Deadline: April 10th, Transforming Health Systems

Deadline: April 10th, Transforming Health Systems
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Norms to start medical colleges may be relaxed

CHENNAI: The Centre is considering relaxation of regulations for starting medical colleges, especially in areas under-served by healthcare systems, Union Health Minister Anbumani Ramadoss has said.
The category “under-served areas” will be applicable to the northeast region and backward States, where the National Rural Health Mission is operational, he said. This measure was to handle the huge shortage of doctors in these States.
“A matter of concern”
Dr. Ramadoss said that while the country needed one lakh doctors, only a third of this requirement was being met. Every year, 32,500 graduates passed out of medical schools and not all of them entered the public health sector.
Due to scarcity of doctors in the northeast, the Union Health Ministry had roped in the armed services medical corps to pitch in.
Referring to relaxation of norms, Dr. Ramadoss said that while the focus would continue to be on quality there was no doubt that given the present conditions in those States, some of the existing rules for setting up medical colleges would perforce have to be relaxed.
Changes would have to be made to the Establishment of Medical College Regulations, 1999. The Regulations insist that “a suitable single plot of land measuring not less than 25 acres is owned and possessed by the person or is possessed by the applicant by way of 99 years lease for the construction of the college.”
The government was considering splitting up the 25 acres into two campuses and making such a recommendation to the Medical Council of India. In most hilly terrains, it would sometimes be difficult to accommodate the entire 25-acre campus in a single location, the Health Minister explained.
Also, it had been specified that the applicant “owns and manages a hospital of not less than 300 beds with necessary infrastructural facilities capable of being developed into a teaching institution on the campus of the proposed medical college.”
Dr. Ramadoss said that “since the lack of hospitals itself is a concern in some States, we intend to introduce a public-private partnership model. Private institutions that do not have such a large-capacity hospital too can start a medical college.”
Source: The Hindu -08 may 2008

Absenteeism among health workers highest in India: Report

Absenteeism among health workers is the highest in India, according to World Bank’s Global Monitoring Report-2008 (GMR). Referring to a survey carried out in 2002 -03, the report says that the rate of absenteeism among primary healthcare workers in India is 40%. This has a strong impact on the Millennium Development Goals (MDGs) like reducing child and maternal mortality and sanitation MDGs. The GMR attempts to highlight how healthcare quality is critical to reaching the MDGs. “The quality of healthcare services matters because it reflects the extent to which investments to national healthcare systems are able to raise both human capital and individual welfare,” says the report.

Trained doctors can make a dramatic difference in improving healthcare, but absenteeism is both chronic and pervasive in many developing countries. While India and Indonesia top the list, countries like Bangladesh and Uganda follow with more than 35% absenteeism among primary healthcare workers. The absence rates in five developing countries averaged 35% in 2002-03. The report mentions that it is possible that these figures underestimates the severity of the problem because health care personnel can be present without actually providing medical care. When asked what can be the possible reasons behind such absenteeism, Dr Zia Qureshi, senior advisor with the office of the chief economist of the World Bank and the lead author of the GMR 2008 report said: “The government framework is weak. There are issues of governance which includes incentives, oversight and accountability. The government in developing countries need to expand their programs with effectiveness.” According to Qureshi, the incentives are weak in India and hence people respond to that by taking leaves and being absent from their work station. There is also lack of accountability among health workers due to which they move freely without attending to jobs. Agrees Shrawan Nigam, Senior consultant, Indian Council for Research on International Economic Relations (ICRIER), who feels that the problem is more severe in rural India. “There is a concept of passing on the responsibility to the panchayati raj, whereas the work is not happening at that level as well and there is a need for monitoring,” asserts Nigam. According to Nigam, absenteeism is high among teachers in India too. The report points out that though there is a need for more spending on education and health programs, that is not the sole answer. “The quality and equity of spending are equally important,” says Qureshi. Improved governance, stronger accountability mechanisms and sound expenditure management are essential to raise the quality of health and education. Although, the report predicts that on current trends the human development MDGs are unlikely to be met yet they can be achieved if stronger efforts are made both by the countries and their development partners. “Progress must be accelerated and made more inclusive. Private players along with public ones have a major role to play. It calls for a reform to make sure that resources are spend effectively and reaches poor and undeveloped areas,” suggests Qureshi.
Source: ECONOMIC TIMES -17MAY 2008

