Three things Indian healthcare needs

With a population that is almost twice of Europe, squeezed into a land mass that is one-third of that very continent, India has been struggling to prove its worth to the world. As a post-colonial economy, education and healthcare were thus late entrants into the milieu of privatisation.

This is understandable since private enterprises do not focus on nation-building, which is generally the domain of governments. Thus, although small scale businesses which provided education and healthcare have cropped up since liberalisation, structured businesses, managed by large corporates, have been few and far between in these domains.

With a late start, private healthcare and to a large extent government-managed healthcare have yet to mature. Neither the management of hospitals by administrators nor the management of patients by doctors has been standardised. This brings us to what I believe is the first need of the healthcare industry in our country.

Standardisation

While the healthcare industry progresses and the clinical talent in India is regarded as one of the best in the world, we still haven’t moved from a person-driven to a process-driven industry.

Doctors with inflated egos believe that it is the uniqueness of their knowledge and experience which saves the majority of their patients’ lives. This ethos is driven by a combination of teaching by professors with exalted self-images, attitudes of a society which believes that doctors are gods, and most importantly, insecurity on the part of doctors with regard to their knowledge.

But the situation has changed. Disillusioned by medical malpractice and the unreliability of individual doctors, patients are perpetually looking for the best doctor in the best hospital. They are happy to hand over their lives to the hands of their physicians but are perpetually unsure of the delivery of healthcare. And whenever the outcome of treatment does not match their expectations, they are left dejected and sometimes violently upset. This has pushed medical teams to a corner, where they huddle and try to gain sympathy for themselves and complain about an ungrateful society.

But could healthcare be better delivered by standardisation of practice? It has been shown that rigorous implementation of evidence-based medicine, via protocolised therapy and standardisation of communication, can reduce medical errors as well as the dissatisfaction of patients and their relatives.

With greater exposure to current standards of medical practice and a degree of reverse brain-drain, such practices are now more common in the country. This has also been supported by hospitals which have been moving towards accreditation by national bodies such as the National Accreditation Board for Hospitals (NABH) and for laboratories (NABL). An important confidence-building exercise has been the adoption of accreditation by government healthcare providers too.

I was especially impressed by a paediatrician talking about the low mortality rates in the Neonatal Intensive Care Unit in his department, compared to that in the rest of the state. And he was working in a government hospital in a Tier 3 city. Data collection and competition does seem to foster excellence.

Combine this with the lack of knowledge of how to run hospitals and we begin to understand why hospitals are getting into financial and legal troubles and are then taken over by international investors. Models of managing hospitals in this unique socio-economic situation are urgently required. This could lead to better clinical outcomes, happier employees and profitable ventures.

Thus, a lot remains to be done and continuing implementation of quality processes and standardisation of clinical and administrative work will be required to ensure wider and deeper implementation of process standardisation in the industry.

Data collection

This brings me to the next need of the decade–detailed data collection. While it is not surprising that data from a country which has about 1/6th the population of the world is incomplete and inaccurate, we need to work on collecting as much data as possible. Networks of doctors and professional bodies need to be created. They need to work together to create comprehensive databases. We have already seen some work being done in this direction. The Indian Academy of Paediatrics and the Indian Society of Critical Care Medicine are among the professional bodies which have shown us the path for creating collaborative studies.

While it is understood that such data will help the government plan a distribution of its resources, it is also clear that doctors and hospital administrators could use such data to understand the medical problems that affect this large population, develop customised solutions and then test these solutions and fine-tune them further.

Insurance cover

But how to use this knowledge to treat individual patients? About 1.35% of the nation’s GDP is spent on healthcare. This leaves people vulnerable to the strain on their finances, due to out-of-pocket-expenditure for medical care. Some studies show that up to 20% of annual income of households is spent on medical care. And with drastically varying incomes, this often leads to incomplete and inadequate treatment.

Consequently, the morbidities and mortalities of diseases in our country are high. The burden of partially treated, ongoing diseases further incapacitates an individual from being gainfully employed and thus creates a vicious cycle of suboptimal economic status and poor health. It is unreasonable to expect the government to foot the bill for the entire population and probably a good solution is improving medical insurance penetration from the current level of about 35%. A large proportion of the population does not have enough insurance cover.

It is thus imperative that we do better, although the healthcare sector has been a late entrant into the growth story of our country.

I believe that standardisation of clinical and administrative processes, better data management and a wider insurance cover would go a long way towards bridging the gaps created by our history.

(The writer is group head, haematology and bone marrow transplant, HCG Group of Hospitals)