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10 The Academy Oct.-Nov. 2008 11 The Academy Oct.-Nov. 2008
monkeys near the faculty and OT residences. The
health prospects for humans of these technologies is
under study since what is scary for monkeys cannot
be totally beneficial for humans, them being 99.5%
genetically related to us. (Aryaji corrects me that
some prankster probationers are 150% related). Some
faculties feel that trainees are challenging enough
without any prospective ultra sound induced
mutations!
Seriously, the Academy is a place where we have to
throw "the monkey on our back" away and come out
of our comfort zones. Weightlessness to fly high is
the aim, freedom in thinking and action come
through freeing the binds and comfort zones of the
mind. Monkeys, Jhavad and ordinary add to the
challenge and remind us the fluidity of the World we
inhabit. Let them be, let us be, and let us keep
learning from each other.
* Deputy Director, LBSNAA
National Health Information Highway
Dr. S. H. Khan *
Researchers have joined IBM's Business Consulting
Services on a pilot program with one significant
healthcare group. The challenges faced by the team
were formulating healthcare standards specific to
India and convincing healthcare entities across the
nation to integrate those standards into their business
processes. The partnership formed with a large
hospital chain in India will facilitate the formation of
a working committee, consisting of hospitals and the
IT and Health ministries, to create health data
standards for the country. IBM has already deployed
Clinical Document Architecture (CDA) over the data
grid to demonstrate standards-driven claim data
exchange. And, as the first pilot program is
progressing, other programs will be rolled out to two
hospitals and two insurance third-party
administrators.
National Health Information Highway system offers
information technology to help reduce medical
errors, improve efficiency, assist planning (locations
of specialty hospitals or medical schools, crisis
management, drug and equipment supply and
budgeting etc.), and accelerate research and training
(using diagnosis data to train medicos or using
medical problems captured on the network to build
test cases.) In 2002, India's healthcare industry
contributed five percent to the Gross Domestic
Product (GDP) and employed approximately four
million people. By 2012, it is projected to contribute
8.5 percent of the GDP. Healthcare spending in the
country will double over the next 10 years with
private healthcare contributing a large portion of this
spending, rising from US $14.8 billion to US $33.6
billion. Because the traditional system of medicine is
faced with escalating healthcare costs, the state
health systems desperately need to improve
efficiency in how they allocate and use health
resources to combat the many problems the rapidly
developing country has. These problems include
infant and maternal mortality rates that are still high;
basic reproductive and child health services, supplies
and infrastructure needs that are unmet; and
universal immunization of children against all
vaccine-preventable diseases has not yet been
achieved. In addition, the government is striving to
achieve zero-level growth of HIV/AIDS, reduce
mortality from vector-and water-borne diseases by
50 percent, and increase the use of public health
facilities-all by 2015.
Other healthcare highway capabilities include:
facilitating electronic data exchange (which will
automate the current manual process and reduce
the time it takes to settle claims from the current
four to six weeks),
providing data standardization (which will allow
for interoperative and collaborative networks),
middleware-based (to allow flexible collaboration
among multiple third-party administrators and
hospitals nationwide),
supporting information integration and extraction
(to answer queries from the doctors and
administrators),
supporting hybrid client platforms and
programming languages (to allow different TPAs
and hospitals to be part of the network),
using industry standard interfaces (so that crosstraining
and re-training won't be necessary),
offering security through an authorized data
channel (so that only authorized personnel can
access this highly confidential information), and
provide auditing, which is required by the IRDA,
the insurance regulatory body in India.
High-tech, five-star hospitals have pushed costs skyhigh.
A simple headache will warrant a CT scan to
rule out a brain tumour. Doctors have used the CPA
to further justify expensive and sometime
unnecessary investigations and therapies. On the
other hand, sophisticated equipment is available in
government hospitals, but it is often not in working
condition. According to the VHAI report, the
government's annual public health expenditure is
about Rs. 10,000 crore - a pittance compared to an
estimated expenditure in the private sector of
between Rs. 40,000 and Rs. 60,000 crore. Private
services experience support from ruling class , who
often receive free treatment-which is actually
intended for the poor, and is a pre-condition for the
various concessions and tax benefits that these
hospitals enjoy. The entry of the corporate hospital
signals an open focus on profit rather than people's
needs. Private medical colleges and high-tech private
hospitals are proliferating across the nation. In
essence ,stakeholders in these ventures, treat medical
education and healthcare as any other industry
which survives on profit.
* Deputy Director, LBSNAA
It is Mean to ignore the Median
Alok Kumar *
India is an economy in transition; I would say that it
is at an inflection point. The right policy mix could
put it well on its way to becoming a developed
country. It is the second fastest growing economy in
the world, clocking up average growth rates of 8-
8.5% per annum in the last 5 years. It has seen a
steady increase in consumption as measured by the
Real Average Monthly Per Capita Expenditure
(MPCE). The Below Poverty Line [income levels less
than $1 (PPP) per day] population has been
decreasing at a rate of 1% per annum.
That said, however, it is also clear that the number of
poor at 267 million [2005] remains unacceptably
large. If you also include the fact that of the
remaining population, 190 million earn between $1
and $1.25 a day and a further 170 million earn
between $1.25 and $1.35 a day, it would be clear that
a large number of people 55% to be precise-are
unable to afford a dignified life. The increases in per
capita income (currently $575) largely reflect the
income growths of the top quintile of the population.
In fact, the data on changes in per capita
expenditures reveal that the increase (between 1993
& 2004) in case of top quintile (richest 20% of the
population) was 2.03% per annum against 0.85% for
bottom quintile.
It could arguably be said that a few billionaires could
possibly raise the mean income; without affecting the
vast majority of poor. Very recently we have seen
how the voters rejected the idea of “India Shining”
which focused on a very narrow base of well to do
sections. What are the lessons for the policy makers?
The inherent learning from the above is that public
policy to be effective needs to target the median
voter. From our high school mathematics, we would
remember that the median voter would be that voter
who would divide the population exactly into two
halves (one half having income greater and the other
having an income lower than the median voter). If
the median voter does not gain from the policy, it
may not be achieving its objective.
New schemes such as NREGS, RKVY & NRHMtarget
exactly the median voter but the jury is still
out whether they shall be able to achieve the
intended outcomes in view of the delivery systems in
place. Perhaps the expenditure data published by the
next “thick” round of National Sample Survey on
expenditures and poverty would throw some light
on the subject.
Till then, however, it would be safe to say with due
apologies to John Allen Paulos- that it is “Mean to
Ignore the Median”
* Deputy Director ( Sr.), LBSNAA