UPSC CSE Mains Syllabus: GS-2- Issues relating to development and management of Social Sector/Services relating to Health,
Education, Human Resources.
COVID -19 – A window of opportunity for healthcare?
Private health care – accumulated ills:
- Indian health care has been increasingly privatised over the last few decades. This has led to intense market competition.
- A uniquely unregulated form of health care has thrived.
- It has also been marked by several questionable practices. Over-diagnosing and over-treating certain emergencies.
- Cut practice’, with doctors and hospitals prescribing tests, drugs, referrals and procedures in return for commissions, is entrenched in India.
- This leads to significant negative consequences, be it increased patient expenses, patients not reaching the right doctor or not getting the appropriate investigation, and also an erosion in the doctor-patient relationship and the image of the fraternity.
- It puts ethical doctors in a quandary, making them cynical about their profession.
- There are several grey areas in treatment decisions, where doctors are not sure of the best way forward for the patient.
- For example, terminal patients with widespread cancers are often prescribed chemotherapy, which can cause side-effects worse than the disease, without impact on life span or quality of life.
- These have been under the media and public glare leading to a huge trust deficit.
- Will the changed milieu have an impact on this?
Some positive signs:
- COVID-19 has led to a dramatic reduction in the numbers of patients seeking care.
- This is especially true of planned, non-urgent problems including procedures and surgeries.
- Many patients are scared to visit health facilities fearing COVID-19.
- While this has caused collateral damage, there may indeed be those who have avoided interventions without any deleterious impact.
- In other words, they have been spared of procedures for debatable indications.
- For eg, the large number of women who undergo an unnecessary hysterectomy has reduced.
- The incidence of Caesarean sections is reported to have gone down.
- Similarly, procedures such as coronary stents, knee replacements or cosmetic surgery which reflect supplier-induced demand have almost stopped.
- ‘Routine’ admissions for ‘observation’ or ‘insurance claims’ have got curtailed.
- However, during the pandemic, the availability of doctors, beds and proximity are now the chief drivers for patient referrals, rather than the commission route.
- The focus has instead moved back to the basics of preventive health such as diet, exercise, good sugar control, and quitting smoking and tobacco.
- The pandemic may have finally taught our population the importance of not coughing or spitting in the open.
- These may indeed have more far-reaching benefits in a much larger population.
- The COVID-19 epidemic has centre-staged the need for a robust public health system and increased investment.
- While disrupting care, it may have unwittingly lead to some ‘desirable’ changes by the circumstantial curb on unwarranted medical practices.
- However, there are dangerous fallouts of the disruption as well.
- The breakdown of overburdened health-care facilities, negative impact on the morale of health-care workers, and the collapse of private sector institutions (under financial strain) are all real.
- With hospital and doctors incomes falling during the pandemic, there may be a resurgence of unethical practices as the industry tries to make up its losses.
- This is already evident in the huge bills being slapped with, often by creating additional billing heads for COVID patients.
- Though prices in the private sector have been capped, loopholes in the system may be found, such as profiteering on personal protective equipment.
- Artificial demand maybe created in an effort to increase footfall.
- Thus, the epidemic’s ‘positive’ impact on unnecessary practices may get washed away as ‘normalcy’ is restored.
- In general, the medical fraternity in India has risen admirably to the challenge of COVID-19. .
- It has forced them to consider alternative paradigms. Public respect for the profession has also improved.
- If we can seize this chance to correct undesirable practices, it may help the return of trust in the doctor-patient relationship.
- In the middle of gloom, this is a window of opportunity.
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