Guest column: Too much focus on tertiary healthcare, what about basics?

It’s not only curative care that impacts the health of an individual, but also nutrition, water, sanitation, housing, gender, employment, education, caste, religion, geographic area and so on. If a government invests in the social determinants of health, the people are likely to be usually healthier. There are four tiers of public health care – preventive, primary, secondary and tertiary. While all four are important, most diseases can be addressed at the first two levels. It is only serious or complicated cases that should require tertiary facilities.

In India, unfortunately, most of the focus is on the tertiary level of health care. The insurance model of healthcare that India has adopted on a large scale, directs most of the resources of the country to tertiary healthcare, 70 per cent of which is currently provided by the private sector.

Let’s take lung cancer as an example. The private sector will not profit if the population receives health education to stop smoking as a preventive measure. Neither will it benefit if a lung disease is picked up and treated early so that it doesn’t advance into a more complicated or malignant condition. This is the same with many other diseases of the heart, liver, kidney and other organs.

Often one hears doctors moaning about how they spent so many years studying medicine and that it is their right to make money. But the reason the curriculum is stretched for so many years is because the body is extremely complex and one needs to invest time to understand how it operates in sickness and health. There are many professions where one can make money, but if one enters the medical field with the primary agenda of getting rich, then it will not be long before one has to sell one’s soul. Doctors with such a goal begin to thrive on cuts and commissions, unnecessary tests and procedures, denial of care, negligence, clinical trials, medical tourism at the cost of local patients, particularly the poor and so on.

It is important that doctors as individuals try to make private healthcare more responsive to the needs of the community. If this doesn’t come from them and the bodies that govern the profession, then it will come as an external form of regulation. They shouldn’t then really complain.

— Dr. Sylvia Karpagam, a public health doctor and researcher