• Appropriate concerns for patient needs
• Clinically updated
• Patient outcome oriented
• Know when to include a specialist in care/ refer the case (not hold onto patient)
• Ability to work in a team/ develop his team for delivering care
  

• Curriculum needs revision
• Limited and poor (in terms of quality) Post Graduate opportunities
• Post Graduate Medical Education in India is self paid- it ought to be subsidized; In the West based on the bed strength each hospital is allowed certain number of residents who are paid a salary for dispensing their duties along with enhancing their qualification.
• In India the Medical training structure is too hierarchical and reward for merit is not necessarily established.
• Inability to retain talent
• Greater effort, poor financial compensation
• Quality of Life

Medical training in India has not kept pace with the rapid changes in Medical field; our current curriculum does not include new subjects like Translational Medicine, Genetics, Molecular Biology etc.  Also, Indian students are not taught about current trends/ recent advancements in healthcare and management etc both of which are important for them to become physician leaders in future.
Also as a system we do not train our students to ask questions; students are merely left to deduce inferences from didactic lectures which are mostly one way communication.

Unlike West wherein Undergraduate studies primarily focus on practical skill development our curriculum is mostly didactic and delivered through old teaching methodologies. In India we are unable to retain talent because of multiple reasons; financial remuneration offered to our graduates is far below what their compatriots would be getting as Managers etc. Also, the number of years and efforts put in along with rigorous shift duties does not justify the paltry sum they make every month. Not to forget that reaching the top is a long arduous process in Healthcare. A physician essentially becomes financially comfortable in private practice in his 40’s- by which time his earnings primarily would be enjoyed by his family as he has little time to spare from his practice.

Also in India we have limited PG seats (not in proportion to the Undergraduates we churn out); hence to overcome the frustration Junior Physicians prefer to study and go abroad to enjoy better quality of life with greater professional satisfaction.

Yes, PPP is workable.

Limitations:

-Divergent views of Partners (Public/ Private) on intent of business
-Govt focus on Primary care, private focus on tertiary care

Bed to population ratio in India stands at 0.7 per 1000 against Global average of 2.7; for India to match the global standards we need to add 2 beds per 1000 population. To align Indian Healthcare with the current global average it is imperative that policy initiatives foster PPP and stimulate investment in healthcare sector.

CII subcommittee on PPP has recommended following:

-Offer land on a lease of 99 years
-Structure PPP through equity participation or infuse debt at subsidised costs of borrowing or provide extended tax holiday from a period of 5 years to 10 years for hospitals in tier 2 and 3 cities.
-Provide budgetary grants for capital and operating expenses of the systems covered under PPP
-Ensure non compete policy within a predefined geographical limit to ensure sustenance of the model.

Public private partnership model is workable in the health sector provided the project objectives and risks associated are established  clearly by both the parties. Other critical to success factors include developing performance measurement metrics, growth and expansion strategy, establishing clear and frequent communication with stakeholders and use of technology to ensure transparency.
The PPP should essentially focus on ensuring that it is not loss making (preferably profit making but not profiteering).

Limitations: Intent of the 2 partners i.e public party and private party tend to be divergent; Govt essentially leverages it to get to the vote bank whereas Private player consider it as an opportunity to get land at lower costs, build equity with Govt. Govt should essentially focus on Free primary care delivery and select Referral centers like PGI/ AIIMS. Whereas for providing enhanced quality healthcare coverage it is important for Govt to enter into PPP. (Private players shall bring Management expertise to the table).

Model needs to be well thought of as providing free care at the same cost destroys the viability.

• Lack of financial discipline (large funds available but not utilised)
• Poor Infrastructure maintenance
• Lack of accountability across services (support cum medical)  
• Equipment (downtime)
• Quality control
• Service delivery

• Access (enhanced) to private healthcare
• Cost of product (Price sensitivity)
• Outcome oriented
• Optimise costs

Medical Insurance shall have significant impact on the health care delivery system; for one, general populations ability to access to Private Healthcare shall be enhanced. From the delivery aspect organizations shall be challenged to deliver better clinical outcomes at controlled costs. Per procedure cost is likely to be capped by the Insurance provider and hence Private Healthcare Providers will have to rationalize their product price.

On the professional side, my former Chairman, Deptt of Medicine, NY who taught me one very important of medicine which was to listen to your Juniors and give them every opportunity to excel.

On the personal front I have been most influenced by my Father and now by my wife.