Daily Editorial Analysis for 31st December 2019

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For a personal healing touch

Paper:  GS II & GS IV

Topic:  Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.

For Prelims: The NITI Aayog’s healthcare plan.

For Mains: Government Policies & Interventions for Development, Health Infrastructure in India, and  Medical ethics.

Why in News: The NITI Aayog’s healthcare plan was released in November 2019 titled ‘Health Systems for a New India: Building Blocks—Potential Pathways to Reforms’

NITI Aayog releases Report on Building a 21st Century Health System for India

With insights to transform the Indian health system in the twenty-first century, the report presents a preliminary menu of strategic choices available before India to reform its healthcare system.

  • By placing health at the centre-stage of the policy narrative, this report charts a clear roadmap for the complete transformation of India’s health system.
  • It focuses on breaking silos in the health space and removing fragmentation between various initiatives, ensuring greater convergence between ministries as well as the Centre and states, as already initiated under Ayushman Bharat.
  • Primary healthcare is extremely important for all. India is in a very hopeful situation to set an example for other countries.
  • The private sector needs to be involved to meet key challenges.
  • The report identified 5 focus areas of future health system,
    • Deliver on unfinished Public health agenda.
    • Change health financing away from out of pocket so spend into large insurers.
    • Integrate service delivery vertically and horizontally.
    • Empower citizens to become better buyers of health.
    • Harness the power of digital health.
  • Highlighting the need to build India’s opportunities, the vision for health over the next fifteen years is to transform the delivery of health services in a way that they improve at a much greater pace, without financially burdening its citizens.
  • Key health system themes of financing and provisioning, with a focus on risk pooling, strategic purchasing, health-service provisioning, and digital health.
  • Highlight that investments in strengthening the current health system will reap tremendous social and economic dividend for India.

Issues associated with NITI Aayog’s healthcare plan

  • Not to be a supermarket system: The NITI Aayog’s healthcare plan should not end up emulating America’s supermarket system. The evolution of more and more organised structures like Health Maintenance Organisations (HMOs) in the forthcoming years, which were criticised for turning healthcare into a marketable commodity sold by unfeeling healthcare providers in supermarket-like institutions, destitute of traits like empathy, regard and loyalty. As the fact that U.S. healthcare ended up as one of the most impersonal healthcare systems.
  • Problematic proposition: The NITI Aayog’s proposed 15-year plan for Indian healthcare outlines prospects of such an infelicitous turn in Indian healthcare. While the report makes otherwise commendable proposals for health system strengthening including elimination of informality, merging of fragmented risk pools, and reduction of out-of-pocket health spending the proposal to consolidate small practices into larger business-like organisations appears problematic on multiple fronts.
  • Favouring consolidation could be a harm? That nearly 98% of healthcare providers have less than 10 employees is identified as a negative trait, to be dealt with through a set of incentives and disincentives favouring consolidation.
  • Commodification of healthcare: Apart from cost and competition-related concerns, an enthusiastic pursuit of it could portend an exacerbated commodification of healthcare from the bottom-up. The report’s bent towards the U.S. HMO model further adds to such a foreboding.
  • Loss of personal touch: In a setting of overcrowded public hospitals, and profiteering healthcare enterprises, where the patient-physician interaction is largely fleeting and transactional, mistrust in the healthcare provider and its gruesome implications are not difficult to anticipate.
  • Doctor-patient relationship considerations: However, the subtle, fuzzy, and perceived non-urgent nature of problem keeps it from assuming significance to policy-makers as a result of which doctor-patient relationship considerations are largely invisibilised in the policy discourse in favour of more pressing concerns like lack of funds and manpower. Time and again, however, this omission has surfaced in the performance of health systems worldwide. As India looks forward to a long-term healthcare plan, neglecting this consideration could be of sizeable consequence.

Measures that can be adopted to revive health infrastructure

Role of a family physician for patient satisfaction:

  • Loyalty and longitudinality form vital pillars of the patient-physician relationship. The edifice of these is built upon a substratum of mutual trust, warmth, and understanding that accrues over time between a patient and their personal physician.
  • For patient satisfaction: Momentary and haphazardly physician-patient interactions in a system that limits access to one’s ‘physician of choice’ are incapable of fostering such enduring relationships. It is in this context that the role of a family physician becomes instrumental. Apart from providing comprehensive care and coordinating referrals, a family physician’s longitudinal relationship with their patient helps in a better understanding of the patient’s needs and expectations and in avoiding unnecessary clinical hassles and encounters which in turn reflects in better outcomes and increased patient satisfaction.
  • Widespread commercialisation of care over the past few decades has entailed that the family physician is a dying breed in India today.
  • And it would be of little surprise to learn that this has a sizeable role in impairing the doctor-patient relationship, manifesting popularly through violence against healthcare providers.

Advantage of small clinics

  • Studies have demonstrated that healthcare received in small clinics indeed scores higher in terms of patient satisfaction than that received in larger institutions.
  • This increased satisfaction manifests as better compliance with the treatment regimen and regular follow-ups, culminating in improved clinical outcomes.
  • Indeed, disregard for this aspect in health services design is bound to entail a sizeable cost to the health system.

The need for empathy

  • A popular myth often floated is that considerations regarding emotive aspects of healthcare such as empathy and trust are disparate from, and thus cannot be realistically factored into, hard-headed health policy and system design considerations.
  • But, in reality, these are entirely amenable to cultivation through careful, evidence-based manipulation of the health system design and its components.
  • It would necessitate, among other measures, installing an inbuilt family physician ‘gatekeeper’ in the health services system who acts as the first port of call for every registered patient.
  • The Government has already taken a minor, yet encouraging, step of sorts by introducing Attitude, Ethics, and Communication (AETCOM) in the revised undergraduate medical curriculum.
  • The plan needs to be revisited to ensure that healthcare clinics delivering patient care don’t transform into veritable supermarket stores marketing medical services any further.


  • Over the last few years, India has embarked on a journey towards providing improved access to high-quality, affordable healthcare for the most unreached and vulnerable population of the country. Many indicators, however, continue to show significant scope for improvement.
  • India now needs to build on its many opportunities to achieve further progress on the health of its citizens and respond to the growing aspirations and needs of a New India.

Way Forward

  • At a systems level, overcoming the challenges of fragmentation, across healthcare financing and service delivery will help us optimize both quality and access.
  • A systematic review and meta-analysis of randomised controlled trials have established that the patient-clinician relationship has a statistically significant effect on healthcare outcomes.
  • The NITI Aayog’s long-term plan provides a good opportunity to envisage such long-called-for reforms, but that would require not the U.S. model but the U.K. model to be kept at the forefront for emulation.

Mains Question

The fact that U.S. healthcare ended up as one of the most impersonal healthcare systems. The NITI Aayog’s healthcare plan should not end up emulating America’s supermarket system. Analyse.


Question Demand: Question demands to write about the changes that are needed in the health infrastructure so that the UK model of health care is adopted.

Introduction: Mention the need for reform in the health care system not from the infrastructure point of view but also from an ethical prospect.


  • Explain the importance of personal touch in health care.
  • Issues associated with commercialization of medical health care system.

Conclusion: Suggest steps that are necessary to chalk-out by the Government and policymakers to adopt a multipronged approach for the medical system in India.

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