January 21 2015, Wednesday
Will take up cashless facility issue with FM: Javadekar

Express News Service | Pune | January 18, 2015

Union minister for environment and forests Prakash Javadekar on Friday made an assurance that he would resolve the issue of the cashless facility that had been stopped at hospitals since December last year. “I will take up the matter with the Union Finance Minister Arun Jaitley in the next three days,” Javadekar said, while interacting with representatives of the hospital association, insurance firms and consumer organisations.

Later, Javadekar said he would take up the matter with the finance ministry and try to resolve the issue as soon as possible. An expert from New Delhi will also be appointed to check the rates and consult doctors in Pune before listing a new rate list, he said. Several small and big hospitals were aggrieved over the issue of ‘preferred provider network (PPN)’ floated by the four public sector general insurance companies and had been forced to stop the cashless facility from December 1.

Public sector insurance companies — New India Assurance Company, United India Insurance Company, Oriental Insurance Company and National Insurance Company — under the banner of General Insurance Public Sector Association (GIPSA) had introduced a new scheme known as PPN under which hospitals have to comply with rates of surgeries and other procedures. Indian Medical Association doctors have said that the rates were too low as compared to that in Bangalore and Mumbai.
Longer Chest Pain Equals Bigger MI Risk
Dr KK Aggarwal Patients with acute myocardial infarction have longer duration of chest pain than those without a myocardial infarction. Patients with chest pain of short duration, less than 5 minutes, are unlikely to have an acute infarction and have a good prognosis at 30 days.

A single–center study showed that only 8.9% of the patients received a final diagnosis of acute MI, and these patients had a significantly longer duration of chest pain compared with the rest of the cohort (120 versus 40 minutes) according to Carlos Calle–Muller, MD, of Henry Ford Hospital in Detroit, and colleagues.

Those who had chest pain lasting less than 5 minutes always had a good outcome, with no acute MIs or deaths within 30 days, as reported in the September issue of Critical Pathways in Cardiology.

If the clinical assessment and ECG are benign, such patients might be able to be discharged directly from the emergency department without stress testing for outpatient follow-up.

The median chest pain duration was 180 minutes among the 10 patients who died and only 40 minutes for the others.

Among patients with acute MI, longer chest pain duration was not associated with higher 30–day mortality, but it was associated with a higher initial level of cardiac troponin-I.


Health Check Up and CPR 10 Camp at G B S.S.School, Varun Marg, Defence Colony, New Delhi on 22nd December 2014
Quote of the Day

I feel sorry for people who don't drink. When they wake up in the morning, that's as good as they're going to feel all day. Frank Sinatra
News on Maps
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Make Sure
Situation: A patient on 10 units of insulin developed hypoglycemia after taking a light breakfast.

Reaction: Oh my God! Why was the insulin dose not reduced?

Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with 10 gm of carbohydrates.
Reader Response
Thanks for your eMedinews. Excellent scientific content. Hats off to KKA: Dr. Ghodke Priyadarshi, President, Kolhapur Surgical Society, Maharashtra.
Adulterated cosmetics
“9E. For the purposes of this Chapter, a cosmetic shall be deemed to be adulterated,-
(a) if it consists, in whole or in part, of any filthy, putrid or decomposed substance; or
(b) if it has been prepared, packed or stored under insanitary conditions whereby it may have been contaminated with filth or whereby it may have been rendered injurious to health; or
(c) if it contains colour other than those prescribed; or
(d) if it contains any harmful or toxic substance which may render it injurious to health.”
Amendment of Section 10
17. In section 10 of the principal Act,-
i) after clause (bb), the following clause shall be inserted, namely:-
“(bbb) any adulterated cosmetic;”;
(ii) in clause (d), the words “patent or” shall be omitted.
Amendment of section 11.
18. In section 11 of the principal Act, in sub-section (2), the following proviso shall be inserted, namely:-
“Provided that in the event of that package or sample of that drug or cosmetic found in contravention of any of the provisions of this Chapter or any rule made thereunder, the same shall not be allowed to be imported from that or any other port of entry in the country.”.
Substitution of new section for section 13.
19. For section 13 of the principal Act, the following sections shall be substituted, namely:-
Penalty for Import of drugs Or cosmetics in contravention of this Chapter
“13. Whoever, himself or by any other person on his behalf, imports,-
(a) any drug deemed to be adulterated under section 9A or spurious under section 9B and which when used by any person for or in the diagnosis, treatment, mitigation, or prevention of any disease or disorder is likely to cause his death or is likely to cause such bodily harm which amount to grievous hurt within the meaning of section 320 of the Indian Penal Code, solely on account of such drug being adulterated or spurious or not of standard quality, as the case may be, shall be punishable with imprisonment for a term which shall not be less than ten years but which may extend to imprisonment for life and shall also be liable to fine which shall not be less than ten lakh rupees or three times value of the drugs confiscated, whichever is more:
Provided that the fine imposed under this clause shall be paid to the person who had used the adulterated or spurious drugs:
(b) any drug-
eMedinewS Humor
Matka was caught by the police.

