Is it time to clean up Indian health care system?

Even as we bask in the glory of yet another Indian winning the Pulitzer Prize for a brilliant "biography" of the "emperor of all maladies" - cancer - there is an urgent need to focus on the many cancers that have already gained entry into the Indian health care system.

If left unchecked and untreated, these cancers could soon advance to subsequent stages and terminally debilitate the already precarious health care delivery apparatus that caters to 1.2 billion Indian citizens.

The first of these cancers, and perhaps the most worrisome, is the emergence of malpractice in the as yet nascent "organised" health care delivery sector.

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Increasingly, we get to hear stories from patients and their attendants who claim to have been subjected to uncalled-for (expensive) investigations and medical procedures, extended stay in hospitals, and unnecessary visits from "specialists" who come to patients' rooms merely to mark their attendance and add visitation fees to the bill.

Also reported are instances of irregularities in pricing, with prices and procedures markedly different - and higher - for those covered under some kind of medical insurance.

Even worse is the deteriorating quality of outcome despite inflated costs.

There is understandably a vehement denial from many of these operators or a studied silence since there is little regulatory or market-driven pressure on them.

Currently, India has less than 700,000 functional hospital beds, of which more than 40 per cent are located in the top-20 cities.

On a conservative note, given the geographical spread of population, India urgently needs almost one million additional hospital beds and another million by the end of the decade.

The second of these cancers is the unchecked proliferation of adulterated and expired medicines and devices across India.

There are no reliable estimates of the extent of penetration. However, considering that most government agencies tend to under - report the magnitude of this malaise, the number could be as much as 20 per cent - or even higher - of all drugs.

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Delhi (and north India) seems to be the hub of this nefarious trade.

The third of these cancers is the unregulated entry of unqualified medical practitioners into the health care system.

Under the garb of accepting, and even encouraging, all forms of medicinal systems, including those with little or no scientific basis, India has created a situation in which there may be more quacks than qualified practitioners.

Going by Medical Council of India data, there are less than 650,000 qualified medical professionals in India.

This estimate could be guided by optimism. India urgently needs an additional 750,000 to one million doctors if universal access to health care is to be attempted.

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With the current capacity of less than 45,000 seats for Bachelor of Medical and Bachelor of Surgery, and less than 10,000 Doctors of Medicine, it isn't surprising that all kinds of charlatans flaunt fancy fake qualification certificates and ply their trade openly.

If fake pilots can gain entry into airlines, it is far easier - and more lucrative if not as glamourous - for doctors to start business by putting a signboard outside their shop.

At the same time, the entire Indian health care delivery system, practitioners and service providers are not be tarred with the same brush.

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There are tens of thousands of exceptionally talented, committed and conscientious doctors.

Similarly, hundreds of independent operators continue to offer high-quality, affordable and reliable health care services.

The worry is that these cancerous developments could affect the healthy and the good in the near future.

Further, as described by the Pulitzer Prize-winner in his book, each type of cancer requires different approaches to tackle and "resilience, inventiveness, and survivorship" of the "patient" are equally important.

Thus, all the stakeholders in the Indian health care delivery ecosystem would do well to acknowledge that that there is a problem and it could threaten lives if immediate and radical steps are not taken.

The root cause and the lines of treatment are, fortunately, known to these stakeholders.

They just need to take urgent, firm and decisive steps.