Healthcare: India has worst indicator of child malnutrition

New Delhi, May 14 (ANI): Over 1.5 million children in India are at risk of becoming malnourished because of rising global food prices, the Unicef, says.It warns that food inflation could be devastating for vulnerable women and children right across South Asia.According to the BBC, the region already has the largest number of malnourished children in the world and levels could get even worse.Even before the current crisis almost half of all Indian children showed signs of stunted growth, Unicef says."It is a perfect storm, we have increasing malnutrition in an area that already has the majority of malnutrition in the world," Daniel Toole, Unicef's regional director for South Asia, said here on Tuesday."We have huge numbers of people living in poverty and a doubling of food prices. Those factors combined mean that we're going to just create tremendous vulnerability," he added.According to Unicef's latest State of the World's Children's report, India has the worst indicators of child malnutrition in South Asia.It claims that 48 percent of under fives in India are stunted, compared to 43 percent in Bangladesh and 37 percent in Pakistan.The report further goes on to say that 30 percent of babies in India are born underweight, compared to 22 percent in Bangladesh and 19 percent in Pakistan.Unicef calculates that 40 percent of all underweight babies in the world are Indian.Put all that in hard numbers and the figures are stark. Fifty million Indian under fives are affected by malnutrition. Rising food prices, Unicef says mean 1.5 to 1.8 million more children in India alone could end up malnourished.And already Unicef says more expensive food is having an impact.Three hundred million Indians live on less than one dollar a day, according to the UN.Poor families who cannot afford rising food prices are having to save money where they can, and that also means spending less on healthcare and education.Food prices, he believes, will remain high for at least the next two years, and in that time it isFirst the priority must be to feed the hungry across South Asia, Unicef says. India must invest more in agriculture, Unicef says. (ANI)

Source: Yahoo India News

Healthcare In India Unsatisfactory

NEW DELH: Healthcare in India still lags behind countries like Sri Lanka, China and even Bangladesh on several key parameters despite some improvement in the sector, the Economic Survey for 2007-08 said on Thursday. "India's position on health parameters compared to even some of its neighbours continues to be unsatisfactory. While India has improved with respect to some important health indicators over the years, it compares poorly with countries like China and Sri Lanka," the survey said. While India's maternal mortality rate per 100,000 live births remains a high 450, it is 45 in China, 58 in Sri Lanka and 320 in Pakistan. Similarly, infant mortality rate (IMR) in India is 56 per 1,000 live births against 12 in Sri Lanka and 23 in China. Even Bangladesh fares better than India in infant mortality with 54 children dying per 1,000 live births. India shares its IMR with the landlocked country of Nepal and fares better than Pakistan (79). The survey has revealed that 74 Indian children per 1,000 die before attending their fifth birthday as against 14 in Sri Lanka, 27 in China and 73 in Bangladesh. Giving a comparative study of life expectancy in south Asian countries, the survey underlines that the average life expectancy in India is 62.9 years. It is 72 years in China, 63.6 in Pakistan and 70.8 years in Sri Lanka. Only Nepal (61.3 years) and Bangladesh (62 years) are behind India. There has been some improvement in the quality of healthcare but wide inter-state, male-female, and rural urban disparities in outcomes and impacts continue. Reproductive and child health services reach communities and households through the primary healthcare infrastructure in the country. "Inadequacies in the existing health infrastructure have led to gaps in coverage and outreach services in rural areas," the survey noted. However, it praised the National Rural Health Mission (NRHM), a flagship programme of the health ministry, for improving rural health. "NRHM has successfully provided platform for community health action at all levels. Through united and flexible financing, NRHM is trying to drive reforms that empower local communities to make their own decisions."
Source: Times Of India