Police: How did you kill 20 people..?
Matka: Mai gaadi tej chala raha tha par jab maine brake lagaya, to pata laga ki brake fail ho gaye hain. Phir maine saamne dekha to 2 aadmi ja rahe the…doosri taraf 1 barat ja rahi thi. Ab aap batao mai gaadi kidhar modta…? Police: Of course, jis taraf 2 aadmi the. Nuksan kam hota.
Matka: Exactly. Maine bhi yehi socha tha par woh 2 aadmi meri gaadi dekh kar barat me ghus gaye…Toh mai kya karta!!!
Pediatrics eMedinewS
  • The timing of gluten introduction into an infant's diet does not appear to influence a child's subsequent risk of developing celiac disease (CD), reports an article published online January 19 in Pediatrics.
  • Bariatric surgery should be considered as an option in carefully selected obese children and adolescents, suggests a new position statement from the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. The position statement was published online in the Journal of Pediatric Gastroenterology and Nutrition.
Dr Good Dr Bad
Cardiology eMedinewS
  • Participating in a walking group may remarkably improve overall health with little to no adverse effect, suggests new research published online in the British Journal of Sports Medicine. Researchers noted that participants of group walking showed significant reduction in mean differences for systolic blood pressure, resting heart rate, body fat, body mass index (BMI), and total cholesterol.
  • Asian-Americans have a higher risk of stroke and hypertension than non-Hispanic white people, suggest new data published in the Journal of the American College of Cardiology.
eMedi Quiz
Which of the following is not a post transcriptional modification of RNA?

1. Splicing.
2. 5' capping.
3. 3' polyadenylation.
4. Glycosylation.

Yesterday’s Mind Teaser: Which of the following is present intracellularly in muscle cells?

1. Insulin.
2. Corticosteroid.
3. Epinephrine.
4. Glucagon.

Answer for yesterday’s Mind Teaser: 2. Corticosteroid.

Correct Answers received from: Dr Avtar Krishan, Daivadheenam Jella.

Answer for 19th Jan Mind Teaser: 2. pKa.

Correct Answers receives: Dr Avtar Krishan, Daivadheenam Jella, Dr Sushma Chawla, Dr Gopal Shinde.
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IJCP Book of Medical Records
IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us at: www.ijcpbookofmedicalrecords.com
  • First person and NGO to trained Maximum Number of Police People trained in Hands only CPR10 in one day
  • "First NGO and doctor to provide "hands on training" to 11543 people in "Hands Only CPR 10" in one day.
  • First individual doctor and NGO to provide "hands on training" to 8913 females in "Hands Only CPR 10" in one day.
Video of the Day
Dr K K Aggarwal head on with Arnab Goswami of Times Now on MCI Issues
h t t p : / / w w w . t i m e s n o w . t v / D e b a t e -
Heart Care Foundation of India announces the Mrs Abheeta Khanna Oration on Excellence in Sports and Health
Betiyan Hain Anmol, Bachao Dil Se, Medanta joins hands with Heart Care Foundation of India
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh,
SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund,
Post CHD Repair
Deepak, SM Heart Care Foundation Fund,
CHD TOF https://www.youtube.com/watch?v=rjOel0aaqt0
IMA in the News
  • Medical fraternity wants to make acute care free: Times of India
  • Tobacco Spiting at public places will now be an offence – IMA: Rajasthan Patrika
  • Move, Move and Move is the mantra as inactivity is more deadly than obesity: IMA: Shah Times
  • Move, Move and Move is the mantra as inactivity is more deadly than obesity: IMA: Focus News
  • Move, Move and Move is the mantra as inactivity is more deadly than obesity: IMA: Hindustan Express
  • IMA welcomes Tobacco Amendment Bill 2015: Healthyduniya.com
  • Supreme Court guidelines against criminal complaints against doctors: IMA: Country and Politics.in
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IMA supports ESI students
The Times of India, Kolkatta, | Jan 18, 2015

