PVT healthcare – Is it to blame?

Healthcare – who is responsible – govt or pvt sector

Healthcare delivery in India- A Cesspool

WHO definition of Health: Is a state complete physical, mental and social wellbeing and not merely the absence of disease of infirmity. Notably it does not say economic wellbeing! Essentially healthcare delivery is not responsible for economic conditions of it’s beneficiaries.

A healthy economy is usually associated with healthy citizens. It is not chicken and egg situation. Sanitation, health education, healthy eating and lifestyle choices and safe conducive environment lead to healthy productive population which in turn contributes to a thriving economy. Better health indicators are a matter of pride for most nations.

World over there are two concerns pertaining to healthcare: Affordability and Accessibility. Governments are responsible for ensuring that good quality safe healthcare is available for all its citizens. Sound and mature governments understand that investing in health, education and sanitation are as important if not more than focusing on financial growth indicators. Long queues and poor service and upkeep in Govt Hospitals created the need for Private healthcare. Delivering world class healthcare in India required astronomical investments which were previously unheard of. Like Dr Prathap C Redy said when he set up Apollo, “ I wanted Indians to get their heart treated by Indian doctors in India and not by Indian doctors in USA”. That mere thought established Apollo centers across India and the world and led to proliferation of other private healthcare models. With the capping of margins on drugs, implants without understanding private healthcare costs borne to service patients will limit private healthcare funding and axe what probably is the only fabric that is working in Healthcare as of now. I am afraid such ill thought through decisions will lead to pre Apollo situation wherein due to lack of advanced technology and latest medications and implants the rich and famous will go abroad for their treatment and the middle class will deal with long queues,sub optimal, apathetic care at Govt institutions.

Failure of Indian govt to provide good quality, accountable, safe, affordable and accessible to care its citizens …years after indepemdence led to proliferation of private healthcare. Private sector delivers services at a cost and return ninvestment is counted for when investors put their money. Ignoring this fact and punishing private healthcare for billing services within the norms and laid down guidelines cannot be accepted. It cannot be the reason for the country to beat private healthcare down. As a country we must decide whether we consider health as a social subject or a business. After the inclusion of Healthcare under Consumer’s Act all stakeholders in healhcare delivery aligned their thoughts and processes to running a business. Commercial activity. The socialist element was lost the day consumers act included hospital/ health service. Our good policy makers who played with the sentiment of behind doctor patient relationship ignored this and consequently it led to erosion of trust and more expensive healthcare to avoid litigations.greed that Healthcare is a business and ought to be treated so if it seen so by our policy makers. The result is here for all of us to see. Nobody trusts any stakeholder in the healthcare delivery chain….not the investors, owners/ promoters, doctors, management, supply chain, insurers..assumption being that each one wants maximum profit at the expense of the patients.

I believe the tipping point has come whereby patient advocacy ought to guide the policy makers. Making more choices available basis the price point (transparently) rather than restricting choices is the way forward. Establishing zero tolerance criterias for private healthcare. Positive steps to course correct will include fair and transparent sharing of outcomes and costs. Quality benchmarks for all providers whether Govt/ Private..sector cannot be the reason to allow poor outcomes as at the end of the day we are dealing with lives of our countrymen.

What are India’s economic indicators saying? What’s the trend over the past decade? How are we benchmarked against worlds best?

What are India’s health indicators saying? What’s the trend over the past decade? How are we benchmarked against worlds best?

Which country has the best health indicators and what’s the correlation with economy?

Role of govt: Prevention, Snitation and hygiene, Health education, Emergency services, wider health insurance coverage, Regulations to ensure safe and quality healthcare. Give more choices to its citizens and not lesser.

Role of private healthcare: To marry good outcomes with good and timely service. Liberty to charge for their services as long as its billing is transparent.

To unify the disparate components we need to identify one measure i.e outcome per rupee spent. This data if duly shared across all healthcare institutions (whether govt or private) should be accessible to all patients such that they can make informed decision. This will ensure that Govt instituions start focusing on outcomes and private institutions start focusing on reduction of cost to patient. Each one pays significant taxes but are yet unable to seek health care in Govt Instituions..why? Who is responsible o set this right?

Health is a fundamental right which the Govt is duty bound to protect. Providing safe, timely and dignified care to its citizens is the Govts responsibility. How is the Indian Govt regulating this aspect of healthcare be it in Govt hospitals or private hospitals? Is there even a central body which collects this information and grades hospitals basis these indicators? If priat healthcare cost has to be compared to Govt hospitals then lets list allthe criterias which matter most to the patient (including financials). Is private healthcare given any exemption/ discount on electricity,income tax liability etc or is it being treated like any other business? If I invest in market I will get 18% returns from first month whereas in Healthcare investors start yielding 9% returns and that too after 3 to 5 years. With the recent changes private healthcare will be forced to cut corners in treatment and service…this will eventually impact patients and their outcomes.

