The commercialisation of healthcare seems to have excised the 'care' out of 'health.' The condition of healthcare in the country demands immediate attention since on the receiving end are a majority of the population.
The bleak ground reality apart, which strikes us when one comes across headlines like, "woman forced to deliver baby in front of a maternity hospital after being allegedly denied admission by staff," the right diagnosis of the afflictions impairing the system is missing.
Profiteering has edged 'service' to the backstage. Articles on healthcare are published more in news journals that deal with money matters, investments and the economy.
These articles feature only sparingly in healthcare magazines which are anyway few and far between. Most expert viewpoints on health come from global management consulting firms who predict the future of health based on assumptions, selective data and surveys without fully understanding the nuances of care in healthcare. Rarely are public health experts invited into this role. The innovation webinars on cyberspace are dominated by digital technologists, start-up aspirants and entrepreneurs, not physicians or scientists. The majority of healthcare start-ups and new hospital enterprises are promoted by investors, with a sliver of medical professionals in the periphery.
One wonders what these shifts mean to the foundations of healthcare. The primacy of purpose in healthcare is visibly shifting from its hallowed core of care to pure business interests, the world over. Whereas earlier earnings were an offshoot of good patient care, today that paradigm stands inverted - care is only the platform on which the edifice of the health industry thrives. And why not, when the health industry is growing at a CAGR (Compound annual growth rate) of 20 percent it is easily the most lucrative business available.
Many will disagree, arguing that there is nothing wrong with this paradigm inversion in the present times. But most will agree if and when they have to queue up to receive care for an emergency medical need without high-level contacts, a VIP status, a premium insurance cover, or robust savings to buttress the prohibitive cost of care. Only 5 percent of India will not worry, but the rest will when one night in an ICU may cost you Rs 50,000. The final bill will help you understand why this paradigm shift should be a cause for concern. Health is a business like any other, with all the dynamics of an industry – costly real estate, advertisements, promotional events, performance propaganda, rankings, top, and bottom lines. One hears more about mergers and acquisitions, valuations and being numero uno on hard financial parameters than patient outcomes. Understandably, which venture capitalist will invest money for social benefit without quick and substantial returns? None. But illness and wellness have their undisturbed timeline which cannot be shortened.
India is craving for a northward shift in its primary and secondary care, more than tertiary. That is where the deficits are, and also in its rural heartland where 70 percent of her people live. Contrary to the marketed opinion, it is not virtual digital solutions alone that will change the health status of the country, but the on-site availability of skill and human presence. The government has done exceptionally well to enlarge the platform for better healthcare by almost doubling the output of doctors from a larger number of medical colleges. They must be applauded for sensitising people to the urgent need and availability of universal healthcare. The deficits in skilled manpower where it matters, do remain. But coupled with motivational training, social sensitivity and upskilling clinical acumen, India’s universal healthcare can potentially become the model for the world. This message needs to reach up into the board rooms where policies and strategies for healthcare are made, often without appraising ground realities.
The last three years have seen millions being pumped into health innovations. A transformation is said to be in the offing. But these innovations, largely focussing on data, devices and algorithms have not crossed over to the last mile. They remain tethered to the tables of investment pundits. There is an urgent need for venture capitalists, digital evangelists and the cash-laden pharma-device industry to make just one visit to the hinterland of India to understand why and where they should park their investments. A changed focus from quick monetary returns to a more sustained social dividend should be embraced. Every business must have a social burden and today it is unarguably healthcare. The long-term dividend from these investments is immeasurable and invaluable, even from a purely monetary perspective. The hype around the digital revolution and artificial intelligence are too far-fetched without the tractions of our demographic variabilities factored in.
Anyone who has spent more than two decades in clinical care will say this. Most human ailments, if detected early, are simple illnesses that call for simple treatment costing very little. Early detection of cancer, heart disease and lifestyle risks can be dealt with at low cost and very effectively. In hindsight, even the devastating COVID experience proved to us that the only treatment that was effective was universal precautions, fever control, isolation, supportive care and vaccination. There are a thousand personal anecdotes in the diaries of all medical practitioners where the simplest and less costly approach has often been the best.
The hallowed ground of Healthcare has been encroached by new stakeholders vying for space in its central core. Data and technology scientists, pharma and device manufacturers and policymakers have captured the health space by highlighting the transformative power of technology over clinical care. The last and the least in this widening circle is the medical cadre who have chosen to be quiet and servile to the overpowering digital noise. One must remember that each new innovation and intervention comes with a price that the end user needs to bear on his final bill. And that is already unbearable.
The care component in health must be therefore revisited and re-embraced by the primary stakeholders of the health domain – the medical personnel. Undoubtedly the supportive dimension from technology and enterprise is essential to keep it contemporary. But they must remain value additions. The buck must stop with the physicians as to what is needed, effective, safe and economical for the last one in the queue.
A few more years in the current direction and many will ask the question – Whose domain is healthcare, anyway?
Dr Sunil Chandy is the Chief Medical Officer, ITC
(Views expressed by the author are personal, and may not represent the organization he works for)