The Indian Medical Association has extended its support to the students of ESI medical colleges who are fighting against the Centre's decision to exit from medical education sector.

The Indian Medical Association has written to President Pranab Mukherjee and Prime Minister Narendra Modi to reconsider their decision which will put the career of many medical students at stake.

"At present, four ESI medical colleges are functioning in the country, while inspection of a few colleges has been completed. Four more colleges are also being developed. So, the government's order means that altogether 12 colleges will stop functioning. When the government is trying to create 1 lakh doctors by 2021, this kind of the decision is alarming," IMA honorary general secretary K K Agarwal said.

"We strongly object to the central government's decision to exit from medical education sector. We asked the central government to reject the proposal and initiate handing over all the ESI-run medical, dental, paramedical and nursing institutions with all its required infrastructure to the state governments or private sector or public sector undertakings," he wrote in his letter to the country's President and the Prime Minister.

In their memorandum sent to the college authorities a couple of days ago, the ESI Corporation wrote that it could neither undertake further admission in the medical colleges and other medical education Institutions nor start new colleges.

The memorandum also said that the already admitted students may be adjusted as per provisions of the "essentiality certificate" issued by the state government. But, the state government's colleges are overcrowded. The director of medical education even said that they could only take the responsibility of the ESI medical colleges if funds were provided by the central government.
The Year in Medicine 2014: News That Made a Difference
14. HHS Secretary Sebelius Resigns, Burwell Confirmed

On April 10, US Department of Health and Human Services Secretary Kathleen Sebelius resigned, ending a 5-year term that was marred by the problem-plagued rollout of the Affordable Care Act (ACA). The next day, Sylvia Mathews Burwell, director of the White House Office of Management and Budget, was nominated by President Obama to replace Sebelius, and on June 5, the Senate confirmed her nomination. (Source: Medscape)
News around the Globe
  • Nearly 20% of adult epilepsy patients report symptoms of attention-deficit/hyperactivity disorder (ADHD), a rate much higher than that of the general adult population, suggests a new study published online in Epilepsia.
  • Radiation therapy alone may be as effective as chemoradiation for relieving dysphagia in patients with advanced esophageal cancer in the palliative setting, suggests a large phase 3 trial. However, radiation therapy was associated with significantly less toxicity. The findings were presented at the 2015 Gastrointestinal Cancers Symposium.
  • Greater sedentary time is associated with increased risk of adverse health outcomes including early death, even in those who otherwise exercise regularly, suggests a new meta-analysis published in the January 20 issue of Annals of Internal Medicine.
  • Patients with systemic lupus erythematosus (SLE) who are treated with hydroxychloroquine have a dose-dependent decrease in risk for developing diabetes, suggests new research published online in Rheumatology.
  • Increased sodium intake was not associated with higher risk of mortality over the course of 10 years in Medicare patients, suggests a report published in JAMA Internal Medicine.
Dr KK Spiritual Blog
The lips of truth shall be recognized forever; a lying tongue is but for a moment

This sutra from Bible has a very deep significance in day to day life. The truth is everlasting and always ends up in internal happiness and self realization and in the long run always gives you happiness and an all–win situation. On the contrary, a lying tongue will only give you a momentarily pleasure but you will end up in some difficulty later in life.

