Healthcare in India
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Healthcare in India
Selection of Articles, Opinions, Discussions and News on Healthcare in India from all over the web covering Healthcare Policy, Healthcare Reform, News, Events, #HealthIT , Edipdemics, Chronic Diseases, #mHealth, #hcsmin ,
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Indian Healthcare Sector is witnessing a huge transformation

Indian Healthcare Sector is witnessing a huge transformation | Healthcare in India | Scoop.it

India is one of the world’s largest democracies and the way it makes a mark on the global map being a powerful and emerging economy, it gives positive insight about the future prospect of the country.

 

Healthcare, being India’s one of the largest sectors both in terms of revenue and employment, has witnessed a huge transformation in the last decade.

 

The latest technology and innovative digital tools have led the Indian healthcare delivery system to get evolved in terms of providing enriched healthcare experience to masses especially in the front of clinical outcomes.

 

With the Government undertaking many measures to bolster patient care and private players playing equally pivotal roles, the sector is making giant leaps to enable people at large to avail accessible and affordable healthcare.

 

The healthcare sector is projected to become 8.6 trillion by 2022. The unprecedented growth of the healthcare sector is due to a range of factors including spike in non- communicable diseases, a considerable increase in income of the middle class, more awareness, quest for quality care, and easy access to service providers.

 

The government also seems to be determined to provide quality health for all. With this objective, the spending is set to be increased to 2.5% of the gross domestic product by 2025.

 

Even though the healthcare sector is growing, there is low accessibility and affordability for most of the population as the insurance coverage is less plus the costs of healthcare are also rising.

 

Some of the biggest factors for limiting healthcare accessibility include:- 

 

1. We have 7 beds for 10,000 population whereas globally it is 26 beds.

 

2. There are more medical professionals in the urban area than in the rural areas/villages where a large strata of our population lives with low accessibility to healthcare.

 

3. The insurance coverage is also very low as compared to other countries leading to an increase in out-of-pocket expenditure taking a toll on the patients.

 

4. There is a shift in disease patterns from communicable to non- communicable diseases like diabetes and cardiovascular disorders. The cardiovascular diseases are the highest known cause of death especially in the younger age group in India.

 

The way technology is making an impact, the time has come when just doctor-patient engagement is not enough. With continuous technological growth, the healthcare industry is going to be more based on “Value-based care “ outcomes in the coming days.

 

New trends as per Vision2024 would be–

 

1. Healthcare will go mobile.
2. New strategies to deliver low-cost healthcare will be on the rise.
3. New drug pricing models will be unveiled.
4. Behavioral healthcare will see more acceptance.

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Cancer Cure: Breakthrough 

Cancer Cure: Breakthrough  | Healthcare in India | Scoop.it

In a breakthrough in research, IIT-Bombay scientists have developed technology to leverage a patient’s immune system to cure cancer.

 

Researchers made use of gene and cell therapies to reengineer immune cells to attack and kill cancer cells in the body.

 

Such immunotherapy using CAR T-cells, a treatment for cancer, which costs Rs 3-4 crore in the US, can be made available for Rs 15 lakh if the technology is developed in the country. 

 

 

Purwar's team has been working on CAR T-cell technology for six years. ''It is an autologous cell therapy for personalized medicine, where cells are taken from patients, re-engineered and re-infused in the patient. We got immune cells from volunteers and clinical patients with help from TMH and re-engineered them using the technique. The modified cells were positively tested in laboratories on artificially grown cancer cells.'' said Purwar. 

 

T-cells (a type of white blood cell or WBC), an integral part of the human immune system, can identify tumors and destroy them. But in advanced stages, the cancer cells adapt to the presence of T-cells and remain undetected. In the new approach in immunotherapy, called CAR (chimeric antigen receptors) T-cell therapy, the T-cells ability to detect and kill cancer cells is restored. CARs are the protein that assists T-cells to recognize and attach to protein or antigen, present on cancer cells. These proteins help to destroy cancer cells.         

