"INDIAN PRIVATE PRACTICE AND DISCONTENT WITH THE INDIAN DOCTORS DR. PETER MWENDWA KITHOME MBChB(Nrb) ,MMed(Surg),Nrb Fellowship, G.I. Surgery/HPB/Liver Transplantation. Sir Ganga Ram, New Delhi. PhD student, Asan Medical Centre, S.Korea SUPERVISION Prof.S.Nundy, Emeritus Prof of G.I. Surgery & Liver Transplantation, Dean of Post-Graduate studies, Sir Ganga Ram Hospital, Delhi.

HISTORICAL/CULTURAL INDIA World’s largest democratic country 18 Official languages,325 different languages.(2 official,43) 3rd World’s largest economy, by GDP on Purchasing Power parity(PPP)( 21st Oct.,2015)(World bank) 1.USA,2.China 2nd Largest pool of Scientists and Engineer, BUT 9th in Citable publications (SCIMAGO,2015) Largest English speaking nation in the world. Corruption Perception index 85/174……Kenya 145/174(2014)

INDIAN PRIVATE PRACTICE AND DISCONTENT WITH THE INDIAN DOCTORS BACKGROUND Total expenditure $90.4B(Ksh.9 Trillion) Government 33%, Private 67%(Largest in the world) The problems facing India’s health care system have a greater impact on the poor. Doctors 80% in private sector Private Hospitals(60%) Dispensaries75%, are situated in urban areas.(Jan,2013) 1 Million die from TB, more than half million, diarrheal diseases

Government allocation & Market potential The government identified H/care as priority, but to private sector more than state owned institutions.3:1 The driving factor in H/care is blooming population at 1.2B Annual population growth is at 2%, to surplus China in 2030 or before. 75% of the population is in rural India, where h/care is scarce or absent at all( Ayurveda medicine takes role).

Government role in H/care There are 29 states ( Kenya 47 counties) Seven Union territories. STATE (Min of health & Family welfare) Central(Policy,planning,guidance) State (Independent in service delivery) Local/periphery(H/centres, Dispensaries) AUTONOMOUS STATE BODIES Established by act of parliament/State legislation. These are : NIMS,AIIMS,SVIMS,Tirupathi,Dehli,PGI Chandigarh etc.

S.Nundy, Editorial article,BMJ 2005 By 2005, India ranked 20 of the world’s countries in its private spending, at 4.2% of GDP. Employers-9%;health insurance 5-10%, and 82% is from personal funds. 40% of all patients admitted to hospital have to borrow money or sell assets , inherited property or farmland. Private h/care perform unnecessary diagnostic tests and surgical procedures, Indians are choosing the private sector in overwhelming numbers Public alternative is worse, with long waits ,dirty surroundings with hordes of other patients.

INCENTIVES In a recent survey carried out by Transparency International, 30% of patients in government hospitals pay bribes or use influence At independence in 1947 the private health sector provided only 5-10% of total patient care. Spending on health has not been a priority for successive governments, and they have encouraged the growth of the private sector. Government subsidy to private sector by 1.Releasing prime building land at low rates (as long as a quarter of patients are treated free—a condition that is rarely met), 2.EXEMPTIONS from taxes and duties on import drugs and high tech medical equipment, and through concessions to doctors setting up private practices and nursing homes

CHALLENGES 30 years ago the private sector comprised solo practitioners and small hospitals and nursing homes With technology driven practice, smaller organizations,indivuals are surviving or closing up. Large corporations, Indians in diaspora, the rich have taken over such as drug and information technology companies. The private health sector in India has made some impressive strides at the cost of the public sector The government failed to impose the 25% rule of health care access to private for poor.

Indian v/s Kenya Doctor Starting salary for an MBBS doctor is Rs. 25,000 in government sector(Ksh. 40,000) Resident(SMO) Rs. 84,780 (Ksh. 135,648) Super-specialty Rs.  92,989 (Ksh.148,782 ) Highest earning Rs.15 Million(Ksh.25m){Private practise,Liver transplant} KENYAN Politics and holidays. No research. Research is reserved to Local/Foreign funding

TAKE HOME MESSGE IS IT NEW? No IS IT TRUE? Yes IS IT IMPORTANT? Yes SHOULD WE CHANGE? Yes