Competition Commission of India again delivers on its mandate. If only older regulators had...
The healthcare industry is virtually run by “big money” pharma companies and manufacturers of modern equipment. Doctors are mere pawns in their hands. A new series on solutions for the ailing healthcare industry
Aamir Khan has stirred a hornet’s nest, by exposing the malpractices in India’s healthcare services. Personally I am surprised by the sharp reaction of the medical associations and their intention to sue him or to boycott all his programmes. I thought he presented a rather balanced picture; the cut-practice, unnecessary investigations and operations, etc are issues that are discussed almost everyday by the media. What is more important is to find out what is ailing our healthcare services and what can be done about it. As a doctor, I feel that the least we could do is to stop the “blame-game” and the clamour to “punish doctors who misbehave”. Are they really guilty? If so, to what extent?
Even the most well-informed and well-placed intellectuals have not understood the complexities of our healthcare system. There are two distinct streams to this service. The state provides “public healthcare” for essential services to benefit the maximum population. The importance given to public health services and the amount of money spent on it by the state varies from country to country. India spends hardly 0.5% of its GDP (gross domestic product) on health, which accounts for just around 26% of the total amount spent on healthcare; the remaining 74% comes from the pockets of Indian citizens. Even though the importance given to this section is enormous and primary health service is so neglected that a survey by some social institutions found that 80% of the people opted for private services for their primary health—despite abject poverty. Moreover, it found that less than 20% of the MBBS doctors were involved in primary health care—private or public. This is because the union and state governments seem to be inclined to leave health services primarily in the hands of the private sector.
While the private sector dominates healthcare services in India, barring a small section of general practitioners, it consists of nursing homes, hospitals and specialists. The hospitals are turning high-tech and people end up spending three times of what the state is the spending for their health. Unfortunately, the private sector offers only the lucrative ‘cold’ work and modern high-tech services and thrusts all uncomfortable or non-profitable services on to the public sector—the poor, destitute, old people, tuberculosis, leprosy; even emergency services are a headache to them. “Health is the responsibility of the state” is a convenient argument.
WHY? Though George Bernard Shaw warned society a hundred years back, the people have steadfastly refused to accept that the (private) healthcare sector is an INDUSTRY—a highly profitable industry because of extremely low consumer resistance. Worse, now it sells attractive healthcare ‘products’ at profitable rates. Profit gets priority and healthcare becomes a subsequent objective. Hence, actual “health service” becomes a by-product and the proportion of its availability depending on the moral concepts of individual doctors. In just around 10% of the cases one gets miraculously good results and the patient is gifted with some extra and valuable years of good life. By then, the remaining 90% suffer so much economic loss that nearly a crore of Indians are being pushed below the poverty line every year because of crippling medical expenditure. Who is at fault and what needs to be done to correct this situation?
The medical industry is virtually run by “big money”, “ably aided” manufacturers of modern equipment and by big pharmaceutical companies. The media is cleverly used, first to create panic about every illness and then to glamorise new technology or a new ‘miracle’ drug/ invention which will save you from a ‘deadly’ illness. Doctors are mere pawns in their hands. The cost of research, PR and advertisements needs to be covered and the doctors must then earn money for the industry chain to make a profit. How can all this come cheap? The overuse of costly investigative and treatment modalities is further increased by:
a) lack of knowledge and expertise in specialist doctors
b) ever-increasing expectations of patients and
c) growing intolerance in society towards any untoward consequences during the management of treatment.
Earlier, there was a lot of emphasis on close observations and other clinical methods for diagnosis but now, due to the need to avoid ANY MISTAKE, the trend is towards “Objective Diagnosis”. Less you know, more you depend on technology. Less your expertise, more you need precision equipment to perform. The costs escalate, doctors are blamed, “internal trading” is suspected—and confirmed even without any evidence. But the fact is that many doctors are now totally dependent on these costly modalities; they are crippled without these aids for reasons mentioned. “Cut-practice” is but a small aberration for additional gains and merely indicates the same degree of corruption as is prevalent in the society in general. Totally unindicated misuse just for making money is an unpardonable crime. It does exist but I cannot judge the percentage of such unethical practices—could be 30% or so!
But overall, are you better off than previously in terms of your health-care? Facts are stranger than fiction. Average life expectation at birth is a useful indicator of the health of the community. Sri Lanka and Thailand have a much better lifespan than for Indians (more than 71 years compared to 64 for us). Reason? Those governments depend more on public healthcare, spending more than 50% of the total health expenses. And there is more attention to primary (and secondary) healthcare needs as indicated by a much better ratio of nurses in those countries, despite less number of doctors per 10,000 population. Mumbai fares the worst. It has 20 doctors, all sorts of specialists and all sorts of modern facilities, yet a Mumbaikar lives just around 58 years. This is universal; small town people have a much healthier life than those in metropolitan cities, all over the world. MODERN TECHNOLOGY DOES NOT OFFER YOU A BETTER HEALTH CARE EXCEPT SPORADICALLY. Mr Aamir Khan, don’t blame the doctors, blame the market, blame faulty medical education.
(Dr Sadanand Nadkarni, 80, is the former Dean of Sion Hospital, author of several books, a serious thinker of medical issues and hugely respected for a series of path-breaking ideas on improving the delivery of medical services to the aam aadmi. His book “Management of the Sick Healthcare System” is among the first to speak out about medical malpractice and other issues).
The path of least resistance is higher
The market is behaving as if it wants to head...