The Uncertain Glory of Indian Clinical Medicine: A Case for Institutional Audit of Public Tertiary Care Hospitals

from the path-breaking work of John Rawls, the American philosopher. The capabilities approach has been applied more topically to the health sciences by the outstanding work of Sridhar Venkatapuram (Health Justice, Polity Press 2013), where the author makes a case that it is the right of all human beings to be entitled to the capacity to be healthy. In recursive mode, Sen et al. attempt to reinforce the value and inherent strengths of providing universal healthcare from a larger economic perspective. Outside of the constant lament that there is poor relative spending on health delivery of these services, a very low cost with reasonable quality is only possible if ‘the society, including the political and intellectual leadership can get its act together’ (Sen; Universal healthcare: the affordable dream. The Guardian January 6, 2015). A study from the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh has reported that even as private healthcare results in catastrophic out-of-pocket expenditure and drives patients into penury, the public health delivery apparatus (although better in absolute numerical terms) does not altogether prevent impending impoverishment (Prinja et al., Ind J Med Res 2013). Outside of the costs of medicines, this study attributes the fiscal catastrophe that illness brings to a large proportion of our people to other Medicine is a utilitarian science, which has overarching effects on the quality of human life and longevity. Its effectiveness in promoting and managing the health of people it claims to serve should be a focus of regular audit. In India, there has been a dramatic expansion of healthcare services, particularly in the private sector. On the other hand, the public health system while expanding on a smaller relative scale continues to be under stress and in some kind of perpetual duress. A large demand-supply mismatch could lie at the core of the discourse on their current state. There is, however, an added lack of efficiency as well in the delivery of these services, at least in the public perception. We suggest a compelling need for introspection and factual audit of the largest and oldest institutions that sit at the apex of public healthcare delivery. These institutions of national importance, although stellar in some aspects of their performance, have not hitherto been scrutinized in proportion to the funding they receive from the public exchequer. Regular and stringent audit in the public domain could actually propel them to higher heights and enable the realization of their potential more fully. Amartya Sen, renowned for his empirical work on famines, has also pioneered the capabilities approach with Martha Nussbaum, both of them in turn drawing Received: November 9, 2015 Accepted: December 15, 2015 Published online: March 11, 2016