Amongst all the prominent and necessary events in the latter half of last week, an innocuous, but an essential one lay dormant in the media, for though it had much sense, it lacked the bugles, that make up the TRPs.
It was a step towards the nation’s health-care system, particularly the mismatch between hospital expenses, and insurance refusing to pay up, and on what are undecided issues between the consumer, caregiver, and third- party payment assurances.
Since medical conditions are not homogenous, hospital managements cannot interfere beyond a point in medical matters, and the amount of final billings continue to tilt the balance sheets of one or the other. If both insist on what was “promised” and what “due” to the hospital, the gap is to be sheared from the patient’s lean and torn pockets!
The situation is not new. The famed American Health Care system having gone through, “Managed Care” (a fixed amount for a reported illness). It came as a bitter lesson when it was realized that thousands who confront complications, have a longer recovery period, were de-boarded from the health bus, because there was no further third-party backing. It was no good to anyone, for half a treatment is no treatment, as is half a payment is termed as debt.
Keeping aside, the troubles and massive health taxes of western European and Scandinavian countries, that “pay for all”, including England’s NHS, Indian Healthcare that is just sprouting in the form of a “system”, can only be compared, simulated, modulated in terms of magnitude, on the US system.
Talking of the US, a population, we may look to take clues from, despite, a well- structured Medical Insurance in the private sector, and Government aided Medicaid (for the underprivileged), and the Medicare (no charges after 65), all three modules of bearing health costs, were facing financial unsustainability despite the fact that the health sector accounts close to 18% of GDP, still leaving 16% of the population uncovered by health coer of any sort.
There-in came Obamacare (Affordable HealthCare Act), met with great resistance, besides its own shortfall to register 5 million population in a period of few months—a necessary figure to bag premiums for financial viability, and even evolve into a viable national plan, replacing he previous multi-patched, and the multi-leaking one.
One cannot say if the intrinsic equation, which sounded good failed in the ground test, or the program came at a time when the Republicans had begun to take the upper hand, and reclaim an idea they felt was first spelt by them.
So, came Trumpcare. With big man Trump holding the reins, the implementation of care should not be far away, after he diverts back from wars, terrorism, and an “atomic scare”, so openly mentioned in the UNGA (without reprimand that the premises do not allow such mentions, as the UN was formed after atomic bombings, the world regrets), and now being talked openly in the Indian sub-continent! Kim Jong, sorry you have perhaps faced un-shared notoriety, and sitting close to Mr Trump, you have changed your views in favour of your country and world peace. Perhaps learnt a bit from your brother who stays on the ground floor!
The crucial step, that was mooted was an understanding between private healthcare providers, and third-party payers. Human disease, and the intricate mechanisms through which various vital biological systems share the functions of life, often are unpredictable for a single procedure both in terms of human as well as ancillary inputs.
However, since the mare runs faster on seeing the buck, a certain predictability of total costs should be agreed upon, with caveats if so required. It is therefore necessary to have a basic sum assigned for a particular procedure, say, a coronary procedure. It may vary by gradation of health providers, based on experience, infrastructure, preparedness for the most- dire emergencies, and a record of the grade of complications handled, and their outcomes. In a sense, a first -time airline to Bhagalpur may charge less, than the daily Indigos/ Spicejets, others to Mumbai.
Most hospitals have an assigned amount called a “package” for defined procedures as Cardiac Surgery, cataract, gall bladder, kidney stone removal. However, fair as they may be, there is no national blue-print, much less, a black print that may define violations or deficit to any of the three partners.
Statisticians and chartered accountants have to step in to work -out the sum to be assured, and the amount to be fixed as a “package”. There is much wisdom here. Think of a consumer base of 1.25bn, and the clock starts clicking right at the time of conception, delivery, vaccinations, and onwards. Top-ranked logisticians (most IT biggies do this all the time), may be employed by the Health Ministry, as well as the private health providers.
It is also not necessary that the care-giver should realize his margins on every procedure. But as in every consumer related transaction, the concept is overall profits. Any private-sector medical health provider, who sees the wisdom, shall be doing its own self-marketing, much stronger than whatever be the methods and concession/deals. I agree ethics, sincerity, matters of conscious, have a value. But re-stated as affordability, professionalism, outcomes, on a competitive platform, these are what makes a winner—-call it money, professional superiority or reputation.
The Health Ministry and private health givers are not antagonistic, but perhaps never had enough time for each other to share methods to maximize the returns to the patient. The two extremes are to allow the patient, to choose, under medical advice, the essentials from “a la carte’”, bring in the family physician, to manage, at home costs, and of course serve a “Big Mac” with limitless servings for those who want to live life large!
An experienced doctor Health Minister, should set up a “New India Health Forum,” and align, step-by step, repeated set of formal meetings, between the numerous players mentioned.
India spends between 2-3% of it GDP on Health (figures on the flattering side), so these literally empty hands, are proverbially full!
“Dard nat kase dawa na hua,
Mein accha hua, bura na hua”
(My pain did not cross the threshold to relief,
I neither improved nor worsened)
DISCLAIMER : Views expressed above are the author’s own.