What is health care?
In the development index of a country, the coverage available for health care is an important criterion. Health care is a term, which is comprehensive to cover diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in human beings. Health care is delivered by practitioners in allied health, dentistry, midwifery (obstetrics), medicine, nursing, optometry, pharmacy, psychiatry and other health professions. It refers to the work done in providing primary care, secondary care and tertiary care, as well as in preventive public health measures.
Health care primarily consists of prevention, screening, diagnosis, treatment and rehabilitation. All these aspects can be standardised having in mind the requirement of safety. If well organised, it need not be expensive on use of available technology with efficiency and effectiveness. The important aspect of providing health care is to enhance the availability of vocational training for health workers and faculty specialising in training them as was pointed out by Dr.Sanjay Singh of AIMS. There is considerable body of literature provided by World Health Organisation (WHO). With a robust financing mechanism, well trained work force, reliable information to base decisions and policies with advice on logistics to deliver quality health care, significant results can be achieved.
Health care helps productivity by reducing absenteeism and loss of trained staff by premature death. It promotes well being not merely in physical health but also mental health if properly devised. Significant progress has been made by complete eradication of small pox and control of malaria. It would advise formation of groups of trained professionals, para professionals in different branches of medicine and all those engaged in public health services and volunteers for community work to have a system of preventive, curative and rehabilitation care services. Health care is classified as primary health care, ambulatory care and urgent care.
Health care going digital is a major step as pointed out by Dr.Robert Wachter in his latest book “The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age”. He regrets that though digital medicine replaces the eye contact between the doctor and patient, it has greatly helped easier availability of medical aid. He feels that some sections of population like senior citizens are not computer-savvy, so that greater exposure to computer learning is one of the requirements not only for ensuring immediate health care, but also various other advantages of modern life. Digital tools for health care would now make it possible for all to avail health care benefits by enabling contact as between the patient and service providers including the State.
Health care today
In view of the fact, that health care makes a contribution to the gross domestic product (GDP), it occupies a significant part of country’s economy. The outlay on health care exceeds 10 per cent GDP in the developed countries, while in India its stagnates at 1.2 per cent. Budgetary allocation for this year is even less making a mockery of our Prime Minister’s assurance that the Government is working tirelessly for a healthy India.
Government policy now relies upon insurance making it cheaper with subsidy by making it universal.
India has a vast shortage of not only doctors but para-medical assistants, trained nurses and other staff, but what is promising is that, there is potential of people who can adapt themselves to provide competent assistance with some effort on the part of those concerned with health care to train them.
Health care according to the United Nations International Standard Industrial Classification consists of hospital activities, medical and dental practice activities and other human health activities, which includes supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities for the sick along with allied health professions, like optometry, hydrotherapy, medical massage, yoga therapy, music therapy, occupational therapy, speech therapy, chiropody, homeopathy, chiropractics, acupuncture, etc. Health care also comprehends ensuring quality of medical equipments, instruments and services like bio-technology, diagnostic laboratories and manufacture and delivery of drugs and other substances. Progress in bio-pharmaceutical field is rapidly advancing health effort.
Mr. Malcolm Gladwell would point out that rather than the amount of quantum available, what is necessary is qualitative assistance. Any scheme of the Government should follow the advice “Don’t be a Goliath, dare to be a David”. There is vast scope for innovation in having a health plan by an integrated planning within the reach of all. Insurers can play a major role in ensuring affordable hospital services.
Some pioneering efforts
Gram Vaani: Community service through media has made it possible to get medical assistance through a community media in the name of Gram Vaani meaning “Voice of the Village” started in 2009 reversing the flow of information bottom up instead of top down. It was incubated out of IIT Delhi and has got more than two lakhs users in seven Indian States with membership in Afghanistan, Pakistan and South Africa. Exposure of corrupt ration shop officials and indifference and inefficiency of public servants through media is as popular as Facebook/ You Tube/ Twitter providing contact with remote and rural areas with updates of local village events, folk songs and cultural feed back. Complaints to the Government are promptly attended to in view of the wide publicity attendant for such voice request to help lines. Live broadcast of Panchayat meetings have helped participation of the entire population of panchayat. Though it is not primarily intended as health care effort, it offers a broader platform, where health care is made available in areas, which are not otherwise possible.
AIMS: Amrita Institute of Medical Science (AIMS), Kochi is another pioneering institution with exclusive health service. There is an interplay of science, technology, finance and human resources. Information through internet under the modern devices, studies undertaken in different areas by the student community in their locales will all go a long way. AIMS has extended its health services beyond its campus with extensive infrastructure with 25 modern operating theatres, 210 equipped intensive-care beds all fully computerised with networking information system with clinical laboratories working all the 24 hours as telemedicine services. It partakes the goal of World Health Organisation towards “new universalism” with massive health care treating over 7,79,055 out-patients and 47,577 in-patients last year with a team of physicians, surgeons and other health care professionals with support of 2000 computers with every aspect of patient care with patient information including lab testing and radiological imaging readily available at the click of a button.
PURA: Providing Urban Amenities for Rural Areas (PURA) scheme with participation of a coterie of voluntary organisations like schools, a polytechnic, colleges monitored by Periyar Maniammai University for a group of 52 villages in Thanjavur and Nagapattinam Districts has been making pioneering effort to provide integrated services with health care being one of them.
Health care – Tomorrow
Primary health care should be generally available from general practitioners or family physicians or even from non-physicians. Primary care provided like physiotherapist, or a physician assistant or practitioners of indigenous medicine may be given formal training because they are the main suppliers of health care in poorer and rural areas. Those persons in primary service may refer cases to secondary or tertiary centres, wherever necessary. The problem of ageing with increasing number of adults due to rise in life expectation has led to the risk of chronic non-communicable diseases, which can also be tackled by primary health providers, if they are trained to provide them with such care as pointed out by World Health Organisation.
Secondary care is generally characterised as hospital care. U.K. and Canada dispense with referral process to qualify for services from medical specialist by permitting self referral for its social security scheme for free medical treatment. Most professionals provide secondary care.
Tertiary care is specialised consultative health care usually for in-patients on referral involving advanced medical investigation and treatment relating to cancer management, neuro surgery, cardiac surgery, plastic surgery.
Prevention is better than cure
Preventive aspect is an important feature of health care. Creation of interest in public health by education of all those connected services and the public, purveying knowledge of potable drinking water and food safety. Community rehabilitation services can assist those with loss of limbs and other functions and would include prosthesis, orthotics and provision of wheel chairs.
Dealing with problems of ageing is another important feature of health substituting old age homes with help of trained volunteers is another preventive activity.
Educating children in eating habits, making physical education compulsory in schools and teaching young adolescents to have positive self- image are some of the non-medical preventive measures.
Role of the State
The role of the State is to make ample allocation of funds for health, make health insurance social, reduce out of pocket expenses and mobilise donations for charities, connected with health services. Health information technology, management and informatics generally understood as eHealth is a major activity today. It involves application of computer hardware and software to a very large extent collecting data and making it available at all levels not only for decision making, but also for research with enlarging network making the progress of health care universal and expeditious.
Health research is the most important matter, which is progressing at rapid strides with the great interest created in bio-technology with 80 per cent of world research and development on this field. Social models for those with disability and old age are other matters of interest. The research helps to improve what is clinically useful, timely and sensitive to cultural and other changes at low cost and in building up standard procedures.