By DR. V. N. JINDAL

 VERY OFTEN, people ask me why GMC does not have facilities that are available in Jaslok or Hinduja hospital in Mumbai. When I tell them that MRI machine costs Rs 5 to 6 crores, they say this “is nothing” for a state government. They don’t realize that it is not only buying the machine, but running it also costs a fortune. The worst is that all these people expect free treatment including CT scan and MRI, while they pay for each and everything at Mumbai. Thus it is not fair to compare GMC with large five-star corporate hospitals that charge you a fortune even for a simple sickness, while in GMC you get everything for free. We must realize that the so called free treatment is in fact not free, as the same is being paid by the tax-payers.

 In a way GMC is a unique hospital, probably in the world, where the treatment is offered totally free to all the patients, irrespective of their paying capacity. This includes, provision of most expensive drugs (sometimes costing rupees three to four thousand per day), Implants (costing up to 35 to 70 thousand rupees), surgical appliances, other medical material and of course all the services. Even food is totally free (that itself is sometimes an incentive for some patients not to leave hospital)! Even poorest of the poor are eligible for treatment under Mediclaim in five star hospitals in neighouring states, and it is learnt that doctors/hospitals there are fully exploiting and cheating the government of Goa of the taxpayers money by inflating the bills to the maximum extent.

 Foreign tourists, who are heavily insured do not pay a single penny after receiving treatment in ICU and undergoing expensive investigations like C.T. scan that would cost them a fortune in their own country. When they are told that all is for free they are shocked. Is it practical? After all this is tax-payers money. Should not those who can afford to, pay for the treatment and those who can’t, for them the health care be subsidized? Though health care can’t be looked upon as a revenue earning facility, yet should we not, at least, partly offset the expenses incurred on healthcare by charging those who can afford to pay?

 Many people are of the opinion that health services should be totally free. Why charge the patients at all? Health is a State responsibility – hence treatment should be free. These populist measures have done a lot of harm to health care services in Goa. While it is agreed that health care is State responsibility – so is education, so is providing food, clothing and shelter to all. Do we get these facilities absolutely free? If not, why only health care?

 Education is free only up to primary level and selectively thereafter. In fact fee for most of the education institutes has been hiked many folds in last two to three years. Even the Apex court is in favour of decontrolling education. Similarly, except for a few people below poverty line, others have been denied access to subsidized food grains under Public Distribution System. Government does not give free clothes or houses even to the poorest of the poor. Thus, while it is the responsibility of the government to see that health care is made adequately available to every citizen; it need not necessarily be free. It is all the more important that State provides health care free of charge or subsidized to those citizens who cannot afford the paid services. This is possible only if those who can afford are made to pay.

 In the same context, we must understand that the primary aim of GMC is not to provide health care to the whole of the State, but is to train the health care personnel – doctors, nurses and technicians etc., who in turn will take care of health needs of the State. Similarly, medical research is another very important aspect of any medical college. Promotion of preventive medicine is the third important function of GMC. Care of the sick is in fact a bye product, required to be undertaken for the purpose of medical education and research. However, due to free medical treatment at GMC, the patient load is so much that the staff is always busy with patient care, thus rendering teaching and research secondary functions. This is unfortunate. This is harmful for the future of health care in Goa, because if the products of GMC i.e. the budding doctors are not well taught, the future health care will suffer.

 Free treatment at GMC also breeds corruption and malpractice. The patients are seen in private clinics, but are sent to GMC for free but expensive investigations. Thus, the doctor seeing the patient in private can charge more for his services at the cost of GMC. Similarly, the patients are examined at home or in private clinic but are operated in GMC. To give these patients a sense of importance, they are adjusted ‘out of turn’ on the operation lists. The poor, who cannot afford to pay, suffer. This also amounts to revenue loss to GMC.

 Free treatment does not mean equal opportunity to all the patients coming to GMC – though that was the noble aim. Influential people get examined, investigated and treated out of turn and poor who do not have the right connections remain moot spectators in the serpentine queues of the patients at GMC. The fact is that many influential and well to do patients come to GMC because of better facilities and expertise of the doctors there. Why not make them pay for the services? We must understand that affording patients spend anyway, though less, and the beneficiaries are the unscrupulous doctors at GMC or in private (who get free investigations done at GMC through their counterparts). The scrupulous and dedicated consultants on the other hand watch helplessly, but can do nothing.

 Free treatment also puts private practitioners at a disadvantage. Many patients, who can afford and would have consulted private doctors, come to GMC, because everything here is free. Thus, this results in less patients going to private doctors – who in Goa are large in number. This will result in malpractices, because after all the doctors have to earn a living for themselves.

 Even medical education has suffered due to free treatment at GMC. Because of the availability of free investigations, there is a tendency amongst doctors to develop short cuts in examining patients. Instead of detailed clinical examination, they order for expensive investigations. Even the patients demand these investigations knowing these are for free. This has a deleterious effect on medical teaching, as the students do not develop clinical acumen, that they would develop if they had to first examine the patients in detail and ask for investigations only in selected patients where required. The young doctors develop so much dependence on investigations for diagnosing the sickness, that they feel handicapped if the same are not available when they go in for practice. This is one of the reasons of the reluctance of doctors to go to villages. This kind of education will be disastrous for the society.

 The people in Goa have got so used to free treatment that it may not be politically prudent to change the system overnight. However, one can devise means to generate some revenue from health care and then the same can be ploughed back to create new facilities and expand the existing ones. We will discuss these means a little later.

 GMC in fact should act as a role model in health care. It should be a trend setter, where patients should be treated for difficult medical problems and not for routine day to day ailments. The health care of the population of the State has to be a collective responsibility shared by Public Health Department, private practitioners, private nursing homes and private hospitals. While, government funding will remain a major source of funds for GMC, at the same time GMC should be able to generate sufficient revenue. This is essential for development and further expansion of facilities at GMC. How this can be achieved, will be discussed in the next section on suggestions.

Back