The dynamics of healthcare have been slowly but surely changing over the last few years. When we talk about changing dynamics it is not limited to clinical issues alone. The change must consider the changing social dynamics, the changing disease patterns, changing patient expectations, the changing regulations and the reality of delivering healthcare keeping all these factors in mind. For the healthcare organizations it is becoming increasingly difficult to balance the needs of all stakeholders.
The society as undergone a tremendous change over the last few years. The trust in the medical practitioner has been on the ebb. The tendency to diagnose one’s ailments on Google without understanding what to search for and the inability to comprehend the search results leads to inappropriate self-medications and delay in seeking proper medical help. Work stress and inability to provide adequate time for the body to heal is the main reason for delay in seeking help. When complications arise and quick turnarounds become elusive the only possible direction to vent this frustration is the Healthcare Organization and the hapless medical practitioner.
On the other hand, disposable incomes and availability of cashless insurance has increased the expectations on the hospitality quotient of the healthcare organizations forcing hospitals to offer premium rooms at a higher cost. At the end of the day the expectations and the willingness to pay for the services do not meet.
Over the last decade we have seen the profiles of the same diseases changing. While communicable diseases are being brought under control and we have been declaring many infectious diseases as eradicated, we have begun to see resurgence of the same micro-organisms in a more resistant and virulent forms. Vector borne diseases are on the rise, probably due to increasing garbage accumulation. Work related stress and the rise in overall stress levels has seen a rise of psychosomatic illnesses and mental health issues.
While all of this has been happening, we have very little investment going into medical research. India has not registered a significant patent in any area of medical field for a long time.
India’s public health spend has typically languished around 1.15 to 1.5% of its GDP. This has always been grossly inadequate. Though the government has set an ambitious target to increase this spend to about 2.5% of GDP, the figure looks elusive. Increasing inflation, increasing prices of pharma drugs and medical devices, increasing minimum wages of the skilled workforce required has been pushing up the cost of healthcare beyond the means of the common man. The per capita healthcare spend has already increased from Rs. 621 in 2009-10 to about Rs 1500 by 2018. Yet the budgetary spending has remained around Rs 458. The government has typically responded by increasing regulatory oversight, price caps and seemingly pro poor schemes like the Ayushman Bharat. While some of these measures seem justifiable to an extent, there has been no attempt to arrive at the real cost of the healthcare delivery apparatus in both public and private sector.
Overcoming the challenges will require a consistent effort from all the stakeholders involved.
· Increasing budgetary allocation to healthcare: The schemes like Ayushman Bharat have been ain increasing the accessibility of healthcare to the underprivileged. This will cover about 70% of the population. However, this measure only transfers the responsibility to the already creaking private healthcare. Ayushman Bharat can only be a stop gap measure. Fortifying Primary healthcare should be the main focus of the government. Providing the requisite infrastructure, manpower and drugs & devices and ensuring their continued availability will decrease dependence on costly private healthcare.
· NitiAyog has proposed higher tax on tobacco, alcohol and unhealthy foods. A focused approach to use this tax collection to fund wellness initiatives and non-communicable disease prevention should be considered.
· Focus should be on devising minimum care standards which are imperative to achieve the goal of affordable healthcare.
· A mechanism needs to be developed to discover the true cost of healthcare delivery before fixing prices
· Neither the US model of insurance-based healthcare nor the NHS based model of UK have succeeded. India needs to think and evolve a completely new model to fund healthcare.
· Private healthcare providers have typically sacrificed cost and efficiency in their unbridled pursuit of growth. They have consistently indulged in non-transparent, unscientific and at times opportunistic commercial practices which has eventually contributed to the yawning trust deficit. In the end these private providers are in poor financial health with unsustainable Return On Capital Employed (ROCE).
· Private players need to wake up to the fact that healthcare as a sector has a social obligation. There is an inherent risk of market failure and the economics of the business of the business will always open it to public scrutiny and skepticism.
· The business of healthcare has a right to reasonable profit and there is always a cost to deliver quality healthcare. But then perception is very important, and the providers must lend themselves to it. Organizations must be proactive in reinventing the model, methods and measures to evolve best possible efficiencies.
· Private players should explore newer avenues to deliver healthcare. Acute care, Home care, Convalescence care, Rehab care, Hospice care are some of the promising options to explore.
· Modern medicine does not equip the clinicians in the art of communication. It does not teach empathy to the sick. The curriculum pays only lip service to these parameters.
· Building trust with their patients must be an ongoing endeavor. Morality is an evolved self-interest.
· Patients need to take control of their health. The age-old dictum of “Prevention is better than cure” is truer in terms of health than any other. Taking the right advice at the right time is in their own self-interest. Communicate well with your physician and know the extent and severity of your illness.
· Do not hesitate to seek a second opinion.
· Health insurance is important, but it is wiser not to depend solely on health insurance. Invest in your own health but at the same time save for an eventuality.
· Last but not the least, be accountable for your health and minimize sickness because sick care will never be cheap.
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