Spoken words cannot come back as in the case of a released arrow from the bow. Once lost, one cannot get back their youth, virginity, or respect, similarly, spoken bad words cannot be taken back and once spoken will create negative waves in the other persons (on whom they were spoken) mind which will persist as repressed thoughts or memory in the people’s mind for ever. Such bad memories will keep on coming back in the person’s mind causing damage to the personal relationships.

A spoken word is a karmic expression. For every karmic action there is an opposite and equal reaction. For every negative karmic expression one has to pay the debt either now or in future. The law of karma says that every debt has to be paid. It is always better to avoid indulging into negative language both in spoken words as well as in the mind. The yoga sutras of Patanjali describe thinking, speaking or doing anything wrong as having the same karmic significance. We should not only purify ourselves in actions and spoken words but also in the mind. If a person keeps negative thoughts in mind, sooner or later they will be reflected to the outside world.

The momentary pleasure which one gets by "lying" has no spiritual significance as it only satisfies your ego sense or makes you attached to any of the five senses. The transient pleasure experienced by the body stimulates a chain of reactions, consisting of action, memory and desire leading to action again, which will only intensify the greed and attachments. In the Mahabharata, Lord Krishna has given only two examples which work as an exception to such a situation. Any truth which harms others may not be spoken and any lie which does not harm anyone but benefit a few may be spoken. Truth is the opposite of doubt and it is always better to clear all the doubts from the mind as any repressed doubts can end up into causation of heart attack, paralysis and cancer.

Truth also means taking conscious-based decisions as the consciousness will never lie. While taking any decision one should always ask oneself: Is it the truth? Is it necessary? And will it bring happiness to me and the people around? Lord Krishna is also described as "SATCHITANAND" which only indicates the qualities like truthfulness, conscious based decisions and internal happiness. The practice of truthfulness has to be practical over a period of time and made a part and parcel of your daily life. To start with a person may have bad experiences but in the long run truthfulness will always win.
Inspirational Story
A Wise Donkey

One day a farmer’s donkey fell down into a well. The animal cried piteously for hours as the farmer tried to figure out what to do. Finally he decided the animal was old, and the well needed to be covered up anyway; it just wasn’t worth it to retrieve the donkey.

He invited all his neighbors to come over and help him. They each grabbed a shovel and began to shovel dirt into the well. At first, the donkey realized what was happening and cried horribly. Then, to everyone’s amazement, he quieted down. A few shovel loads later, the farmer looked down the well, and was astonished at what he saw.

As every shovel of dirt hit his back, the donkey did something amazing. He would shake it off and take a step up. As the farmer’s neighbors continued to shovel dirt on top of the animal, he would shake it off and take a step up. Pretty soon, everyone was amazed, as the donkey stepped up over the edge of the well and trotted off!

Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of a hole is to shake it off and take a step up. Each of our troubles is a stepping stone. We can get out of the deepest holes just by not stopping, never giving up! Shake it off and take a step up!
Rabies News (Dr A K Gupta)
Can the type of vaccine be interchanged during the course of IDRV?

As far as possible, the same vaccine should be used throughout a course of IDRV. However, in exigencies, the permitted vaccines are interchangeable.
Twitter of the Day
Dr KK Aggarwal: Raw milk not safe by Dr. K K Aggarwal http://bit.ly/173zZ6B #Health

Dr Deepak Chopra: In QM wave functions are mathematical abstractions of the phenomenon of quantum measurement. As such they exist in consciousness alone
Wellness Blog
Work–related stress can kill

Job stress increases the risk of heart disease by disrupting the body’s internal systems.

The findings from a long–running study involving more than 10,000 British civil servants also suggest that stress–induced biological changes may play a more direct role than previously thought. The researchers measured stress among the civil servants by asking questions about their job demands such as how much control they had at work, how often they took breaks, and how pressed for time they were during the day.

The team conducted seven surveys over a 12–year period and found that chronically stressed workers – people determined to be under severe pressure in the first two of the surveys – had a 68 percent higher risk of developing heart disease. The link was strongest among people under 50.

Stressed workers also eat unhealthy food, smoke, drink and skip exercise – all behaviors linked to heart disease.

