Must get our healthcare priorities right
The plethora of healthcare conferences in India brainstorming on various issues is astounding. Not a week goes by without some conference somewhere discussing the ‘how’ of expanding healthcare’s business dimension.
There are a few eye-catching developments that have gripped the medical community. Clinical data, artificial intelligence and digital technology are some of them. They promise to herald a revolution in healthcare delivery. Undoubtedly, a transformation is in the offing. Medical technology companies, data management firms, and insurance and accreditation agencies have taken the centre stage of healthcare, pushing the core group of caregivers to the periphery. It would not be long before healthcare becomes a ‘fly-by-wire’ system akin to the airline industry. Physicians may eventually be relegated to the role of front-desk managers in the hospital, taking care of triage and keyboard controls.
It is prudent to appraise breakthrough technologies and put them in perspective. There are enough examples where they have not delivered as expected. The hype over electronic health records is now overshadowed by its own complexity. Robotic surgery has had a much slower growth curve than expected. The explosion of IoT, blockchain and AI are the next best things in the Western context. Indian healthcare stakeholders seem happy to follow this trajectory without factoring in the idiosyncrasies of our ecosystem.
There is a small world in India that mimics the West—insurance-driven, company-paid, the rich and famous for whom it matters little how much the final bill is. There is another world, a bigger one, that cries out for basic healthcare without having enough for three meals a day. It is this constituency that Ayushman Bharat caters to. As a medical community committed to societal transformation, it is incumbent upon us to address all our strategies towards them. This means brainstorming on need-based care, appropriate technology, cost control, medical wastes, public and preventive health. But I do not see many conferences address this even as they package the new tools of tech as revolutionary.
The ‘why’ is missing. As a clinician, I fail to understand the generality of ‘data’ solving the specific problem of my patient. As a planner, I cannot comprehend how AI will solve the problem of thousands of patients waiting to be seen by the doctor in a busy OPD. As a physician, I cannot fathom how gadgets will transmit the crucial elements of care, concern and compassion. As an administrator, I remain concerned about the unstated costs of new technology that will make healthcare even more unaffordable.
The current influx of technology and the changing trajectory of thinking in the leadership circle disregards the fundamentals of what care is all about. Healthcare in India is drifting dangerously into the abyss of business, where service matters little. The main metrics of healthcare dwell in the domain of money. It is all about industry parameters—EBITDA, ARPOB, GIPSA, marketing, sales, profits and competition. If all is well, how do we explain the recent selling of big hospital chains in India, beleaguered by unmanageable debts? How do we bridge the expanding trust deficits built up by all this in the public mind? Occupancy in many hospitals is at unsustainably low levels. The new policies such as Clinical Establishment Act have curtailed healthcare where it is needed most—in the rural areas. Even with price regulations from the government, tariffs are shooting sky-high in most private hospitals. The gap between demand and supply is only widening.
It is time to pause and reflect before moving further. There is a need to re-jig the ‘why’ of healthcare. It must begin by either creating or re-orienting the uppermost layer of stakeholders—the leadership—to a collective vision, mission, objectives and values. The current crisis of service, manpower, standards and outcomes shows that something is wrong somewhere. An unhurried series of sessions must be planned in the national capital to address three questions: 1) Who are we as healthcare providers? 2) What are we doing currently? 3) Where are we going?
These must be addressed against the backdrop of our nation and its serious healthcare problems. Irrespective of whether it is public or private, primary or tertiary, service or teaching, general or specialised, a common fabric of service must weave through the entire fraternity of healthcare providers. More than regulation and being monitored externally, this must emerge spontaneously from the collective conscience of our fraternity. Service, education and research, the three pillars of medical science, must converge to the benefit of patients. Profit must be a by-product of good service, not the other way round, as it seems today. All technology, software, real estate and capital vendors must be asked to stay outside the lakshman rekha of medicine, but continue to complement the core work of the healthcare professionals inside the circle. The principle of austerity must govern healthcare profit-making.
This is urgent. India stands at the threshold of a new dawn. The potential for growth, population, clinical wealth, data and scientific expertise has made India the preferred destination for multinationals to park their businesses here. With the sweeping changes in governance, public mindset, millennial thinking and epidemiology, the health of its people is a significant contributor to our future economy. Blindly adopting innovations and global trends without putting them in the context of our nation would be detrimental. This change will come only with renewed thinking done honestly, ethically and in the interest of people.A new echelon of healthcare leadership with a new mindset and renewed commitment needs to emerge.
Dr Sunil Chandy
Former Director, CMC Vellore
Email: sunilchandycmc@gmail.com