Tuesday, June 10, 2014

A possible prescription for a better healthcare system

As the new government settles down, it is busy outlining the priority areas and has made some initial announcements on what it is planning to do. India's healthcare system needs an urgent overhaul. While most people do not have access to even basic healthcare, there are many things that ail the system even otherwise.

For starters, my biggest frustration with Indian healthcare is that many people cannot get treated because they cannot afford it. Imagine the frustration of someone suffering from something life-threatening and knowing that there is a way his life can be saved but not being able to access that treatment just because he does not have the means to do that! That is possibly the worst punishment of not being wealthy that anyone can ever get.

We have to go in for a healthcare system where any treatment that is available in the country is not denied due to the lack of the individual's capacity to pay for it. Healthcare is as basic as food and water. Nobody should die because of the lack of money to pay for this.

This can be done even in India and its huge population. States like Andhra Pradesh have shown the way. The Aarogyasri scheme for all its deficiencies has saved thousands of lives. This scheme can be replicated for the entire country in a phased manner. It would be one of the most ambitious project taken up by the government ever but the benefits will be immense.

Another major initiative that needs to be taken up is the way doctors are compensated. We need to move to a system where doctors get fixed salaries based on their experience and capability. We need to figure out a way by which the only yardstick used to evaluate their performance should be the outcomes of the patients they treat. Hospitals need to move away from a per-service or per-referral fee to a compensation structure which purely depends on how the patient has done. The compensation should be high enough for doctors to stop worrying about their income and focus on improving the quality of life for their patients.

Let us face it. The reality today is that doctors spend a lot of time and money to become doctors. It is natural that they would look at recovering the money spent and make the time spent on this worthwhile. The system needs to change so that the incentives of the doctors and their patients is aligned. This would need a huge change in the way corporate hospitals function and this is going to be the biggest roadblock in implementing this change.

The government has to step in and figure out ways in which this can be done. A major boost to achieving the second objective outlined above would be obtained by implementing the first initiative outlined above. If the government has control over payments, it can dictate how much is paid to whom.

I obviously have no readymade solutions. Neither do such solutions exist. It is up to the government, its advisors and the bureaucrats to make any change happen. Rome wasn't built in a day. Such a cleanup would be take even greater effort. More than the effort, however, is something far more important - the intent. Does the new government have such an intent is the million rupee question.

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