Indian HealthCare : The steep fall of the Doctor
The legacy of Indian healthcare system and peoples’ physical wellbeing is one of most ancient and happy one to talk about. The doctor was a demigod and hence the saying vaidyo narayano hari (meaning that doctor is like a god). However possibly somewhere in the last 100 years, things have changes globally and shaping into something very alarming, specifically in India. The key symptoms that I observe and read are primarily, are around the complete loss of trust in hospitals and doctors from a large majority of patients and communities in India.
We read and hear of two serious symptoms
- Exorbitant medical care costs and over-interventions right from child-birth to vaccinations
- Loss of faith in medical care that patients and communities attacking doctors and hospitals when an untoward incident happens
Both the symptoms are scary and can significantly shake-up the social and financial stability of people and the strata of society that is more financially vulnerable. We do hear of stories where a bout of disease pushes a family into serious debt for years etc., Hence, it needs to be understood by caregivers and caretakers that, we are on a downward spiral and needs our collective thoughts and change.
Before discussing possible solutions, Let me attempt to share key cause of the current situation. Looking deep into symptoms and how we arrived here, I see three major causes for the situation. They are:
- For a country like India (for that matter any country), the government participation in healthcare is of utmost importance. Europe and specifically Scandinavian countries, even with their high tax rates are getting better quality of life ratings — thanks to subsidized healthcare. However in India, the government funding and focus has seen a steep decline in last 25+ years. Both for primary care and tertiary care, government hospitals are not even a partial answer. IMO, this situation got worser in last 20+ years
- Entry of pure-play businesses into healthcare. Lot more of publicly traded companies are entering into healthcare, where they optimize for profits and the so called shareholder value. From the 1st rupee invested, these businesses will optimize their services and engagement for profits. Healthcare and profiteering are just not going to peacefully co-exist, for sure
- Lastly the medical education in India has significantly moved from Government funded to private education, pushing up the affordability of such education. Not just affordability but severe controls on number of students who can graduate is severely restricted, leaving doctor-patient ratios abysmally low
Having stated the problem symptoms and key causes, Let meexplore some possible solutions (on the periphery), as deeper solutions may need larger and wider behavioral changes etc.,
Fortunately or unfortunately, most solutions involve government’s direct or indirect participation. First line of intervention is to increase the quantity and quality of investment into healthcare facilities (Both at Tertiary and primary centers, covering metros and villages alike). We do have some good tertiary care facilities like AIIMS, NIZAMS etc., but these are too few and too far from each other. The second intervention is to fix and control caregiver fee structures. There was a recent attempt in a couple of key procedures that are widely used in India, which are knee transplants and stent insertions for cardiac issues. (IMO, the attempt was half-hearted and cosmetic). Interventions and guidelines need better enforcement and need swift government responses like license cancellations for violators.
To conclude this part, the fall from seeing a doctor as demigod to engaging with a doctor with utmost concern and suspicion is devastating. This is settling into a dangerous environment where the two parties are engaging with each other but with a high degree of suspicion. Whenever an engagement results in non-desired outcomes, we can foresee bitter incidents and even violence. I am sure some of the old-timers in the profession see this as a huge loss of face for the doctor fraternity. (Hear more from Dr. BM Hegde who is more qualified to talk on this subject)
Lastly, as the ancient Indian wholistic approach to health preaches, preventive medicine is a huge area that is conveniently muted by vested interests. Preventive medicine and life style adjustments are key to personal health and I hope to talk on that topic in the part-2 of this blog.
Ranadheer Velamuri is a technology leader with close to 20 years experience with Technology, Data, Building products and teams in companies like Yahoo, Microsoft and eBay. You can read more from him here.