 

''Our team has delved into strategies that would improve the efficacy of the technique and demonstrated that a single injected dose can lead to multiplication of modified T-cells that can destroy cancer cells,'' said Punwar.   

 

Globally, over 600 clinical trials are in progress for CAR T-cell therapy, many of which are on in China said, Dr. Narula from TMH. 

 

''It has got huge potential. With the cancer burden, we have, the therapy will be considered a success, even if it is applicable to only a fraction of patients currently. Technologies are being developed globally, but are exorbitant. There are high expectations from this technology as it can create pathways for developing newer technologies, for newer therapies, for more forms of cancer. Thousands of Asians can benefit,'' said Narula. 

 

Read More: https://timesofindia.indiatimes.com/city/mumbai/iit-bombay-scientists-now-develop-cheaper-tech-to-cure-cancer/articleshow/72483167.cms 

 

 
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Why is India’s healthcare system in such a sorry state?

Why is India’s healthcare system in such a sorry state? | Healthcare in India | Scoop.it

R Srinivasan’s credible government document on healthcare in India titled ‘Health Care in India – Vision 2020’ draft published in 2004, sub-titled ‘Issues and Prospects’, has suggested four criteria that make a just healthcare system 


1. Universal access, access to an adequate level, and access without excessive burden.

2. Fair distribution of financial costs for access and fair distribution of burden in rationing care and capacity and a 
constant search for improvement to a more just system.

3. Training providers for competence empathy and accountability, pursuit of quality care and cost effective use of the results of relevant research.

4. Special attention to vulnerable groups such as children, women, the disabled and the aged.
 
Srinivasan's  draft is dated; but the criteria are relevant even today as India’s healthcare system remains in a very sordid state.


A recent study by IMS Institute of Health Informatics (19 July, 2013) has revealed that 72 percent of the rural Indian population has access to just one-third of the country’s available hospital beds while 28 percent of urban Indians have access to 66 percent of the total beds. The study also notes that those living in remote pockets have to travel more than five kilometres to access an in-patient facility, 63 percent of the time.


Evidently, the country’s historical spend on healthcare, apart from immunization programmes, has not been enough. WHO statistics show the total expenditure on health is 4.4 percent of the GDP, for a population of 1.27 billion. As a result of a low healthcare spend and lack of special attention towards this sector and absence of concrete regulatory policies, India’s healthcare system is in shambles.


Here is a picture of the current healthcare scenario:
 
Universal Access and Financial Costs: The IMS study noted that long waiting time and absence of diagnostic equipment at public facilities has caused an increasing number of patients to rely on private healthcare facilities.  Quality of treatment is also a reason why patients switch to private centres. However, this shift from public to private care is posing an affordability challenge to poor patients.
 
Training and distribution of Health workforce: Statistically speaking, Indian cities have four times the number of doctors and three times more nurses than in rural areas. Meanwhile, almost 80 percent of the medical colleges are located in South and West India. The direct impact is a dearth of trained professionals practicing in rural India.






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Genetic labs, counselling centres under health department's lens

Genetic labs, counselling centres under health department's lens | Healthcare in India | Scoop.it

The absence of adequate checks on genetic labs and genetic counseling centres functioning in the state has prompted the health department to inspect them for possible misuse of sex determination technology.

Sonography centres have to submit form 'F' which gives details of a pregnant woman undergoing an ultrasound scan. Similarly, genetic counseling centres must maintain form 'D' while genetic laboratories need to fill form E.

However, 'health officials have been lax in inspecting the records at these centres', states the letter issued by the state health department to civil surgeons and civic health officials in the city on August 3.

Health authorities said the genetic labs have Pre-implantation Genetic Diagnosis (PGD) facilities, which allows testing of the embryo before implantation and hence the daily monitoring of their functioning is crucial.

state health official, on the condition of anonymity, said, "The fact is that there has been no monitoring of genetic labs and genetic counseling centres functioning in Maharashtra. So, we have ordered civil surgeons in rural areas and civic health officials in cities to carry out inspection of such labs and centres and report to us every day."