Indian healthcare success story - Emergency Management and Research Institute

"EMRI (Emergency Management and Research Institute) is a pioneer in Emergency Management Services in India. It is a not - for - profit professional organization founded, funded and nurtured by Mr.B.Ramalinga Raju, founder and Chairman, Satyam Computers and his brothers. Operating in the Private Public Patrnership (PPP) mode, EMRI is the only professional Emergency Service Provider in India today.EMRI handles medical, police and fire emergencies through the ' 108 Emergency service'. This is a free service delivered through state- of -art emergency call response centres and over 610 ambulances accross Andhra Pradesh and Gujarat. With the expansion of fleet and services set to spread accross more states in 2008, EMRI will have more than 2000 ambulances covering a population in excess of 200 million by July 2008."This is one of India's great healthcare success stories ! They provide emergency medical care which is as good as the US 911 care - at one tenth of the cost ! This is a great example of using a clever mix of managerial skills; advanced technology; entrepreneurship and public-private partnership to provide high quality medical care. It's a very inspiring story - and is full of lessons we can all learn from.
Posted by Dr Aniruddha Malpani, MD


State of health care in India

Thursday, May 15, 2008
Indian health care features in the latest issue of TIME magazine. Its tough to read through it without being angry and frustrated.,8599,1736516,00.htmlI live in Kolkata and my sister is a doctor. I keep hearing horror stories from her about our state hospitals. Power cuts are common in the state hospitals rendernig whatever equipment is available, useless. Cleanliness is difficult, true, given the huge rush of patients, but dogs and cats under beds???!!! Whenever something happens to a patient there are doctors being beaten up and blamed. What most dont realise that in the "system" the doctors are also victims.And we compare ourselves with China? The next global superpower? With a population that cant afford basic healthcare, wont we be too sick to work our way up the ladder to that dream?Added to that is the mentality of our population. Women are still denied basic care, here, in the heart of the city. Our house cleaners daughter is approx 5 months pregnant (at 16, so much for our govt policies, she married last year on her own). Her inlaws are yet to get an ultra sound done. They were reluctant to take her to the hospital at all, was forced by people like us. My baby's ayah is 24. Her sons are 7 and 6 yrs old. Recently her brother got married. Age of the bride- 15 yrs. This is Kolkata, not some out of the way village. In anything, any situation, women are always the first and the most to suffer.
Posted by Smelling oranges on winter afternoons at 11:07 AM


