India is the second most populous country in the world. It is a socialistic state where the government is committed to provide for the health care of its people.
HEALTH CARE INFRASTRUCTURE IN INDIA
Indian Health Infrastructure is divided into a three-tier structure of primary, secondary and tertiary levels. Currently, the government has 117 tertiary medical colleges and hospitals,1200 ESI and PSU hospitals,4400 district hospitals, 2400 community health centers at secondary level, 23,000 primary health centers 1,37,000 sub centers and 1500 urban posts at primary level.
Health Care spending pattern
This massive infrastructure seems more than sufficient to meet the needs of the Indian population. The ground reality, however, is very different. According to the Economic Survey 2005, it is seen that India’s overall health spending is 5.6% of the GDP. However, health care spending is only 1.2% of the GDP against WHO norms of 5%.
Fund availability for health care
Thus, although the overall health sector spending is adequate, the spending on health care, which provides treatment and care for the sick, is insufficient. As per the Annual Report of the Ministry of Health of 2004, hospitalized Indians spend 58% of their total annual expenditure on health care and 40% of hospitalized Indians borrow to cover for these expenses. 25% of hospitalized individuals fall below poverty line due to hospitalization expenses.
Resource distribution
According to National Commission for Applied Economic Research (NCAER) reports, 80 % of the resources are cornered by the affluent (which form only 30% of the population) and only 20% is available to the poorest (which form 70% of the population). In addition, individuals do more than 75% spending on health care from their personal resources. Only 45% of the indoor patients actually utilize the government infrastructure and the rest go to expensive private hospitals. Health care expenses are thus a major cause of impoverishment in Indian society.
CHALLENGES IN HEALTH CARE SECTOR
An analysis of the above data clearly reveals that the health infrastructure is beset with problems. The main problem areas are:
1. Inadequacy of funds
2. Available funds not reaching targeted population
3. Insufficient treatment facilities
4. Non-availability of requisite manpower to man the facilities.
5. Absence of resource co-ordination between the private and government sector.
The annual per capita income of India is a minimal $ 380 (according to 2005 IMF figures). This is barely sufficient to meet daily needs and grossly inadequate to fund the cost of hospitalization. This also negates the idea of fund generation through levy of user charges.
MECHANISMS TO MEET THESE CHALLENGES
This essay will attempt to suggest mechanisms whereby adequate funds can be generated to run the health care sector and there is equitable distribution between the affluent and the deprived strata of the society.
1. Community based Health Insurance
The concept of a community-based health insurance is a viable solution. Various studies have estimated the average annual expenditure per family at $25-30. A CBHI scheme at $2 per month per family administered through a third party administrator can be launched for a target population of 100,000 per hospital. The government can fund specialized treatments to support the scheme.
2. Generating resources through cess
By levying a cess on health degrading products like Tobacco, Cigarettes, Pan Masala, Alcoholic beverages etc funds can be generated. This cess could be extended to pollution causing or hazardous industries. These funds can be kept in a separate pool and disbursed for the treatment of specific diseases like Tuberculosis, Cancer, AIDS, Leprosy, Renal failure which require prolonged and expensive treatment.
3. Health Tourism
India has several excellent hospitals, with state-of-the-art equipment and diagnostic facilities. These hospitals also boast of the internationally acclaimed doctors. This combined with spiraling costs of treatment and long waiting periods abroad could woo foreign patients for treatment in India. This could well be combined with a holiday or a tourism package. The resources generated by these hospitals can fund the Hospital-rural neighborhood health cluster discussed in next paragraph.
4. Hospital-rural neighborhood cluster concept
Most rural areas lack proper medical care centers. Also as rural areas do not provide good quality of life, medical professionals do not want to settle there. The minimal health infrastructure, which exists, is thus not manned by trained personal. This vicious cycle results in non-availability of treatment facilities. Studies have established that 95% patients require prescription treatment and only 5% require hospitalization. Small rural dispensaries manned by staff of urban hospitals in the morning, can do this job. Ambulances could shift patients requiring specialized treatment to urban hospitals. This concept would provide good treatment facilities and medical manpower to patients in remote areas.
5. Public-private sector resource sharing
Private enterprise in health sector, private nursing homes and corporate hospitals should be encouraged. The government should tie up with the private sector for low cost insurance based treatment wherever adequate infrastructure exists in the private sector. This can be partly funded by the government. The government can then focus on hitherto neglected areas of health care where the private sector is not investing. Thus duplication of resources will be avoided and better facilities would be available for remote areas.
