Friday, May 26, 2017

Winds of change - 10

(This is the tenth part of a short story which is entirely a work of fiction.)

Dr. Som did not have a good feeling about this discussion. He sensed the negativity around this from Swamiji’s voice. He put those thoughts behind and started thinking about how the entire healthcare system could change. Every revolution begins with a small step. The entire commercial nature of healthcare was something that bothered him right from the days he began practising. He however felt compelled to go with the flow rather than to try and change anything radically. He did feel a tinge of guilt when he went on his first sponsored trip from a pharmaceutical company. He also accepted handouts  from companies on prescription targets with a sense of embarrassment. He would justify these to himself in one way or another. ‘Everyone takes this’, ‘I am only prescribing when necessary’, ‘Nothing wrong in going on trips’.

As Dr. Som walked into Vasudha’s cabin, he found her in a good mood. He was a little relieved. He could do without any additional obstacles. He sat in front of her and opened his laptop. He wasn’t very good with presentations but wanted the whole pitch to come across as well-thought. It also helped him give structure to the discussion.

Vasudha was surprised when she saw him start a presentation. “Wow, this must really be something important. You have actually put together a presentation.”

“Yes, actually. I also figured you could use this to review later or when you wanted to discuss with others.”

Sheshu started the presentation with his experience of dealing with pharmaceutical companies. He explained how embarrassed he would be to accept doles from them. He said that even though he would never prescribe anything unnecessarily or prescribe something that is not genuinely good, he was sure there could be other, more commercial-minded doctors who would not mind doing such things. He had a slide that asked a question, “Is there a way doctors can be compensated in a manner where these incentives could be completely avoided and yet the doctor made enough money to lead a comfortable life?”

Sheshu then detailed the specific contours of his plan. He called for a fixed, high remuneration for doctors based on their degree and experience. He added a variable component that was based on the clinical outcomes of the patients the doctor treated. The plan removed all incentives for pharmaceutical prescriptions and investigations. Another thing which he proposed was to charge for all procedures and investigations for patients admitted to the hospital at the same rate as when they were out-patients.

The plan banked on the hospital improving its reputation by reducing the cost of treatment to the patient and improving outcomes due to these measures and improving the volume of patients treated. This would offset the loss incurred due to a reduction in the volume of investigations per patient. He had also put some proposed remuneration numbers for some of the specialties. He also detailed on how the variable component would be calculated for those specialties. The presentation was silent on how this would impact the hospital but he added, “In the long run, the hospital would benefit due to a much better reputation and better financials - but it would all be very ethically done.”

Vasudha listened carefully to the entire presentation. At the end of it, Sheshu asked her if she had any questions. She shook her head and said, “I need some time to digest this. Can you email a copy of the presentation to me?”


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