For the Delhi government, medical tourism is fine as long as the patients are from foreign countries, bringing precious dollars to the capital’s corporate hospitals. But, the Arvind Kejriwal government has found it difficult to manage the huge influx of non-Delhiites to state-run hospitals. It has, therefore, decided to limit inpatient facilities at the biggest state hospital, named after Guru Tegh Bahadur, to those who produce proof that they reside at a Delhi address. The move has been challenged by an NGO, and the Delhi High Court is checking whether the restriction is violative of the rights to life and equality.
The Delhi government, however, has argued that owing to an overburdened All India Institute of Medical Sciences (AIIMS), run by the Centre, the influx of patients from across the country is diverted to the GTB Hospital. Also, patients from far-off villages and towns throng government hospitals for their free services.
This is a problem that is not peculiar to Delhi. Medical infrastructure is under tremendous strain in most states, especially those with a well-organised system, like Maharashtra, Karnataka, Telangana and Gujarat. Speciality hospitals run by the state are groaning because of the rush of local residents and outsiders. Speciality hospitals in Hyderabad, Mumbai, Bengaluru and other state capitals, and even in some districts, are overrun with patients who are lured by cashless surgeries and advanced treatments. It is only now that the Union government is coming up with a dozen replicas of AIIMS in many states, otherwise Central government hospitals are meant for special categories like railway employees, factory workers (under employees’ state insurance) and defence personnel.
Also, there are local mafias that organise treatments for patients from other states in connivance with the staff of state-run hospitals. As beds are difficult to get, these mafias do wholesale business. When a government hospital in Bengaluru insisted on a local address proof, the mafia had no problem. It ensured that the patients, even before their arrival, had an Aadhaar card, and even a ration card!
The Indian Medical Association and other organisations representing government doctors have been arguing that there should be a strict limit on the number of patients treated by a doctor in a day. This is to ensure that the doctors are not fatigued and also get time to update themselves about the latest medical advances. There are suggestions of following the European system of issuing hospital cards to local residents, but that would require a local network of hospitals, with adequate specialist doctors as well as paramedical, support and administrative staff, in every state. There are also suggestions that more charitable hospitals should be encouraged and supported by the state to avoid expanding an already puffed-up public health system.
The crisis is acute because experts argue that there are not enough doctors or hospital beds. Against a World Health Organization recommendation of one doctor per 1,000 patients, the country has one allopathic doctor per 2,300 patients. But the rate is niggardly when it comes to specialists and surgeons. Of the seven lakh hospital beds, 4.3 lakh are in urban centres and 3 lakh in rural areas. But, there are serious doubts whether these facilities actually exist or they are mere statistics. In crowded hospitals, it is common to see beds being shared and patients lying on the floor. States like Bihar, Bengal, Uttar Pradesh, Odisha and Jharkhand have not invested much in health infrastructure.
But, a critical question—which is being argued in the Delhi High Court and which will have a ripple effect in other states—is whether hospitals should restrict their services to those who are domiciled within a specific area or should it be an open-door policy for all those who live in India.
sachi@theweek.in