A SOUND referral and back-referral system in health care potentially has several merits. It can ensure equitable access to specialised health care. It can optimise the use of resources. It can improve patient outcomes. It can also enhance coordination between levels of health care. This is, therefore, a welcome move that the health-sector reforms commission is set to recommend 鈥榓n effective referral and back-referral system鈥� to link tertiary to primary health services. The commission鈥檚 members say that it would not only facilitate the full recovery of critical patients at minimised costs but also unburden public and private hospitals in cities. In a society where out-of-the-pocket expenditure of patients is too high and quality medical treatment is too costly, the likely move certainly appears a glimmer of light at the end of the tunnel. If the referral system works effectively, insolvent patients from remote, rural areas would receive specialised medical care in tertiary hospitals, which the commission envisages to be upgraded from district general hospitals. In the back referral part of the system, patients could receive rehabilitation services in the initial health centres after they receive specialised treatment in tertiary hospitals.
A commission member says that there are plans to develop a network of general practitioners to initially respond to patients. No patient but in case of emergencies can visit a specialist or specialised hospitals without referral. The restriction would save patients unnecessary hospital visits and money on avoidable diagnostic tests and medical expenditure. The commission also envisages the availability of at least two people with MBBS degrees to work as family care physicians or one family care physicians per 15,000 people at union health centres in rural areas and at wards in urban areas. The Bureau of Statistics in a survey made public on March 20 shows that 91.3 per cent of respondents want primary health care to be recognised as a constitutional right. And, experts believe that the constitution should make citizens鈥� primary health care legally-binding for the government. The commission on constitutional reforms on January 15 recommended that the right to health should be implemented based on the 鈥榓vailability of resources鈥� with a commitment to 鈥榩rogressive realisation.鈥� The commission on health-sector reforms notes that it would propose that the government should be legally bound to ensure citizens鈥� primary health care. And, the basic emergency care should be free even if the patients receive the services in private hospitals.
Most of the propositions that have come to light appear well-meaning steps towards an effective reform of the health care system, but the government needs to show the will to carry out the reforms in the first place.