The NITI Aayog has proposed a 15-year plan for Indian healthcare.
There is a concern that the arrangements in this proposal would deprive the personal touch in the health care of a patient.
Why is there such a concern?
A health care company had set-up a prolific prototypical multispecialty group practice in the U.S.,
There was a concern that such arrangements would be bereft of the personal touch in patient care were vociferously raised.
This continued through the evolution of more organised structures like Health Maintenance Organisations (HMOs) in the forthcoming years.
This were criticised for turning healthcare into a marketable commodity sold by unfeeling healthcare providers in supermarket-like institutions.
Why is this problematic proposition?
The NITI Aayog’s report entitled as “Health Systems for a New India: Building Blocks - Potential Pathways to Reform” outlines prospects of such an infelicitous turn in Indian healthcare.
While the report makes otherwise worthy proposals for health system strengthening the proposal to consolidate small practices into larger business-like organisations appears problematic on multiple fronts.
That nearly 98% of healthcare providers have less than 10 employees is identified as a negative trait, to be dealt with through a set of incentives and disincentives favouring consolidation.
Apart from cost and competition-related concerns, an enthusiastic pursuit of it could portend commodification of healthcare from the bottom-up.
The report’s bent towards the U.S. HMO model further adds to such a foreboding.
Why a patient-physician relationship is needed?
Loyalty and longitudinality form vital pillars of this relationship.
The structure of these is built upon a substratum of mutual trust, warmth, and understanding that accrues over time between a patient and their personal physician.
Momentary and haphazardly physician-patient interactions in a system that limits access to one’s ‘physician of choice’ are incapable of fostering such enduring relationships.
It is in this context that the role of a family physician becomes instrumental.
A family physician’s longitudinal relationship with their patient helps in a better understanding of the patient’s needs and expectations and in avoiding unnecessary clinical hassles and encounters.
This in turn reflects in better outcomes and increased patient satisfaction.
Widespread commercialisation of care over the past few decades has entailed that the family physician is a dying breed in India today.
What are the advantages of small clinics?
Studies show that healthcare received in small clinics scores higher in terms of patient satisfaction than that received in larger institutions.
This increased satisfaction manifests as better compliance with the treatment regimen and regular follow-ups, culminating in improved clinical outcomes.
Disregard for this aspect in health services design is bound to entail a sizeable cost to the health system.
However, the non-urgent nature of this problem keeps it from assuming significance to policy-makers.
As a result of which doctor-patient relationship considerations are largely invisibilized in the policy discourse in favour of more pressing concerns like lack of funds and manpower.
As India looks forward to a long-term healthcare plan, neglecting this consideration could be of sizeable consequence.
What is the need for empathy?
Myth - Considerations regarding emotive aspects of healthcare such as empathy and trust are disparate from hard-headed health policy and system design considerations.
Reality - These considerations are entirely agreeable to cultivation through careful, evidence-based manipulation of the health system design and its components.
It would necessitate, among other measures, installing an inbuilt family physician ‘gatekeeper’ in the health services system who acts as the first port of call for every registered patient.
The NITI Aayog’s long-term plan provides a good opportunity to envisage such long-called-for reforms, but that would require not the U.S. model but the U.K. model to be kept at the forefront for emulation.
We have already taken an encouraging step by introducing Attitude, Ethics, and Communication (AETCOM) in the revised undergraduate medical curriculum.
The plan needs to be revisited to ensure that healthcare clinics delivering patient care don’t transform into veritable supermarket stores marketing medical services any further.
