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It is common to encounter discussions about health issues, health insurance, and the rising cost of hospitalizations when people gather. While there is frequent mention of the demographic dividend due to a younger population, there is often little awareness that life style diseases among the young and ageing population are leading to higher healthcare costs.
Recognizing the need for a robust healthcare system and to serve the rural population, Government of India established a committee in 1943 under the chairmanship of Sir Bhore to survey country’s health conditions and organization. Report was submitted in 1946, with key recommendations being:
- Establishment of three-tier health care system— Primary Health Centres, secondary units, and district hospitals.
- Integration of preventive, promotive, and curative health services at all levels.
- Reform of medical education by introduction of standard MBBS qualification.
- Creation of a major central institute for postgraduate medical education and research, which later led to the establishment of AIIMS (All India Institute of Medical Sciences).
Committee’s report laid the foundation for comprehensive healthcare in post-independent India and shaped the structure of nation’s primary healthcare system. State governments began establishing Primary Health Centres and expanded secondary healthcare units. However, limited funding and shortage of qualified Doctors hindered extension of health services to every village, and development of tertiary care units was largely neglected.
Medical education and healthcare were traditionally considered the responsibility of the government. Due to limited resources, governments could not establish as many medical colleges as needed, resulting in inadequate number of graduates. Only a few medical colleges offered postgraduate courses, prompting several graduates to go abroad for higher qualifications and specializations, which further exacerbated the shortage which resulted in demand for private sector involvement. Kasturba Medical College in Manipal, established in 1953, became the first private medical college in the country.
Medical education in USA was disorganized in late 19th century. Abraham Flexner (1866–1959), an influential American educator, critically assessed 155 medical schools in North America and exposed widespread inadequacies in medical education. In 1910, he submitted the landmark “Flexner Report,” which drew on concepts from Britain and Europe. The report exposed serious shortcomings and led to reforms that shaped the structure and standards of medical education in the USA.
Flexner Report called for higher admission standards and rigorous scientific training. It emphasized that medical education should be grounded in rigorous science and closely connected with universities, using Johns Hopkins School of Medicine as the model. The report led to a major reform of medical education in USA, resulting in the closure of many institutions due to substandard facilities.
Medicine is both a science and an art. High teaching standards and the quality of medical education were largely maintained before rapid proliferation of private medical colleges. However, once medical education became a business, staffing issues emerged, including problem of “ghost” faculty. This has led to deterioration in educational quality and increase in inadequately trained graduates.
In 1983, India’s first corporate hospital, Apollo Hospital, was established in Chennai, marking a significant shift in country’s healthcare landscape. At that time, there was strong resistance to viewing healthcare as a business; most people relied on government hospitals or those set up by trusts, which generally lacked the facilities and specialized doctors required for comprehensive tertiary health care. Determination of founders and growing needs of the community led to Apollo’s success. Availability of quality medical care attracted patients from all segments of society, including the economically disadvantaged, who sought treatment because of hospital’s advanced facilities and high success rates.
This successful model was soon replicated by others, making profit a primary motive for healthcare investments. As a result, management and treatment expenses began to soar, and health insurance became essential to cushion patients against burden of large medical bills.
Government hospitals are crucial for bridging healthcare gap for the middle class and the poor. However, pace of development remains slow due to bureaucratic processes. Additionally, shortages of professional staff, investigative facilities, and medical supplies contribute to inadequate patient satisfaction.
Corporate hospitals continue to face criticism, with concerns that patients are often investigated and treated for isolated symptoms rather than holistically. There is frequently no single doctor assuming overall responsibility for a patient’s care; instead, patient management is divided among multiple specialists, each focusing on their own area of expertise. Despite these observations, one undeniable benefit is that tertiary treatment is now available in tier II cities and towns, bringing advanced care closer to patients.
Education and medicine were once regarded as “noble” professions, but entry of businesses and investors has commercialized both fields. This shift has led to declining standards in medical education and soaring treatment costs, signalling that the country has crossed the Rubicon—a point of no return.