Many of these hospitals have taken land on lease from the government at throw away prices. They are thus bound to give free healthcare facilities to a stipulated number of patients from poor economic groups. But this hardly happens in practice. Even the doctors and other staff see such patients with contempt. This may be because of pressure from the management or apathy that they have developed in the system they have been working for long.

The process of shift in values in medical profession started by the 1980s when the policies in South Asian countries began to be influenced significantly by the Bretton Woods institutions, specially the World Bank. The developing countries had to accept structural adjustment policies (SAP) under the corporates-driven one-way globalization which served the interests of the international finance capital. The governments in the developing countries changed laws in favour of multinational corporations and the local elite while denying the basic fundamental rights to the poor strata of society. Rights to hold protests and unionise were curtailed. Subsidies to the poor were taken off. Job security was taken away and employment generation occurred in the form of contract labour with very low wages. This happened not only in private sector but even in public sector. The priorities in agriculture production also shifted from the basic food to produce that was to be used by the elite in these countries. All this further resulted into increase in the problem for the lower income groups leading to fall of health determinants.

There occurred a policy shift that treats health as ‘techno-dependent and amenable to commodification’. The shift in concept is evident in the WHO itself when in 1996 it proposed a behaviorist model, which stressed more on the individual effort for better health rather than social responsibility. The WHO started working under the influence of international monopoly corporates and took position to increase privatization and partnership with multinational companies. So the emphasis shifted to address only population control and some selected communicable diseases at the cost of its earlier broad-based approach. As a result the institution which was supposed to work for inclusive healthcare policies took lead in destroying its own agenda set at Alma Ata.

There were serious implications on medical education in our country. More medical colleges opened in private sector than in state sector affecting the very concept of social service in the medical training. During 1947-2017, 251 private colleges were setup as against 214 new medical colleges setup by the government and 9 by government led society.

This is the time when the patent laws also changed under the new patent regime of the WTO. The local pharmaceuticals industries suffered. As a result, prices of newer drug increased. After a lot of hue and cry from the public the government appointed a committee to go into the drug prices vis a vis trade margins, that is the difference between the price of the drug when it comes out of the manufacturing unit and the maximum retail price i.e at what it is sold at retails. The committee pointed out startling figures of the trade margin to be the tune of even 300% - 5,000% in some cases. The committee recommended capping of trade margin so that the cost of drugs to the patients is streamlined.

The committee also pointed out that in case of bonus offer the benefit should go the consumer not the retailer. For example, if there is a bonus offer of 1+1 then trade margin should be halved.

The market system also pushed practices of cuts and commissions for referrals and freebies to the medical professionals by the pharmaceutical companies. This corrupted even the doctor. The time has come now to think whether health services are to be treated as business or they have to be retained as a professional service and restore its glory and nobility. (IPA Service)