In the study, stressed workers also had lowered heart rate variability, a sign of a poorly–functioning weak heart and higher–than–normal levels of cortisol, a "stress" hormone that provides a burst of energy for a fight–or–flight response.

Too much cortisol circulating in the blood stream can damage blood vessels and the heart.
IJCP’s ejournals
  • Indian Journal of Clinical Practice
  • Indian Journal of Multidisciplinary Dentistry
  • Asian Journal of Diabetology
  • Asian Journal of Critical Care
  • Asian Journal of Clinical Cardiology
  • Asian Journal of Obs & Gyne
  • Asian Journal of Paediatric Practice
  • Asian Journal of Ear Nose and Throat
Press Release of the Day
IMA to focus from illness to wellness

The meeting of IMA Confederation of Associations of Medical Specialists of India (IMA- CAMSI), organized by IMA on 18th January, 2015 was chaired by Padma Shri Prof Dr A Marthanda Pillai National President, IMA and Co Chaired by Padma Shri Awardee Prof Dr K K Aggarwal Honorary Secretary General IMA.

Members who attended the meeting were Dr S S Agarwal National President (Elect), IMA; Dr VCV Pillai Past National President, IMA; Dr Vinay Aggarwal Past National President, IMA; Dr D R Rai Past Hony. General Secretary, IMA; Dr Alex Franklin Hony Joint Secretary, IMA; Dr Harish Gupta Hony Joint Finance Secretary, IMA; Dr F Ramesh Datta Hony. Joint Secretary, IMA; Dr Manjul Mehta Hony. Asstt. Secretary, IMA; Dr H R Satija Asst Secretary IMA; Dr Pawan Gupta Jt Secretary IMA Health Scheme; Dr Anil Goyal President IMA Haryana; Dr Suresh Amin IMA Haryana; Dr Ajay Gambhir President NNF; Dr Sarvesh Tandon OSD to Health Minister; Dr H K Chopra President Cardiological Society of India; Dr A K Grover Past President All India Ophthalmology Society; Dr P K Kohli Association of Surgeons of India; Dr Suresh Vasistha Association of Surgeons of India; Dr M. K. Taneja Past President ENT Association of India; Dr Panna Choudhury IAP Representative; Dr O P Sharma Past President Geriatric Society of India; Prof. Ashok Kumar Saxena ISA; Dr Ish Kathpalia Secretary Geriatric Society of India, Dr O P Bansal Secretary Indian Radiological Imaging Association; Dr Rajiv Garg President Indian Association of Occupational Health; Dr Chintamani Association of Surgeons of India; Dr Rajeev Sood Urological Society of India and Men’s Health Society and Joint, Action Council Service Doctors Association and Dr Manoj Singh Indian Association of Pathologists and Microbiologists

The following were resolved:

