Adieu Gregorian 2023! As we bid bye-bye to 2023, the eyes and the ears seem to have gone sore reading and listening to the mundane regarding the challenges and the solutions for the healthcare moving forward… and to add to the over-congested literature in the field, I have been asked to pen down one more piece. We have been speaking of patient-centered, quality and sustainable healthcare, which is cost effective. These seem to be cliché phrases, a kind of flavour of the times, and remind me of yester years, when a cricket commentator asked of an expert as to what it would take from India to beat the West Indies, then the supremo in world cricket. Pat came the perfunctory answer, India will have to take 22 (…hic 20) wickets. All these expectations from healthcare that we listed above are valid, but the solutions suggested are as platitudinal, as the problems are mundane. We speak of technology in healthcare, tele-health, digital healthcare, and so and so forth, but to my mind, all of these seem to be quick fixes, and not solutions, to what are the pithy problems of healthcare.
The three major challenges of healthcare that I would like to highlight and desire to be addressed in 2024, or at least a sensitization brought about amongst the stake holders, are:
Deinstitutionalization of healthcare. In contemporary times, everyone wants technical fixes for all ailments, and that too at God-speed. For even a minor ailment, as trivial as sore throat, one rushes to tertiary care hospitals for redemption, thereby burdening them and denying care to seriously ill and more deserving patients. As such, we are miserably deficient in human and material resources in healthcare in India, and this avoidable clamour for tertiary care hospitals for diseases in the realm of primary care is compounding matters further. It is, therefore, important that our focus for healthcare delivery should be removed from the hospitals and taken to the home. This has been proven to be a successful model both in the United Kingdom (for myocardial infarction management) and USA, when during the Corona pandemic, a lot of cases were managed at home with no apparent ill effects on the final outcomes. It is, therefore, desirable, especially for treatment of chronic disorders in elderly people, and for end-of-life care, all kinds of treatment, even if involving basic intensive care, are delivered at home, rather than the patients getting admitted to the hospitals. It is a no-brainer that besides being convenient and more acceptable to the patients, domiciliary care will be cost effective to all the stakeholders, including payers and insurance companies.
Burn-out of the medical professionals. Every day, sad news percolates from some corner of the country that a medical student, nurse, or a doctor has committed suicide. All across the globe, burn-out rates in medical profession have been reported to be as high as 30–40 percent. I grant, a part of this is due to stresses of work; but equally, a significant portion of it is the avoidable stress that has been placed on the medical profession by gaslighting them into altruism, even at the cost of their personal health and well-being. They are expected to place their own, and their families’ interests on the backburner and are virtually forced into believing that they are a notch above the rest of humanity, which in fact they are not. They are just as human as rest of the society. In moments of distress, doctors are venerated both by the society and the patients, and medical profession is elevated to the pedestal of godliness. However, whenever a mishap occurs, or when bills are presented, this pedestal becomes shaky, and doctors are castigated as fleas sucking the blood of an ailing humanity. Such labels are not placed on any other profession, or professionals, e.g., lawyers; but a doctor is expected to deliver healthcare with no profits or commercial intent of any kind. I grant emergency care should always be provided, be it even gratis, to the truly underprivileged class. However, the doctor feels fleeced and cheated when a relatively well-off patient, laden with gems, jewellery, and dressed in designer clothes, flouting expensive cell phones, refuses to clear the bills, or at the time of discharge, produces a certificate from a political authority that he belongs to the economically weaker section (EWS) class and entitled to free treatment! The consequent economic, mental, and psycho-social pressures combine to produce ill health of the medical, nursing, and paramedical professionals.
Even the rapid obsolescence of medical knowledge, techniques, and technologies, and the pressures to keep pace with long working hours in the hospital due to shortage of medical professionals, contribute to this burn out. It is, therefore, important that some thought is paid on the mental health of the profession, which keeps the health of the nation in shape.
Political will. Every political party seems to be doling out Freebies as a largesse during election days despite empty governmental coffers. Expediently, the extra burden on the government exchequer is passed on to the private sector, extolling the virtues of the profession and in the garb of medical profession being noble, to the point of even being godly. It is expected that the medical profession will comply with all the stipulations that the politicians place on them with an ulterior motive. Government regulated capping of prices for the private sector, delayed payments from the health insurance schemes, cut-backs, bribery and corruption in release of payments and the deductions made without any window for remedial action and dispute resolution are ubiquitous and a daily reality faced by the private sector. Unfortunately, there is no discernible political will to even acknowledge these issues, leave alone addressing them.
It is, therefore, important that as we seek technical solutions to the conundrums facing healthcare, we must also look at holistic solutions to promote health and prevent disease. To provide value-based care in 2024, and to be relevant to the society, hospitals should change the model of delivery of healthcare and incorporate a wing under their aegis to look after the loco-regional population in the comforts and the environs of their home, rather than always bringing them to the hospital. A model similar to the Uber, Ola taxi model, in which the medical team can be on the wheels, is a concept worth exploring. Any distress call from the patients at home can be directed through a central server to the nearest medical team, which can respond quickly. It may not only reduce the cost of healthcare, but also improve its quality. Being treated at home under tender loving care of their loved ones will be highly appreciated by the patients and their relatives. Competition for hospital beds would ease as also the doctors and nurses will not be pressed for time, and would look after the needs of those hospitalised more efficiently and diligently. It will be a win-win situation for all, albeit it will require our political masters and the contumacious bureaucracy to wake up, shed their inertia, and act by creating regulatory and enabling framework. On our part, all of us in the profession, including the media, will have to do a Mary Lasker, lobbying with the politicians and the executive, as also with insurance companies, to make this concept see the light of the day.
Hope good-sense prevails!