patients could be getting diverted away from the best hospitals, and how there is reason to suspect on what basis beneficiary hospitals are chosen.
The test of the pudding is in the eating. When our VVIPs, including the politicians and their kin, fall ill, they prefer to bypass Goa’s own health-care system, which they themselves had a hand in creating.
There are many committed doctors, nurses and other health professionals manning our hospitals. Hospitals still retain a touch of kindness, despite all the collapsing infrastructure, over politicisation and political interference, and intense corporatisation of the health-care sector. But our hospitals are no longer centres of efficiency, which once attracted patients from well beyond Goa’s borders. Today, many from Goa trek to Belgaum, Manipal, Bombay, Bangalore, Vellore or Madurai to meet their health-care needs. We need to ponder why this is happening; at the very least, the professionals in the system should be given a chance to manage affairs efficiently and as per their own judgement.