Asaram Khade, a consultant to the state government on Pre Conception and Pre-Natal Diagnostics Techniques (PCPNDT) Act, said, "We have started consolidating the exact number of genetic labs and genetic counselling centres functioning in the state. We have issued orders to civil surgeon and municipal corporation health officials to inspect these centres and report to us about the same in the format prescribed.

Like inspection of form F, officials have been told to report to us the daily scrutiny of form D meant for genetic counseling centres and form E for genetic labs."

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What ails India's healthcare sector: Abhijit Banerjee

What ails India's healthcare sector: Abhijit Banerjee | Healthcare in India | Scoop.it

Here is where we have a huge problem. Ayushman Bharat does very little for primary healthcare.

 

It has been announced that 1.5 lakh health and wellness centers will be set up, partly to deal with primary healthcare issues including NCDs – but, given the budgetary allocation of less than Rs 1 lakh percenter, this looks more like a very minor upgrading of the existing sub-centers and/or primary healthcare centers (PHCs).

 

Similar and sometimes more ambitious upgrading, including the provision of some free medicines, has been attempted by a number of states in the past; but, for the most part, there has been no reversal of the trend towards a wholesale exit from public healthcare, especially in North India.

 

There is now a substantial body of work that documents that, in many states, more than three-quarters of visits to primary care centers are to private providers – even though most of these providers have no medical qualification whatsoever.

 

This is in part because the sub-centers are open intermittently and unpredictably, and doctors and nurses are often missing from the PHCs.

 

It seems unlikely that small investments in these sub-centers and PHCs will change all that; the patients will probably continue to stay away, and therefore using these as the basis of outreach for NCDs and other public health interventions probably have limited potential.

 

The obvious alternative is to make use of informal providers who do have access to the patient population. It should certainly be recognized that they have the potential to be a public health hazard, especially because they abuse antibiotics and steroids – which contributes to rising resistance.

 

However, the policy response to this phenomenon has been mostly to declare these informal providers illegal and then to ignore their existence. This essentially deprives us of the primary tool for dealing with the very serious health problems that we are facing.

 

We need to think of ways to integrate them better into the overall healthcare project and give them better incentives, which would be easier if they had something to lose. Based on this we suggest the following steps.

 

Recognize and train informal healthcare providers.

 

A randomized control trial that was carried out in West Bengal (published in Science, 2016) shows that training private sector informal healthcare providers to improve their performance (measured by sending them ‘fake’ patients) by a very significant amount. Based on that, West Bengal has already begun training many thousands of informal health providers.

 

Develop a set of cell-phone-based checklists 

 

For treatment protocols for these practitioners to use, to react to the common symptoms they face. This is similar to what Atul Gawande has proposed for the United States (but much more basic).

 

Develop a simple test that allows the government to certify these practitioners as health extension workers.

 

Passing this test will allow them to deliver various public health interventions and perhaps be paid for participating in them. Moreover, evidence suggests that the patients are aware of the value of such certification and trust those certified more.

 

Recognize those who are certified

 

As the front line of defense against NCDs and malnutrition. Think of ways to reward those whose referral leads to the detection of a serious ailment.

 

Enforce existing laws

 

That makes it impossible for these practitioners to dispense high-potency antibiotics and steroids. This includes shutting down stores that violate the existing laws about who can prescribe what. At the same time, make it legal for informal providers to prescribe a range of less critical medicines, much like the nurses.

 

Expand the number of MBBS doctors and trained nurses

 

Coming out of the system and consider introducing some other intermediate degrees for practicing a limited range of healthcare. This is the model we had before Independence and the one that many other countries have adopted.

 

In addition, it is not clear that the government should rely entirely on the private sector to deliver tertiary care within PMJAY. There are already complaints from the healthcare sector about the prices the Indian government is proposing, which might result in many hospitals opting out and others selectively refusing to deliver certain treatments (even if that is against the rules). 

 

PMJAY will probably relieve some of this pressure on these public hospitals. However, it still makes sense for the government to try to simultaneously improve the delivery of secondary and tertiary care in the public sector.

