From the desk of Dr KK Aggarwal National President, IMA Generic drugs prescription The current Read more →
Save Small Medical Establishment
Dr A Marthanda Pillai, Dr K K Aggarwal
Draft with input from Team IMA
1. Single doctor clinic and approachable cost effective small medical establishments with less than ten beds provide over 80% of health care delivery . Survival of these small hospitals has a very important bearing on the Indian healthcare system. They provide cheap, affordable , accessible, approachable, quality care with personal touch.
2. The new corporate health care weather single clinic based or ten bedded set up is machine centric and cost escalative. A lot of private equity is coming towards relatively low cost healthcare chains which specialize in one field. Big hospital chains are rushing to small towns. But the same ultimately will raise the cost of treatment and the smaller establishments will start vanishing from the society
3. Smaller medical establishment to cut the cost may lack in some aspects of hospitality and use of cutting edge technology. They will have core clinical care but may lack in support activities.
4. Small medical establishments, most being established in neighborhood residential areas, save money in the land cost
5. Any corporate set up would involve buying land at high prize, huge capital expenditure, buying and replacing expensive equipments and more cost on hiring human resources
6. With over 100 acts to comply the cost of any corporate set up is very high
7. Unfortunately the insurance companies are not covering cost of patients in medical set-ups with less than 10 beds. Under Rashtriya Swasthya Bima Yojana(2007), for Rs.30 a year each family receive 30K coverage in medical care. Out of 8crore poor families, already 1.5crore families are enrolled. But, Only 4000 hospitals are empanelled.
8. Smaller establishments through the IMA will need to fight for their rights. The minimal norms need to change to 5 bedded hospitals and not ten bedded. Insurance companies need to recognize day care centers and single doctor clinics
9. Make sure the treatment cost is low & QUALITY HIGH.
1. Reduce the procedure cost and make profit through volume of work
2. Administrative costs to be contained to 3% of a patient’s bill.
3. Adopt IT in health care: Use telemedicine in radiology, intensive care unit .
4. Transform from GP to FP(Family physician) with GMP.
5. Smaller establishments also need to reduce their cost further and insist in quality. They must rely on cheaper quality drugs; learn the concept of ethical earning; buy equipments through equipment protection scheme of IMA; bargain on the costly of equipments through IMA; get their institution or clinic accredited by IMA and by NABH through IMA HBI; sign up cheap maintenance of medical equipments through IMA; and through IMA extend the life of CT, MRI, Cath Labs and all these expensive machines from the current seven years to 14 years. They also should adopt IT in health care and make hospitals paperless and filmle
6. There is lot of scope. According to WHO standards, the number of beds required is 4 per 1,000 populations, so there is a tremendous scope for growth. Out of this growth small hospitals will contribute to 80% of the beds. Presently, it is almost 600,000 crore industry. 20% Of the $33 billion that Indians spend on healthcare, is spent in smaller towns
7. IMA should fight for a single Window clearance and permissions for these establishment
8. IMA should peruse for amendments to insurance stipulations – empanelment to hospitals, clinics, day care centers irrespective of bed strength and floor-space index. Empanelment criteria should be categorized as rural, semi-urban and urban hospitals.
9. All doctors should use universal disease management protocols- stipulated and structured only by medical associations but not by Govt
10. IMA should ask the government to provide soft loans (4% interest) to these set ups. Also small hospitals should be out of the ambit of CE act implications ,ESI regulations and FIRE SAFETY regulations. Small hospitals are professional service centers and not commercial outfits. Duty on medical equipment and devices should be removed.