6. Telemedicine
India’s strength in the Information technology can be used for the improvement of health infrastructure. Telemedicine can provide advanced diagnostic facilities to the people in the remote areas. Through satellite links the state or district level hospitals can be linked to the peripheral hospitals. Mobile telemedicine vans can also be utilized for the same. The patients in the interior areas can be examined and diagnosis and treatment advised by consultants sitting in the urban institutes. Thus, only patients requiring special care would be moved to the nearest urban hospital.
CONCLUSION
India’s health sector has some inherent strengths which need to be enhanced. Innovative strategies and ‘out-of-box’ thinking are needed to devise and implement a result-oriented action plan. These are some ideas to finance and prop up the health care delivery system. These would ensure adequate funds, efficient deployment and equitable distribution of the resources.
Contributed by: Dr Harmeet Singh MBA(Birmingham)
Tuesday, October 16, 2007
Monday, October 15, 2007
Consubstantiation: Memes and Ideas
The memetic process is one marked quintessentially by the union of disparate linguistic and epistemological substances in the evolution of an idea from a meme. In other words, there is a transitional or pubescent point at which some successful memes may take on the characteristics of an idea or an idea complex as the meme moves from an a-rationally based viral concept or pattern of thought to a rationally based idea or science. A good example of this might be the Nazi "Science" of Eugenics. Nazism's rich, though evil, mixture of all of the major memetic complexes - religion, language or media, politics, and pre-science marked the puerile state of genetic science among other numerous studies.
In Nazi Eugenics, we have a consubstantiation of meme and idea that will eventually evolve into bioengineering in the late twentieth century. In the stage of consubstantiation, we have what equates to a viral soup of ideas - a kind of intellectual minestrone or gumbo. The two or more substances that exist in the memetic-consubstantiation share components - with one system reasoning meaning and the other declaring its own truth. Frequently, the successful emergence of a meme from the unreasoned state into a reason-based state is dependent upon the structure of the language in which it finds itself. Both the success of meme and success of an idea are frequently conditional to the linguistic structure of its hosts. It has been stated that language itself is a meme complex or memeplex - this is true only from the standpoint that it can be both. Whether language is meme or idea is dependent upon how the language is being used at any given time and perhaps upon who it is that is using the language.
Language would more accurately be described as building material for both the meme and idea. And, in as much as both the meme and idea are made from the same substance, the word or communication is the basis for both. What we have here is a process that is similar to the workings of an atom in terms of its component parts - at the final reduction, there is no real difference in the materials that compose the different entities formed by those materials. The significant factor is the process of evolutionary differentiation and not primeval reduction - unless that reduction is being used to force another stage forward in the evolutionary process. Cloning or atomic power would be examples of evolutionary leaps forward with the potential of progressing mankind to a higher level of existence. It should be remembered however that devolution is just as real a possibility as is evolution in a possible scenario. This devolution or transference could be from idea to meme, meme to idea, or species to species in the concept of that which is fittest for a changed environment - Neanderthal to Homo Sapiens, for instance.
It should be clear now the memes rely upon epistemological opacity - were there a kind of checksum attached to a memetic frame - it would be obvious that the meme is not an idea of self-sustaining merit. Memetic frames are however successful broadcasters and do replicate and undergo mutation processes - making them difficult to pin down or to eradicate once they are rooted in an appropriate class of hosts. The opacity is a successful defense mechanism that relies upon obfuscation of thought for its defense.
Idea versus meme evokes the differentiation of Intuition-based Logic versus Classical Logic.
Intuitionistic logic substitutes justification for truth in its logical calculus. Instead of a deterministic, bivalent truth assignment scheme, it allows for a third, indeterminate truth value. A proposition may be provably justified, or provably not justified, or undetermined. The logical calculus preserves justification, rather than truth, across transformations yielding derived propositions.
It is possible for an idea to retrograde back into a state of consubstantiation or to once again become a meme. An excellent example of this process is the "Intelligent Design" movement, which offers itself up as an alternative scientific approach to "Natural Selection." In this movement we also have a theft of language of meaning - that is, the Intelligent Design movement seeks to cloak itself in scientific language and thereby gain acceptance and replicate as another scientific theory. With ID, either we have an apparent mutation of the old "Creationism" meme or a regression of the "Theory of Evolution" - there are probably actually of few flavors of each of these processes going on in the movement. The dialectic certainly resides in the conflict of meme with idea - the synthesis is the transitory wedding of idealism and materialism or a short-lived Weberian-Marxian activation of the ideal in history. This transitory state does not survive in the "real world" of continuous social mutation nor does its language remain fixed by its very proponents, Marx begat Lenin and Trotsky and Stalin and so on.