Health care has evolved but science has largely come through western research.  Although great strides have been made, has become costly as well. Everyone wants best of care for themselves and dear ones. Countries like US spent around 18% of its GDP on healthcare but still don’t have insurance cover for its population and the insurance companies are still dominating. Moreover in many developed countries like UK, the waiting list for getting the right treatment is long and is only permitted after getting a checkup done by the General Physician. Though each country is struggling in one or the other way, India is further unique, the government spending being extremely low at 2.5% (which was currently raised by the National health policy 2017), seems to be one of the poor quality care and service being rendered. Restrictions like these have made the government and public hospitals to reply largely on the private sectors to take care.

Accessibility and affordability

Hardly a few of our countrymen will consider government hospitals as a first choice for a routine checkup or any emergency. Many recent cases have been evident enough that insufficient bed facility, lack of space in ICU and critical care has restricted patients from getting the timely treatment. In cases like dengue or pre-term labor, due to non availability of beds, the patient’s condition becomes so worse that even the chances of survival is at stake where in the condition would have been normal if treated on time. Many dengue patients suffer fatality due to worsening of their health and once multiple organ failure occurs, survival chances reduce rapidly. In such situations, the first priority for the patient and their family members to go for hassle free treatment and well being becomes a hope only at private hospitals.

But one should also think that the private hospitals have emerged through investments from sources and stakeholders and not by doctors themselves. And just like any other field the investors would want the Return on their investment (ROI) in which doctors don’t have any such role of making money. In fact in most of the cases doctors never ever have anything to do with bill payment as the services what they can provide is to the fullest and has no relationship with money making.

Privatization evolving with costly modern machineries has become a deadly and explosive combination. The Indian nature being emotional, when combined with this, blocks their vision and the dear ones take all their chances to get the best of treatment in critical cases. Everybody wants the best of treatments in emergency without paying any heed to their paying capacity or the unpredictable nature of the medicine management.

Getting treatment from the right person has always been a concern. For instance the doctors always try to repair what God has made, and the chances of life saving reduces when a Mercedes is taken to a bike mechanic.  

Though it is always hard to think such finer concerns during emotionally charged situations, but lack of awareness and the anxiety among the patient’s relatives should be handled to the best by the hospital management.

Doctors have always been emphasizing that treatment is an attempt, but the outcomes are unpredictable. Medical sciences do not stick to statistics and not even the doctors are trained to think like wise. When the doctors say there are 10% chances of survival, it also means that there are 90% chances of not surviving. Sometimes these stats only give a false hope to the patient’s dear ones which turns out into rage and disappointment on mortality. And this becomes rampant with the double whammy of huge hospital bills. One has to understand that maximum expenditure is in those cases when outcome is not likely to be good and patient has to be admitted in Intensive care for long.

Corruption is another aspect, where one only thinks about his personal benefits and not of others. As in current situation when the doctors or hospitals are not honest about their intention, it is also termed as corruption. Our society, sadly is filled rampantly with corruption and is slowly becoming a part of our service. The truth is that the doctors or other stakeholders have come from the same society, growing by absorbing the same social values. With years of hard work and struggle (meant to serve humanity), few doctors will absorb the society ethos and try to make money and grow as fast as possible, at times even forgetting that they are dealing with sick and disturbed human beings.

Many situations arise when the doctors perform the treatment whole-heartedly, but lack of communication about the efforts or plans with the patient’s relatives also poise the situation. Attendant is always curious to know what has happened and what needs to be done, and in such a panic if they are unaware of what is happening, panic keeps on piling up and bursts out at saturation.

Being an attendant myself, during my brother’s surgery made e think as a doctor, what could probably be lacking in a doctor that bubbles out emotions in the attendant. Revealing the exact situation by communicating to the attendant from time to time keeps them intact with the current happenings and are aware of the efforts taken by the doctor.     

Currently, we have a reactive suffering society, which is always forced to go to private healthcare for most of the issues. And when they face with the truth of costly and unpredictable modern medicines, they cannot reconcile with huge expenses which could be assisted with poor outcomes. Lack of proper communication and insensitivity of few doctors(aggravated by extremely busy and stressful lifestyle) makes the situation even worse at times.

The administration in many hospitals is usually dominated by the management, who mostly fail to empathize with the complexity of human situations. For instance the final billing is always an insensitivity, where the attendant has to stand in queues for paying the bill and not at all empathized. Instead of finding better solutions, the government instead finds it easy to blame the private medical care and the doctors for not providing proper healthcare and plays along the public sentiments.   

It should always be noted that for instance, 80-90% of the dengue patients with multi-organ failure will die and any attempt to save those few will be very costly. The result of ongoing blame game can be slowing the private healthcare (with lack of Government involvement), doctors also are becoming wary of taking up critically sick patients. With complete destruction of trust and faith between the doctor and patient community has only led to worsening of the situation.  

Instead of relying only upon improving the infrastructure, beds, advanced machinery in government hospitals and governments expenditure on healthcare, research on low cost medication and scientific solution(without solely depending upon ayurveda and homeopathy) better outcomes can also be achieved. Changes in insurance policies according to the cost of modern healthcare, educating doctors for better communication and documentation along with finding solution to prevent corruption will definitely revive the best doctor – patient trust.

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