Tuesday, April 10, 2007

"FREE" Cardiac surgery by private hospitals

I read with interest, the statement (reported by both NST and the STAR) that the honorable Minister of Health had just returned from a visit to Bangalore. I am sure that he was very impressed that Indian healthcare is cheap - much cheaper then in Malaysia. With his new found knowledge, he now wants private hospital to provide cardiac surgery at minimal cost (which the press translated to "free") to two or three cases a year. Possibly his concern is based on the 2-6 month waiting for cardiac surgery in the public hospitals.

We were asked to comment, and of course (through our FPMPAM president) we support the idea (it would be political suicide not to). On the level of a grand plan, this one scores top marks. The devil, of course, is always in the details. Here are a few thoughts.

The first that comes to mind is that public healthcare spending is set at a measly 3.6% of GDP (at last count). The hon. MOH should convince his colleagues in Govt. that they can afford to allocate more for healthcare. A level of 5% of GDP is deemed as reasonable for a developing country. Perhaps once they start putting their money where their mouth is then we would be happier to do the same.

Even for the 3.6% of GDP that we are spending, are we spending it fruitfully? Building fungus-infested hospitals that cannot be used is a waste of money and denies necessary treatment from needy patients. Goodness me, some of those may even be these heart patients we are hearing about. The present system is seen to have too much wastages and too many inefficiencies.

Secondly, the use of public hospital resources. Senior consultants including heart surgeons are called for meetings at Putrajaya, at short notice, so that they have to abandon their surgical cases in favour of going to Putrajaya. Let's keep the few doctors we have in public service productive for as much of the time as possible.

Thirdly, we do have a heart institute, funded by public money through a grant. I think that they should do some charity for deserving cases. I am certain that if many of their consultants reduce their "conference"  travelling, more cases could be done. The amount of trips some of the IJN consultants take, is not in keeping with government service or private practice. They don't have to skimp on too many trips though, enough to cover two or three cases mentioned a year is enough.

Fourthly, one must never forget, that the bigger share of patient's bill at discahrge following heart surgery is the hospital bill.The doctors portion is generally about 20-25% of the total bill. Even if the doctors waive their charges, the bill is still substantial. I hope that the hon. Minister will also speak to the hospital about giving minimal cost treatment for deserving cases.

Fifthly, I spoke to many of my cardiac surgeons in private practice and they tell me that they have been reducing charges for deserving cases,for  many years. It was all done low-key, without press statements or TV cameras. Obviously, many of them are not standing for elections.

The hon minister forgets that, yes cardiac surgery here is more expensive then India and maybe Thailand, but we are much cheaper (by half or more) than Singapore, Australia, Taiwan, Japan, England, USA etc. All said, yes, Doctors in private practice should continue to do their bit for deserving cases. The Ministry of Health should look at their own backyard and see how to improve services to cut done waiting list time. They must make their own service more efficient.

Lastly, do not threaten us with the new PHCFS Act.What a cheap thing to do.

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