Health Budget
  • In the proposed national health policy, a mere increase of GDP to 2.5% is not in the national interest.
  • The policy itself acknowledges that only if the government starts to spend 4 to 5% of GDP, a real impact can be made in the health sector.
  • IMA-CAMSI proposes 8% of the GDP.
Quality and safety of health care
  • While magnitude of care may differ, the standards of care should be same at every level of health care.
  • The standard of care in any emergency should be standardized.
  • All IMA- CAMSI organizations and their branches are to nominate nine members for Swasth Bharat and Swachh Medical Establishments movement.
Policy decisions
  • IMA should be included in every Govt. Policy or any new Act being enacted.
  • There is a need for inculcating better managerial skills; an Indian Medical Service on the lines of IAS, IRS is needed.
  • There should be no unrealistic targets for Govt. and Private doctors. The harassment of specialists in corporate hospitals should be addressed.
  • Ayush doctors should not be allowed to prescribe allopathic drugs and practices.
  • No person in the country should die just because he or she cannot afford it. Acute emergency care should be free in the country. Private sector providing emergency care should be reimbursed by the state governments
  • Considering private hospitals as pure industry is entirely misleading and it contradicts the Govt. policy of making health as a fundamental right. When the Govt. demands that medical ethics need to be followed and considers it as a service sector, branding clinical establishments in private sector as an industry exposes a contradiction in Govt. policy.
  • The need for standardization and quality health care services is understandable, but the mechanism to ensure it through Clinical Establishment Act will be counter-productive.
  • A process of voluntary and incentive driven accreditation is the best practical option.
  • The preconceived notion that private sector is always profit-driven and ignoring it in the overall structure of health delivery and allowing it to run parallel to the Govt. sector rather than promoting them as complementary is unbecoming of a health policy.
  • It appears that the proposed national health policy is more beneficial to people who can afford even otherwise. Govt. policy seems to give undue importance to corporate sector forgetting the fact that majority of health care in the country is still delivered by small-scale institutions, and these small players move the national health indices. Some of the policy statements expose the lack of in-depth knowledge of Govt. regarding the role of the small and medium hospitals in delivering health care, particularly to the poor and in remote areas. Govt. policy should aim to sustain and promote these own-account-enterprises (OAEs) so that affordability and accessibility is not affected. Govt. should consciously discourage corporate culture in health care, which will definitely push up the cost of treatment and affect accessibility because all the corporate hospitals are based in cities.
  • Propagation of the potential of AYUSH remedies in different conditions should only be evidence based in a modern society and on the basis of strict monitoring of beneficial and adverse effects and not on sentimental grounds. It also should not be the policy of the government to envisage a ‘bridge course’, which will result in mixing of various systems of medicine, which works on diametrically opposite basic principles.
Shortage of beds and man power
  • Shortage of beds in the country should be tackled by including, recognizing and accrediting the concept of day care and home care in the main healthcare delivery system.
  • The shortage of teachers in medical colleges should be tackled with the concept of virtual education where one professor can share his knowledge with multiple medical colleges.
  • Better mapping of manpower both professional (including ophthalmologists) and mid level paramedical personnel (for example optometrists) with a stress on qualitative improvement in training
  • IMA should work with the Govt. to find solutions for shortage and retention of doctors in the rural areas.
  • High income tax free salary with free lodging and boarding in high priority difficult postings.
  • Ten percent extra marks for students opting for PGs.
  • One year diploma in rural medicine and surgery for those in rural postings.
  • One year certificate in community health for those in rural posting
  • To consider rural posting near retirement.
Health Priority
  • IMA to appoint State Health Programme Directors to coordinate with national health programmes, IMA programmes and IMA CAMSI projects
  • Care of the elderly; occupational health, men's health, sexual health and pain management care to be included in the government primary care system.
  • There is a need for Gay and third gender health care policy.
  • Instead of universal vaccination, the concept of vaccination during life course should be added which includes adult vaccination.
  • Every birth must be attended and the provider must have knowledge of neonatal resuscitation.
  • 100% general public should be taught cardiopulmonary resuscitation (CPR).
  • Every citizen should get affordable quality healthcare drugs and devices. Hospitals should not insist to buy them from the hospital pharmacy at higher prices.
Health Educational and Medical Education
  • Mobile phones are available practically in every state, district and rural areas and should be used in providing healthcare through various healthcare software solutions (primary healthcare on mobiles), including strengthening of primary care including the use of other telemedicine models.
  • Common medical entrance examination (NEET) should be implemented.
  • Ten percent of medical education should be on mental health. All doctors in the country should be sensitized on mental health.
  • Soft skill education should be imparted to every doctor, both in the medical college as well as those who are practitioners.
  • Priority should be given to open medical colleges in areas where health care services are not available. The medical Education curriculum should be revised in every 5 years.
Financial Health
  • Medical doctors and establishments should be given financial loans at a low rate. When Govt. of India is given loan for healthcare by World Bank at negligible interest rate, then why should the Govt. not do the same for medical establishments.
  • Tax free import of sight saving along with life saving equipments
  • Differentiation of standard of care vs state of the art care and differential or top up payments for the same. Rational criteria based on cost analysis for reimbursements for procedures
  • Income tax, luxury tax and service tax in hospitals and VAT on drugs goes contrary to the government policy of making health a fundamental right. Government policy should influence and encourage private health care establishments by exempting them from the purview of income taxes and providing subsidies to these institutions. Government in turn can demand at least 15% free care in these institutions for poor patients. Government also should provide water electricity and basic amenities at reduced rates for hospitals.