Current Healthcare Indicators- INDIA

This report presents the healthcare indicators for India and discusses industry trends.
Despite the improving health status of the Indian population, healthcare infrastructure in India
has a long way to go towards achieving 100% quality, technology and superior healthcare
delivery systems. While the Central (Federal) Government is limited to family welfare and
disease control programs, the state governments are responsible for primary and secondary
medical care with a limited role in specialty care. Looking at the healthcare indicators and the
growing prevalence of non-communicable lifestyle related diseases, both the government and
private sector, realize the need to meet this basic demand. Today, the private sector
provides 80 percent of the healthcare service.
Market Overview
Increasing private sector participation in healthcare services is stimulating change in the
Indian healthcare industry. According to an ICRA industry report on Healthcare, India
spends 5.1 percent of its GDP on health. The health market is estimated at Rs.1, 408 billion
($30 billion) and includes retail pharmaceutical, healthcare services, medical and diagnostic
equipment and supplies. While India’s overall expenditure on health is comparable to most
developing countries, India’s per capita healthcare expenditure is low due its large billion-
plus population and low per capita income. This scenario is not likely to improve because of
rising healthcare costs and India’s growing population (estimated to increase from 1 billion
to 1.2 billion by 2012).
The government’s share in the healthcare delivery market is 20 percent while 80 percent is
with the private sector.
Structure of the government healthcare service:
- Primary Care (in rural areas): 22,271 primary healthcare centers and 137,271 sub-centers.
- Secondary Care (healthcare centers in smaller towns and cities): 1,200 PSU (public sector
units) hospitals, 4,400 district hospitals, and 2,935 community healthcare centers.
- Tertiary Care (hospitals): 117 medical colleges and hospitals.
The private healthcare providers consist of private practitioners, for profit hospitals and
nursing homes, and charitable hospitals. They are numerous and fragmented. In the
absence of a national regulatory body, some private providers practice without minimum
standards and the quality of treatment varies from one provider to another. The average
size of private hospitals/nursing homes is 22 beds, which is low compared to other
Size of hospitals
84 percent of private hospitals
<30>200 beds
Market Trends
Changing demographic profile: Improving overall health status and socio-economic
pressures have resulted in changes in the demographic profile. With the decline in birth
rates, the population aged 0-14 has declined, while on the other hand improvement in life
expectancy has led to an increase in the old age population. On average this has led to
higher per capita demand for health services.
The type of healthcare service requirement has changed due to the rise of lifestyle-related
diseases such as diabetes, cardiovascular diseases, and diseases of the central nervous
system. There are around 700,000 new cases of cancer each year and approximately 2.5
million cases. It is estimated that there are around 40 million people in India with diabetes,
5.1 million HIV/AIDS patients, and 14 million tuberculosis cases. In the past year, the
Indian pharmaceutical industry witnessed a growth of 7 percent, the cardio-vascular
segment recorded a growth of 15 to 17 percent and the anti-diabetes segment 10-12
percent growth.
Compared to a few private institutions primarily in the form of charitable trusts and small
nursing homes, recently a number of large sized Indian companies have ventured into
healthcare delivery. Companies like Max India, Ranbaxy Laboratories, Escorts, Wockhardt
and Birla have established Specialty Hospitals. There is increased interest is diagnostic
service as well, with companies such as SRL-Ranbaxy, Nicholas Piramal, and Dr. Lal’s
laboratory venturing into this field. Emergence of corporate hospitals has led to increased
professionalism in medical practices and use of hospital management tools.
The demand for quality healthcare has increased with patients preferring to use private
healthcare facilities. Private healthcare service varies in terms of quality and caters more to
the needs of the rich, middle class and urban segments of the population. The growth in
affluence of the Indian middle-class is adding to this demand. In the period 1993-94 to
2001-2002, aggregate household expenditure on health services has increased at an
annual rate of 9.3 percent.
According to a 2002 McKinsey & Co. report on Healthcare, only 14 percent of the
population is covered through prepayment because of poor healthcare coverage. Of total
healthcare spending, 64 percent is out of pocket expenditure or direct household spending.
Economic indicators
GDP (in $ billion, 2004)
Per Capita (in $, 2004)
Real Growth (in %, 2004)
Health expenditure (in $ billion, 2003)
Health expenditure as % of GDP
Public expenditure as % total
Private expenditure as % of total
Demographic indicators
Population (in million 2004)
Population growth (in %, during 2004) 1.9
Demographic profile - Age/years
54 and above
Health indicators
Life expectancy (years)
Birth rate (per 1000)
Death rate (per 1000)
Infant mortality rate (per 1000)
Healthcare Infrastructure
Hospitals (numbers)
Hospital beds (numbers)
Medical colleges
New doctors every year
Retail chemist (pharmacy) outlets
Size of medical and pharmaceutical market
Pharmaceutical market (in $ million for 2004)
Estimated growth rate per year (for 2004)
7-8 %
Medical equipment market (in $ million for2004)
Estimated growth rate per year (for 2004)
Source: Ministry of Health, Medistat Outlook Espicom report January 2007, ICRA report
Indian Healthcare sector February 2007, Confederation of Indian industry.
Indicators of health status of the Indian population
Ophthalmology: Annual incidence of cataract, the cause of 80 percent of blindness, is 3.8
million cases. The total potential for surgical cataract removal is 1.75 million cases per
Cancer: The total number of cancer cases in India was estimated at 924,790 in 2001. This
is projected to increase to 1,229,968 by 2011 and to 1,557,800 by 2021.
Cardiovascular diseases: The mortality rate due to cardiac arrest and related causes was
estimated at 2.4 million in 1990. With increasing urbanization the problem is on the rise.
Malaria: Projected to increase from 2.03 million cases in 2001 to 2.62 million cases in
Hypertension, diabetes and renal diseases: These stress and lifestyle related disorders are
on the rise. The diabetic population in India is projected to increase from 40 million of 2001
to 47 million people in 2010. Hypertension is lower in rural areas but on an increase in
urban cities. Prevalence rate in Delhi alone is 17.34 percent. Both hypertension and
diabetes further cause renal disorders.
Neurological and psychiatric disorders and addictions: The current prevalence rate for
neurological disorders is 15 to 20 people per thousand. The most common ailments are
epilepsy, migraine, cerebrovascular disorders, Parkinson’s disease and peripheral
neuropathies. It is estimated that 1 percent of the population is suffering from serious
psychiatric illnesses, 10-15 percent have neuro-disorders, and 2.5 percent are mentally
Source: ICRA report on Indian Healthcare and TIFAC
In view of the growing population and higher incidence of non-communicable diseases, it is
estimated that the demand for quality healthcare in India will increase. The role of the private
sector is likely to further increase with preference for private care and government’s constrains of
limited resources.
For more information or assistance in exploring business opportunities and establishing a
presence in the Indian market, please contact:
Dr. Ruchi Bhatt,Business strategist
Prosource Strategy