 

Given that public hospitals will be able to bill their patients to PMJAY, which gives the public hospitals stronger reasons to compete with the private sector, it is a natural moment to expand this part of the government system. Therefore, we recommend, for secondary and tertiary care:

 

• Build a second district hospital in every district headquarters outside the state capital. Once it is built and is operational, refurbish and modernize the existing district hospital and bring it to acceptable standards.

 

Finally, it is very difficult to improve healthcare substantially unless we get the customers to demand better care (to fear antibiotics, seek out tests, and so on). This has to be a priority for any government. This is our final recommendation:

 

• Carry out public health campaigns to raise the awareness of NCDs, immunization and the dangers of overmedication. Recent evidence suggests that entertainment-education may be a very powerful device in this regard.

 

Read More: https://www.telegraphindia.com/culture/books/nobel-laureate-abhijit-banerjee-on-what-ails-india-s-healthcare-sector/cid/1711667

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UP court fines doctors Rs 5,000 for poor handwriting  - suggests that medical reports be computer typed 

UP court fines doctors Rs 5,000 for poor handwriting  - suggests that medical reports be computer typed  | Healthcare in India | Scoop.it

The doctors writing prescriptions in illegible handwritings are under the scrutiny of law in Uttar Pradesh now. The Lucknow bench of Allahabad court set an example by imposing fine of Rs 5,000 each on doctors writing in “poor handwriting”.

 

Three different cases of doctors writing in running handwriting were reported from Unnao, Sitapur and Gonda district hospitals. The injury reports of the patients were said to be “not readable”

 
However, the doctors defended themselves, saying the illegible handwriting was due to the extensive workload.
 

The court further directed principal secretary home, principal secretary medical and health and director general medical health to ensure that in the future medico reports are prepared in easy language and readable writing. The court also suggested that such reports should be computer typed instead of being handwritten.


The medico-legal report, if given clearly, can either endorse the incident as given by the eyewitnesses or can disprove the incident to a great extent. This is possible only if a detailed and clear medico-legal report is furnished by the doctors, with complete responsibility," the bench observed.
 

 

curated from  https://timesofindia.indiatimes.com/city/lucknow/court-fines-doctors-rs-5000-for-poor-handwriting/articleshow/66061795.cms

and   https://www.news18.com/news/india/up-court-fumes-over-shabby-handwriting-of-doctors-slaps-rs-5000-fine-1898123.html

 

 

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India is the place to be, say home-bound doctors

India is the place to be, say home-bound doctors | Healthcare in India | Scoop.it

After technology sector, it's the health sector in Bangalore that is witnessing a reverse brain drain. Across fields-nephrology, general medicine, pathology, orthopaedics and oncology among others, doctors are returning to India in general and Bangalore in particular.


On an average big medical hospital chains in the city each get 8 to 10 applications every month from Indian doctors in the US, the UK, Canada, Australia and Singapore. "I interview one doctor a week. And in the last six months I have got 12 applications for jobs from doctors abroad. They are all in their 30s," says Dr H Sudarshan Ballal, medical director, Manipal Hospitals.


The scene is no different at Sparsh Hospital on Narayana Health City campus where chief orthopaedic and hospital head Dr Sharan Patil scrutinizes at least 10 applications every month from doctors in the UK, Australia and the US.

"There is no bigger canvas to paint yourself than in medicine. Two decades ago when doctors left India, the opportunities were few. Today opportunities outweigh frustrations. After the training, they want to return," says Dr Patil, who himself spent five years in the UK before returning to the city to become a doctor-entrepreneur.


Ten of the 40 orthopaedicians at Sparsh are those who have returned from abroad. "I began to feel I was making no difference in my job and decided to leave Australia. I find it more satisfying here. But it is good to study and train abroad for some time," says Dr A Thomas, spine surgeon, who practised for five years at St George Hospital, University of South Wales.


Hospital honchos are seeing the trend only in the past five years. In many hospital chains of Bangalore, the entrepreneurs are doctors themselves who left practice in the dream country where they were and came back home.

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