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Bharatiya Healthcare Policy – A Pragmatic View

It is heartening to know that Arogya Bharati is interacting with eminent healthcare professionals with nationalist mind set to create a ‘Bharatiya Healthcare Policy’ which is practicable and implementable with limited resources at our command for benefit of all citizens. When 30% of the Indian population live below poverty line and cannot afford two meals a day, it is even more challenging to provide reasonable healthcare to all. ‘Health for all by 2000’ could not be achieved due to policy failure. Now it has been extended to 2020.   Dr. Gautam is right that maximum budget is spent on reactive medicare delivery establishments, drugs and devices which is getting costlier day by day, than preventive healthcare for communicable and non-communicable and lifestyle diseases.
            According to WHO, United States spends more on healthcare per capita ($8608) and as percentage of its GDP (17.2%). Most of the population under 67 is insured by health insurance by employer or some buy on their own. However 16.3% of the population cannot afford and are uninsured as reported in 2010. Institute of Medicine (2004 report) said that US is among the few industrialized nations in the world that does not guarantee access to healthcare for its population. This is the position in free market economy. Under medicare, Health Maintenance Organizations (HMOs), which cover maximum healthcare costs, the health insurance policy holders can go to only to doctors and hospitals on the HMO plan’s list and to specialist only on referral. UK and Canada have Federal supported National Health Insurance programmes managed  by provincial and territorial governments to provide medicare to all residents to have reasonable access to medical services.
            Judicious expenditure on health and education should be considered as investment for Nation’s Health and development. With limited Health budget and traditional wisdom on healthy living, how best we can address to the healthcare  of all citizens, needs thorough study. Unfortunately there is no social security plan in India which has to be given urgency it deserves. Planning Commission deliberates on healthcare in India-Vision 2020 and confirms substantially unrealized goals of NHP 1983 due to funding difficulties and organizational inadequacies. Should we not blame unrealistic planning and monitoring for this failure in the health policy?  Good health confers on a person or groups freedom from illness – and the ability to realize one’s potential. Healthcare covers not merely medical care but also all aspects of preventive care. Population, finance, training and managerial problems should be thoroughly studied for methodical planning and executing the plan for successful implementation. We have to take care of communicable and non-communicable / lifestyle diseases of children, adults and senior citizens. Safe drinking water, sanitation / hygiene and balanced diet and immunization (children in particular) are to be given thrust to control communicable diseases. Health Education on Healthy Yoga Lifestyle should be vigorously implemented to control non-communicable and lifestyle diseases to decrease healthcare costs. Further extensive research has to be supported on Traditional Systems of Medicine such as Yoga & Naturopathy, Ayurveda, Meditation to maintain body and mind in sound condition and to make a productive living. Integrated medicine units should be started in all rural hospitals manned by trained doctors in Allopathy & AYUSH areas. Further medical colleges should have Holistic Medicine departments with Yoga & Naturopathy, Ayurveda and Community Medicine actively involved in clinical service and research. India with its ancient wisdom and prevalent practice of Traditional medicine in rural areas, is in best position for active research programme in Holistic healthcare. Many national health policies such as National Rural Health Mission etc are only on paper and are not vigorously implemented and monitored. Sri Sathya Sai Snajeevani Hospital at Naya Raipur is doing commendable work under Divine Child Health Programme, through timely detection of disease, disability, defects and deficiency by systemic screening and providing health relief to school going children in Chhattisgarh state. This needs thorough study regarding generation of committed personnel and resources required. Kasturba Hospital has an attractive health insurance plan to make the individuals, family and rural community to be aware of their health needs and benefit from the hospital service.
            The Summit on Integrative Medicine & the Health of the Public, Washington DC, February 2009 states that the disease-driven approach to care has resulted in spiraling costs as well as fragmented health system that is reactive, episodic, inefficient and impersonal. The Holistic approach puts the patient as the centre addressing not just symptoms but the real cause of illness. The progression of many chronic diseases such as cardiac disease and cancer can be reversed and sometimes even completely healed by making Lifestyle modifications. National Center for Complementary and Alternative Systems of Medicine has classified CAM as (1) Alternative Medical Systems (Ayurveda etc.); (2) Mind-Body interventions (Meditation, Prayer, Music etc.); (3) Biological based therapies (herbal medicine, special diet etc.); (4) Manipulated and Body-Based methods (Chiropractic approaches) and (5) Energy therapies (Qi gong etc.). A consortium of 44 medical schools in United States who have support of their Deans have a mission to help transform medicine and develop innovative healthcare combining conventional medicine and traditional medicine. The relationship between Spirituality and Medicine has been focus of considerable interest in recent years. It is realized that Body, Mind and Spirit are integrally connected and consideration of Spirituality (Prayer) has been shown to help in better healthcare outcome. Yoga based healthy lifestyle is an old traditional and spiritual way of living for prevention and management of non-communicable / lifestyle diseases. Pranayam and Meditation reduce stress and improves quality of life. Mindfulness Meditation Based Stress Reduction Programme (MBSR) is being practiced in over 200 hospitals in US and is currently the focus of number of research studies. Dean Ornish has proved that Yogic Way of Simple Life, vegetarian diet and stress management causing reversal of blockages in the coronary arteries.

There is urgent need for committed managers and task masters for thorough planning and successful implementation. Medical education and public health services should be integrated and Medical college hospitals should work like Health Maintenance Organizations (HMOs) partly supported for services by Central and State Governments. Thus medical college hospitals will be able to get more patients registered and also provide affordable and reliable preventive and curative care to all citizens under a new Bharatiya Healthcare Policy.

June 6, 2014                                                                Prof. B.C. Harinath