90% of `doctors` in slums have no formal deg: Survey

New Delhi, May 12: The poor in the urban areas seem to be facing a health risk with a new survey done in two slum clusters here claiming that over 90 per cent of "doctors" offering medical services have no formal degree. The study, conducted by department of community medicine at AIIMS in collaboration with the university of Aarhus in Denmark, also said that not a single "doctor" surveyed in a slum cluster in Orissa's Bhubaneswar had requisite qualification for offering medical services. Without divulging the locations, the survey claimed that out of the 27 private practitioners covered under the three-year study, only four possessed a formal degree to practice while others dispensed allopathic medicines. "These practitioners have active associations and networks with diagnostic facilities. The majority are "trained" outside Delhi and certificates indicating 'registered medical practitioner' are displayed," Chandrakant S Pandav, head of centre for community medicine, said quoting from the report. According to the study -- health system reform and ethics: private practitioners in poor urban neighbourhood in India, Thailand and Indonesia -- 92 per cent of 207 households surveyed in Delhi cited that they preferred a doctor in the slum cluster as their first preference for treatment. During the two-year field study, the survey said, only in two cases the family took patients to a government dispensary located around four kilometres from the settlement. The situation seemed to be worse in Bhubhaneswar with the study claiming that main providers of primary health care in the settlement were drug vendors and chemists, who often engaged in diagnosis.
Source: Zee News

DELHI Slum dwellers prefer quacks to doctors

A study has found that 93 per cent of slum dwellers in Delhi rely on quacks as their primary healthcare contact due to social, psychological and economic reasons.
The four-year long study was funded by Denmark's Danida Council for Development Research. The study, conducted by doctors from the All India Institute of Medical Sciences (AIIMS) during 2004-08 in a South Delhi slum, found that of the 207 households, only two preferred to visit the government dispensary located four kilometres from the settlement. The others felt that non-qualified medical practitioners are more humane, more communicative and offer more payment options for daily wage workers.
The study also found that non-qualified medical practitioners as well as qualified doctors prescribed similar medicines for illnesses like fever, diarrhoea, dengue, vaginal discharge and tuberculosis on first consultation. The majority of these quacks were former employees with chemists, clinics or hospitals, the researchers said.
"These quacks are the only ones who are physically present in such urban slums. Enacting laws to prohibit their practice will not make any difference, as even today, they are running their clinics without any legal protection," said C S Pandav, lead researcher and head of community medicine, AIIMS.
"Having realised the ground situation, I feel that the central government's proposed National Urban Health Mission (NUHM) should factor in their presence before framing policies. Until there is a credible alternative, they will continue to play a role in the healthcare delivery network in slum areas," he added.
The researchers also quoted Delhi Medical Council estimates to suggest that about 40,000 such non-qualified medical practitioners are functioning as the primary healthcare contact.
According to them, police raids to close down such clinics often prove unsuccessful due to the local support enjoyed by such practitioners.
Besides Delhi, studies were also conducted in Bhubhaneswar to understand the healthcare patterns of the urban poor. Bhubhaneswar however presented a different picture, with a very low presence of non-qualified medical practitioners. Most of the rural households in the area said that their first point of contact is the local chemist and not the doctor.
Reacting to the study, Suyash Prakash, mission director, Delhi State Health Mission said that two-thirds of Delhi's population of over 11 million live in the slums. "If 80 per cent of these 11 million are being attended to by non-qualified medical practitioners, it is a serious matter," he said.
He added that there are no credible figures for the number of quacks in Delhi and put the number at 5,000.
Source: economic times 11 may 2008

