Draft Report of the High Level Group on Services Sector

Chapter 5: Healthcare Services

Public institutions played a dominant role in the Indian Healthcare sector in the past, in the urban as well as in the rural areas. However, the public healthcare has been on a serious decline during the last two or three decades because of non-availability of medical and paramedical staff, diagnostic services and medicines. Consequently there has been a pronounced decline in the percentage of cases of hospitalized treatment in Government hospitals and a corresponding increase in the percentage treated in private hospitals, despite higher costs in the private sector.

The Group is of the view that it is imperative for the health and safety of the population to enforce minimum standards on clinical establishments in both the private and public sectors by laying down minimum standards and enforcing them rigorously. The Clinical Establishments (Registration and Regulation) Bill, 2007 having been introduced in the Parliament it would important to ensure that it becomes law at the earliest and that it enters into force for all the States. The next step would be for the proposed National Committee to set appropriate standards for all categories of clinical establishments.
Implementation of the minimum standards will only be the initial step for improving the quality of healthcare institutions in the country. The next step for improving their quality should be for all stakeholders to advocate that these institutions take advantage of the accreditation system already established in the country. It would be important for the Central and State Governments to take steps to enable the clinical establishments in the public sector also to avail of the accreditation system.
National Commission for Enterprises in the Unorganised Sector (NCEUS) proposed health insurance scheme for BPL families to cover the entire BPL population of 30 crore (5 crore families) in five years time. The High Level Group recommended that the Health Insurance Programme for BPL categories be implemented at the earliest.
The overriding requirement in the country is for increasing the supply of human resources at all levels, from specialists to paramedical personnel and to improve their quality. The Group is of the view that the only way to accomplish this is for the medical education sector to be opened up completely for private sector participation and companies to be allowed to establish medical and dental colleges just as they have been allowed to open nursing colleges. Other entry barriers such as the requirement of land and built up space need also to be lowered to realistic levels in order to facilitate the opening up of new colleges. Government’s role should be limited to opening a few high quality institutions dedicated to research.
In order to improve the quality of education in Government medical colleges it is necessary to give incentive to the teaching faculty. Wherever possible they should be allowed to undertake private practice and in other cases granted handsome non-practicing allowance.
The establishment of the regulatory Paramedical Council is crucial for expansion of training facilities and for improvement of the training programme in respect of paramedical personnel and the High Level Group expressed the hope that the law will be enacted shortly. In addition Government should encourage private players, including large hospitals and hospital chains, to undertake training programmes under the regulatory control of the Paramedics Council. A development council for taking wider initiatives for the training of paramedical personnel could also be considered.
The High Level Group is of the view that the qualifications of doctors and radiologists who have been trained in the UK or other foreign countries should be recognized by the Indian Medical Council on an exceptional basis in order to increase the pool of quality medical personnel available to the Indian service providers and increase their competitiveness in providing service for medical value travel, telemedicine as well as clinical research.
The Group considers the shortage of trained personnel to be the biggest challenge for improving the country’s competitiveness in the field of clinical research. The Group recommends the establishment of a Clinical and Medical Research Council with the participation of the private sector for formulating, promoting and running training programmes for the area.
The Drugs Controllers office needs to be suitably strengthened and manned with personnel (including guest personnel from abroad) who are equipped with knowledge of the latest advances in medical research. A world class testing laboratory should be set up in the country in the PPP mode, where the Central Governments gives assistance for construction of building and purchase of equipment but the management is undertaken by the private sector. Arrangement needs to be made for accreditation of CROs for the purpose of certifying their adherence to Guidelines for Good Clinical Practices.