Constant flux or the ephemeral state of the social dynamic is reminiscent of evolutionary adaptation like that of the finches in Darwin's studies. Any particular ideology is most likely the regression of an idea into a state of consubstantiation or the evolutionary mutation of a meme into a memeplex. Not hoping to read too much into Montesquieu's Spirit of the Laws, the environment of a meme or an idea certainly affects its mutation process and outcome.
Contributed by: Lloyd Bardell
In Nazi Eugenics, we have a consubstantiation of meme and idea that will eventually evolve into bioengineering in the late twentieth century. In the stage of consubstantiation, we have what equates to a viral soup of ideas - a kind of intellectual minestrone or gumbo. The two or more substances that exist in the memetic-consubstantiation share components - with one system reasoning meaning and the other declaring its own truth. Frequently, the successful emergence of a meme from the unreasoned state into a reason-based state is dependent upon the structure of the language in which it finds itself. Both the success of meme and success of an idea are frequently conditional to the linguistic structure of its hosts. It has been stated that language itself is a meme complex or memeplex - this is true only from the standpoint that it can be both. Whether language is meme or idea is dependent upon how the language is being used at any given time and perhaps upon who it is that is using the language.
Language would more accurately be described as building material for both the meme and idea. And, in as much as both the meme and idea are made from the same substance, the word or communication is the basis for both. What we have here is a process that is similar to the workings of an atom in terms of its component parts - at the final reduction, there is no real difference in the materials that compose the different entities formed by those materials. The significant factor is the process of evolutionary differentiation and not primeval reduction - unless that reduction is being used to force another stage forward in the evolutionary process. Cloning or atomic power would be examples of evolutionary leaps forward with the potential of progressing mankind to a higher level of existence. It should be remembered however that devolution is just as real a possibility as is evolution in a possible scenario. This devolution or transference could be from idea to meme, meme to idea, or species to species in the concept of that which is fittest for a changed environment - Neanderthal to Homo Sapiens, for instance.
It should be clear now the memes rely upon epistemological opacity - were there a kind of checksum attached to a memetic frame - it would be obvious that the meme is not an idea of self-sustaining merit. Memetic frames are however successful broadcasters and do replicate and undergo mutation processes - making them difficult to pin down or to eradicate once they are rooted in an appropriate class of hosts. The opacity is a successful defense mechanism that relies upon obfuscation of thought for its defense.
Idea versus meme evokes the differentiation of Intuition-based Logic versus Classical Logic.
Intuitionistic logic substitutes justification for truth in its logical calculus. Instead of a deterministic, bivalent truth assignment scheme, it allows for a third, indeterminate truth value. A proposition may be provably justified, or provably not justified, or undetermined. The logical calculus preserves justification, rather than truth, across transformations yielding derived propositions.
It is possible for an idea to retrograde back into a state of consubstantiation or to once again become a meme. An excellent example of this process is the "Intelligent Design" movement, which offers itself up as an alternative scientific approach to "Natural Selection." In this movement we also have a theft of language of meaning - that is, the Intelligent Design movement seeks to cloak itself in scientific language and thereby gain acceptance and replicate as another scientific theory. With ID, either we have an apparent mutation of the old "Creationism" meme or a regression of the "Theory of Evolution" - there are probably actually of few flavors of each of these processes going on in the movement. The dialectic certainly resides in the conflict of meme with idea - the synthesis is the transitory wedding of idealism and materialism or a short-lived Weberian-Marxian activation of the ideal in history. This transitory state does not survive in the "real world" of continuous social mutation nor does its language remain fixed by its very proponents, Marx begat Lenin and Trotsky and Stalin and so on.
Constant flux or the ephemeral state of the social dynamic is reminiscent of evolutionary adaptation like that of the finches in Darwin's studies. Any particular ideology is most likely the regression of an idea into a state of consubstantiation or the evolutionary mutation of a meme into a memeplex. Not hoping to read too much into Montesquieu's Spirit of the Laws, the environment of a meme or an idea certainly affects its mutation process and outcome.
Contributed by: Lloyd Bardell
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