Call for amenities in Rural areas

Former President A.P.J. Abdul Kalam today said the country requires a “hassle-free” single-window system of clearing investment proposals.
Foreign institutional investors are finding investing in India “attractive”. “We need to accelerate this process,” he said, while charting a course for transforming India into a developed nation with food, economic and national security at the first convocation of Ravenshaw University here.
He also underlined the need for co-ordinated progress in agriculture and food processing, reliable and quality electric power, surface transport and infrastructure for all parts of the country, education and healthcare, information and communication technology and self-reliance in critical technologies. Kalam also said: “There is a need for provision of urban amenities in rural areas (Pura) through the creation of triple connectivity — physical, electronic and economic — leading to economic connectivity.”
The country today requires 7,000 Puras, Kalam said, while exhorting educational institutions to participate in evolving a road map for developing Puras.
Citing the example of Periyar Pura, Kalam suggested Ravenshaw University to consider establishing a Pura covering a population of about 50,000 in 20 villages around Cuttack. In Periyar Pura at Vallam in Tamil Nadu, students and teachers of Periyar Maniammai College of Engineering and Technology are working in the planning and development of a cluster of 65 villages that involves a population of one lakh, he said.
Kalam further exhorted the teachers to play an active role in nurturing five capacities — research and inquiry, creativity and innovation, use of high technology, entrepreneurial and moral leadership through the educational process to meet the challenges of national development.

Shortage of specialists puts healthcare on life support

When seven-month-pregnant Khiloni of MP’s Gwalior district started haemorrhaging, her family bundled her into a bullock-cart and took her to the nearest primary health centre in Murar block. The PHC had no trained birth attendant and Khiloni died on the kuchcha road that links Duhiya village and Gwalior city. When it comes to healthcare, there are two Indias: one that boasts state-of-the-art hospitals which attract medical tourists from affluent countries, and the other — in which most of the population lives — whose residents have limited or no access to quality care. Every public hospital in any big city has serpentine queues, and overburdened doctors. Not surprising since India has just six doctors for every 10,000 people as compared with the global average of 15, according to a 2007 report by rating agency Crisil. "States like Chhattisgarh and Jharkhand have just two doctors for 100,000 people," says Benaifer Jehani of Crisil. A recent Planning Commission report said that India is facing a shortage of six lakh doctors, ten lakh nurses and two lakh dental surgeons. "The availability of specialist manpower at community health centres is particularly bad. As against the sanctioned posts, about 59.4% surgeons, 45% obstetricians and gynaecologists, 61% physicians and 53% paediatricians were not in position (in March 2006)," the report noted. It also drew attention to the low turnout of doctors with post-graduate degrees. The shortage of surgeons and specialists is also worrying doctors like Devi Shetty, cardiac surgeon and chairman of Narayana Health City, Bangalore. "We have 32,000 students passing out every year with MBBS degrees, but only 10% of them get to do post-graduation. Even in Karnataka, which has more colleges for PG as compared to the northern states, as many as 1,000 applicants vie for a single PG seat." The country urgently needs more institutes of higher medical education, he stresses. The government seems to have woken up to the problem. The Union health ministry is modifying some of the regulations under the Indian Medical Council Act, 1956, that will relax operating, staffing and land norms and make it easier to establish medical colleges in India. In a move to bring back Indian doctors settled abroad, the Indian government has also decided to recognize graduate medical degrees from Britain, the US, Canada, Australia, and New Zealand, provided they are recognized in the respective countries. Until now, doctors with an undergraduate degree from India but a graduate degree from another country were not allowed to practice in India. Indian doctors with graduate degrees from the approved countries will now be allowed to practise in India at any public or private hospital. They can also be recruited to teach under-graduates in any medical college. These steps may alleviate the situation somewhat but the medical fraternity is unanimous in its opinion that more needs to be done, specially in view of the continued exodus of medical talent to the West. With millions afflicted with infectious diseases such as TB and the growing incidence of lifestyle diseases such as diabetes and heart problems, the availability of highly skilled doctors may prove crucial in nursing the country back to health. (Neelam Raaj With inputs from Nirmala N Nagaraj in Bangalore)
Source -Times of India

