| DoctorNDTV: Does the Indian health care industry have any problems? If yes, how would you tackle these? | | Dr MS Valiathan: The Indian health care industry is growing rapidly and shining, which is a partial, if not deceptive, picture of Indian realities. Our central problem is access. PHCs are dysfunctional; the services at Taluk and District hospitals dismal; as a result, the common man is compelled to seek private medical care through out-of-pocket expenditure, which is one of the highest in the world. The only answer is social health insurance, with the Government paying the premium of those below BPL. The Central and State Government have taken some action on these lines, but it has been patchy and inadequate.
The second major problem is quality – of infrastructure, of hospital services, laboratories, etc. If the Government hospitals are, by and large, in bad shape, the majority of nursing homes and hospitals in the private sector (barring corporate hospitals) are not much better except they may not be overcrowded. There should be separate autonomous bodies to lay down standards for PHCs, Taluk/District hospitals, tertiary institutions, etc.; and for accrediting them. In the absence of accreditation, the institutions should not be eligible for reimbursement by insurance. Many of these suggestions have been made by Committees in the last 10 years but the follow-up has been poor.
The third issue is the lack or absence of innovation. We are obliged to import 90% of high-end instruments, devices, etc. for our hospitals at high cost and replace them every 3-5 years at still higher cost. This pushes up the cost of specialized care in say, cardiology, neurology, etc. and makes them unavailable to 90% of Indians. MNCs estimate their Indian market as 200 million who can pay – a billion who can’t do not exist in the commercial landscape! The remedy is to develop a strong instrumentation industry – in partnership with MNCs, if necessary – with the global market in view, but a differential pricing system for the developing and developed countries. | | |
| DoctorNDTV: What, according to you, are the attributes of a good doctor? | | Dr MS Valiathan: Knowledge, practical skill and compassion; all three are indispensable. | | |
| DoctorNDTV: What has been your most recent professional milestone? | | Dr MS Valiathan: A recent milestone was to be made a National Research Professor by the Government of India, which is a great honour. | | |
| DoctorNDTV: What do you think are your greatest achievements? | | Dr MS Valiathan: Developing the Sree Chitra Tirunal Institute, Thiruvananthapuram from scratch into an Institution of National Importance by an Act of Parliament in six years. The Institute offers not only first-rate hospital services in cardiology and neurology for common people, and postgraduate training programmes for doctors from all over India, but also promotes the joint culture of medicine and technology. The soundness of this policy is evident from the commercial success of TTK-Chitra heart valve, blood bag, oxygenator, etc., which are widely used in India and also exported to several developing countries. | | |
| DoctorNDTV: Do you think enough is being done to produce prostheses? How would you encourage production? | | Dr MS Valiathan: We are doing too little R&D in the field of medical instrumentation or devices technology; the industry is rudimentary; and the Government, after prodding for 20 years, has still no Devices legislation to regulate the marketing of instruments and devices! This despite the fact that the demand for medical instruments was Rs. 6300 crores in 2003 and estimated to grow at 15% a year. The problem is serious and calls for urgent action. The Sikka Committee of INSA (2004)on “Instrumentation in India” studied these issues and made several important recommendations. It’s call for a “Technology Mission” for medical instrumentation was endorsed by the Prime Minister in his address to the Science Congress in Ahmedabad (2005). But there has been no action on the Report. | | |
| DoctorNDTV: Would you like to tell us about any recent development in your specialty? | | Dr MS Valiathan: Cardiac surgery has witnessed major innovations in instrumentation, bioprosthesis, operative techniques, transplantation, etc. and above all, in simplifying procedures to reduce hospital cost. As none of these innovations – even for reducing cost – originated in India, there is no point in discussing them. We are proud to be followers, with no aspiration to lead. | | |
| DoctorNDTV: Do you think Indian health websites are useful? Your views about Doctor NDTV? | | Dr MS Valiathan: Yes, the young population who visit websites for information is growing rapidly in India. Doctor NDTV is therefore playing a significant role in health education. But one should not forget that health websites are currently not accessible for the “teeming millions” of Indians. | | |
| DoctorNDTV: Do you think the autonomy of premier medical institutions in India is deteriorating? | | Dr MS Valiathan: I believe that autonomy in Government - funded institutions is a myth. The politician and bureaucrat do not want it; and those in charge of institutions are culturally programmed to refer every issue to the Government for “prior approval” even if the rules do not require referral. Statism rules. | | |
| DoctorNDTV: What would you have been if not a doctor? | | Dr MS Valiathan: A versatile drummer. | | |
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