On a minute consideration of the daily life of Indian society, there cannot be a failure to create livelihood if that is the mission.
Employment is natural in a vibrant society and is as much a challenge as it is a cause of social happiness. Unemployment is a perpetual issue in Indian society where the employable in the organized industry will be more than the ever-shrinking opportunities due to evolving technologies.
Yet there is a need for an eagle eye approach to employment identification and creation rather than a lackadaisical one, witnessed by us for over 70 years. We have never had the much needed Minister for Employment. On a minute consideration of the daily life of Indian society, there cannot be a failure to create livelihood if that is the mission. Opportunities are immense.
Life is the cause of an economy and quite humorously the economists try to construct an economy as the nucleus of life and society. This is the fallacy of materialistic literacy. Jobs make up not just families and society but also economies.
I now attempt to search out opportunities for employment in ways not conventional but furthering any national and social cause in the process.
After 70 years of independence still:-
- Every district in India doesn’t have a good government hospital.
- Therefore migration of Medical fraternity to metros and the patients also flock for treatment.
- Medicine is an expensive education
- Doctors have to earn more to recover their education costs.
- Corporate hospitals run on a pure profit motive.
- No standard operating procedure in the profession across the country.
- No counterbalance in society as government hospitals are corrupt and inefficient.
- No compulsion for doctors to do rural service. Large hospitals are in the metros and everyone wants to live in the metros.
- The medical services in urban areas are exploitive. Eg.:- Collusion with insurance companies/agents pharma companies.
Affordable medical facilities across the country which will treat common ailments and charge reasonably.
- Under Ayushman Bharat, if the government takes up a mission of building a 50-bed hospital in each district across the country in partnership with private medical fraternity, over the next 3 years it will do a lot good. The number of beds can be increased to 150 in due course based on the response in each district in phase 2.
- To start with the hospitals must offer treatment for basic ailments, delivery, simple surgery, emergency, ICU, etc. A list of treatments that can be given in the hospitals may be laid out by the government. Any ailment beyond the list approved must be referred to the major hospitals. The list can be revised as the scheme takes off well with more experienced doctors coming in.
- The building will be constructed and all the basic equipment will be purchased and installed by the government. The hospital will be in a ready-to-start condition.
- This can be done in a public-private partnership:
- The government will build and own the hospital under Ayushman Bharat.
- The government can also attract donors for each hospital. If the hospitals are going to be run by private parties then it could attract larger public support (like TTD attracts donors for cottages).
- The hospitals will be named Ayushman Bharat.
- The private doctors will take up, run the hospital, and maintain it.
- The hospital will be given to them for a period of 5 years on a management contract.
- The government will post one administrator in each hospital. All hospitals will be connected in real-time with the Director-General of the program.
- The operating norms will be set by the government.
- Based on an objective performance appraisal the management contracts can be renewed.
5. The selection of the doctor management team who will be handed over the hospital will be on an objective and transparent basis. Preference to local doctors in each district can be given for ensuring continuity and stability.
- The management team must invest the working capital viz., salaries, and operating expenses.
Since the management team has to manage the working capital, they will do it very cost-effectively. They will put up a security deposit also.
- The government will fix a price list for all the treatments reasonably to provide for a profit to the operating team.
- The hospitals will not charge more than the fixed price list, by law.
- Each hospital can be built on a one or half-acre plot. Also, the land in possession of Government/Public Sector Undertakings can be used.
- To start with each hospital will be on a 10000 to 15000 sq ft.
- The investment in each of the hospitals will not be more than Rs.20-30 Crores.
- The Working Capital required will not be more than Rs.50 lakhs. A team of 5 doctors can put Rs.10 lakhs each and get to run a hospital.
2. The government will take 3% of the revenue. There is enough incentive for the managing team as the profit-sharing will keep them hooked to the job. Besides the above, each hospital can have an attached pathology lab, diagnostic service, a medical shop and ambulance service and some other related services to allow the management team to earn.
All hospitals will be online. It will be connected to a Director-General of the program. There will be a state-level Director also. The Director-General can see all the hospitals online with a video camera. He can do an inspection at any time. All billing is online. The administrator of the hospital will be posted on transferrable deputation by the government.
The supervision can be totally system driven.
- The patients can be covered by Ayushman Bharat even in states that don’t implement the scheme. This is a back door entry into such states.
- Since Ayushman Bharat Scheme covers it, the patrons will be many. The hospitals will do well. It will also keep the Ayushman Bharat payouts in a check as the hospital rates are fixed, and exploitation is not possible.
- The doctors will be at peace as there will be no collection pressure as it is in the private hospitals. The doctors from the local area will show a lot of interest. There will be stability.
- Good students who come out of medical colleges successfully but don’t have the capital to set up a hospital on their own will be enthusiastic participants. The hospitals can grow over a period of time with good service. Good talent can be attracted due to the revenue sharing formula.
- The government will always own the hospital and it will be the ultimate authority to keep or terminate the contract of the management team (similar to how large hotel chains running, operate). No exploitation will happen as in a private hospital as the management team will be worried that their contract may be terminated.
- The government can start this in few districts as a trial and if it is successful can expand it to all districts in India. It will automatically gather a lot of interest as doctors will get attracted to the scheme. It will give them a sense of participation and ownership in the National service.
- Most importantly this will help the government keep a check on hospital charges across the Country. It will be a benchmark.
- Ayushman Bharat hospitals can develop into an affordable national health care system.
- Promote a University for Medicine and Public Health, Management system to train and produce future bureaucrats for public health management.
- Bring about some uniformity in standards of treatment across the country.
- Can pass Ayushman Bharat benefits to the public without pilferage, fraud through DTB.
- Employ qualified people in their own districts and arrest migration of the educated to metros.
- Services become localized. The cost of services will be lower if localized.
- Each hospital to grow to not more than 150 beds. Beyond that, open a new one in the same district. Disburse the crowd. Disburse employment. Disburse incomes.
- The system is subject to 24×7 scrutiny
- No operating responsibility on a full-time basis for the Central Government. No pilferage, fraud, and such current problems.
- No operating expenditure on the government.
- Capex initially can be funded by the government and also donations from affluent individuals who want to do a social service by donating a hospital.
- Encourage local entrepreneurship at the district level.
- Success is guaranteed as Ayushman Bharat scheme supports the hospital.
G) Employment Potential:
- 3 hospitals in each district on an average in 5 years. Large Districts can have more.
- Each hospital will support directly and indirectly at least 150 people including various services.
- Quality employment of nearly 5 lakh people in 3-4 years.
- The spillover effect on insurance, other allied services, hospitality near hospitals can be more.
- Addresses 3 problems –
- Health services across India will leap in quality, availability,
- Government control on an important aspect of public life.
- Generates employment.
This could be an easier way to combine the might of the government and the skill and services of the private citizens for the common good of all. It would be a win-win situation for the government and the medical fraternity on hand and the public will get new hospitals in each district. Ayushman Bharat will become very popular and successful and an employment creator. A chain of 2500 hospitals across the country (3 in each district) over a period of 5-10 years will make this the largest government effort in public health anywhere in the world.
1. The views expressed here are those of the author and do not necessarily represent or reflect the views of PGurus.
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