Tips on buying health insurance

Whether you are making a choice between the health insurance plans offered by your employer, or buying an individual policy for yourself, here are 10 tips to take into consideration. 1 Know thy needsBefore you get down to comparing different plans, it is important to determine your insurance needs. You may not find a policy that will cover every contingency, but you should try to find a plan that at least covers the essentials, and meets your medical needs.Does a family member have special needs? Do you plan on having a baby in the next couple years? Does a dependant need prescription drugs? Do you travel abroad? Thinking this through will enable you to match your next policy with your current and future medical needs, and get the kind of coverage that is right for you.2 Shop aroundAll health insurance policies are not created equal. You or your insurance agent should get quotes from different insurance companies for comparison. You will find that there are broad differences in the cost, benefits and exclusions offered by various policies. By shopping around, you may not only save money on your insurance premium, you may also find a policy with benefits that are better suited to your needs. While shopping, be sure to do an apples-to-apples comparison of the standard benefits that each company has to offer.One of the most convenient ways to get quotes from a number of health insurance companies, is at an insurance comparison website. You will fill out a single questionnaire and get several different quotes. Here are three comparison sites:

India's medical system in poor health

By Neeta Lal
The irony couldn't have been starker. Just as India was cementing its position as a world-class medical tourism destination - with revenues from foreign patients set to touch a whopping US$2 billion by 2012, according to a Confederation of Indian Industries-McKinsey report - comes a government survey which states that the country's public healthcare system is headed for a crisis due to an acute medical manpower crunch. According to the recently released Planning Commission report, India is short of a phenomenal 600,000 doctors, 1 million nurses and 200,000 dental surgeons. With positions for 300,000 dental surgeons, only 73,000 are currently full. Meanwhile, 1.1 million nurses are filling up vacancies for 2.1 million, a shortfall of nearly 50%. To make matters worse, there is also a huge paucity of paramedical staff including radiographers, X-ray technicians, physiotherapists, laboratory technicians, dental hygienist, orthopedists and opticians. The report also highlights a skewed statewide distribution of doctors with states like Karnataka and union territories such as Delhi and Goa having a passable ratio while others, like Haryana, Bihar and Uttar Pradesh, are being under-served. The availability of specialist manpower in local Community Health Centers, compared to the number of sanctioned posts, is also disquieting. About 59.4% surgeons, 45% obstetricians and gynecologists, 61% physicians and 53% pediatricians were not in position at the time of the survey. The number of doctors registered by different state councils during 2006 led to a doctor-to-population ratio of 60:100,000. Nationally, this glaring inequity manifests itself in an abysmal patient-doctor ratio. In other words, for every 10,000 Indians, there is barely one doctor available. These figures compare dismally with countries like Australia which provides 249 doctors for every 10,000 people, Canada which offers 209, Britain 166 and the United States 548. The medical manpower shortfall is all the more ironic because, as the report states, India ranks at the top of nations whose well-qualified healthcare professionals, particularly doctors, radiologists, laboratory technicians, dental hygienists, physiotherapists and medical rehabilitation workers, are working in major developed countries. "The current situation in the public healthcare sector is scary," said Dr Aveek Parekh, a senior oncologist at a New Delhi government hospital. "The government needs to urgently re-assess the country's healthcare needs and address the shortfall if it is to avert an imminent national crisis. It needs to probe the various factors impacting the performances of the health services sector and suggest short and long term policies to enhance and sustain its competitiveness in the future." Experts reiterate that the medical staff crisis is partly triggered by the continuous exodus of Indian doctors to foreign shores in search of better growth opportunities and work environment. According to the Planning Commission, Indian docs who have migrated to developed countries, form nearly five per cent of their medical workforce with nearly 60,000 Indian physicians working in the US, Britain, Canada and Australia alone. "For several decades, Indian medical professionals have been serving not only in the Middle East but also in developed countries, including the US and the UK," said Anwarul Hoda, a member of the Planning Commission who headed the group that drafted the report. "The overriding requirement in India, therefore, is to increase the supply of human resources at all levels from specialists to paramedical personnel and improve their quality." This is easier said than done considering the medical profession in India has itself lost much of its old charm. In fact the number of Indian youth who are now opting for medicine as a career choice has whittled down remarkably. For instance, this year, according to the Central Board of Secondary Education (CBSE), only 1.6 million candidates took the medical entrance exam, a 25% plummet since last year. This is in stark contrast to the over 800,000 candidates who registered for the AIEE, the engineering entrance test conducted by CBSE, and another 300,500 who took the JEE exam for entrance into the blue-chip Indian Institute of Technology. Overall, Indian medical colleges currently churn out about 30,000 doctors a year, apart from 20,000 dentists and 45,000 nurses. About 3,181 undergraduate degrees are awarded annually, while 1,316 postgraduate diplomas are given in the country each year. Experts point out that the need for medical staff is at least double these numbers. Undoubtedly, the massive paucity of medical staff in India underscores an overall disenchantment with the profession. The current crop of Indian youth are rejecting the white coat in favor of more lucrative and less time- and labor-intensive professions like business, law or engineering. "As a profession, medicine is an extremely demanding one," says Aditi Pai, 28, who opted out of a premier Indian medical college to pursue an MBA. "Eighteen-hour workdays, seven days a week are quite the norm while the pay scales don't quite match up." And they don't. In fact, even senior government doctors - after putting in 20-25 years - rarely take home salaries in excess of 50,000 rupees (about US$1,200). Poor pay, ill-equipped hospitals and lack of support staff have driven even the most idealistic doctors to explore greener pastures. Worsening the current scenario is a Medical Council of India stipulation that undergraduate and postgraduate qualifications of foreign institutions, which do not grant recognition to Indian degrees, are currently not recognized. Consequently, hospitals and other clinical establishments cannot tap the pool of non-resident Indian medical professionals who may be willing to work in India. If this bottleneck is removed, say experts, it would augment the supply of quality medical personnel to Indian service providers as well as in the areas of medical tourism, telemedicine and clinical research. To prevent the situation from deteriorating further, the Planning Commission suggests that the medical education sector be opened up completely for private sector participation to help it establish medical, dental and nursing colleges. In addition, it also advises the government to fill vacant posts of teachers in government medical colleges to help them provide good education at subsidized rates to meritorious students. Towards this end, Indian Health Minister Ambumani Ramadoss stated last week that India will soon be setting up new medical colleges and recognize the medical degrees issued by five English-speaking countries, including the US, Britain and Australia. The 11th five-year plan, stated the minister, envisages setting up of six All-India Institute of Medical Sciences-like institutions and upgrading 13 existing medical institutes. It is also planning to establish 60 new medical colleges and 225 new nursing colleges based on the template of the private ones. These steps will be crucial in resuscitating India's ailing healthcare system back to health. Apart from addressing the immediate healthcare needs of a billion-plus population, they will also help the country build on its growing status as a world-class medical tourism hub which is growing at a robust clip of 25% per year.