Health Insurance & Medical Profession:

(Following is the text of a speech I had prepared, under invitation, for making at a seminar on common problems faced by the Health Insurance Industry and the Healthcare Industry. It was not accepted, for reasons best known to the organizers. Ostensible reason given was inability to spare a time slot)
Revenue generation capacity and accordingly, prosperity of medical profession (esp. in the private sector) is directly proportionate to incidence & prevalence of sickness and inversely proportionate to that of health, whereas that of the Health Insurance industry is other way round. Therefore, aims and goals of the two are opposite to each other and accordingly, apparently and logically, we are adversaries.
But in this seminar, we are trying to come together as if our goals are common. There is some lacuna somewhere. Either our goals are actually common, the apparent disparity being an illusion, or there is some fault in our understanding of each other. World Health Organization (WHO) defines “Health” as: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. If, and it is a big IF, this utopian dream comes true, hospital centric and sickness orientated medical profession, as it is being practiced today, shall be in a serious trouble, but insurance industry shall have all the reason to celebrate. But this celebration shall be only temporary, as health insurance premiums shall start tumbling, and the disease/ sickness centric so called health insurance industry, as it is functioning today shall also collapse. This proves that we both are in the same boat, having a symbiotic relationship. Medical profession, with its focus on only commercially viable diagnostic & therapeutic services, drives the costs high and makes the medical services inaccessible to the common man. Health Insurance steps in to the rescue of the beleaguered common man, bringing down the costs (only slightly) for him. This technique is often used in interrogation chambers: two interrogators work as a team- one menacingly scares and the other tenderly cares. Ultimate goal is to break the subject into submissiveness and co-operation. Some hunting animals too use the same technique-one tires & exhausts the prey and the other goes for the kill. On the surface they seem to be adversaries, competing for the common prey. Do you find a similarity in the coming together of our two professions? I do. It creates a win-win situation for both of us, but a lose-lose situation for the patients and the public. If we keep ourselves (the two comrades with common goals) on one side and patients/ public (our clients) on the other, then it is win-lose situation.
Marketing and business experts often say that only those business enterprises; where the businessman and the client share a win-win situation; survive & thrive. Those businesses where it is a win-lose situation loaded against the user/ consumer, do not succeed, in the long run at least. If we consider the situation in the context of Healthcare-Insurance Industry combine as the service providers vis-à-vis the consumers, it surely is a win-lose one. True to the aforementioned principles of business, both of us, healthcare as well as insurance industries are in trouble. Unfortunately, this is just the beginning of the end, unless we do some soul searching. Can the two of us come together and join hands as service providers in such a way that we offer to the public a win-win situation? I take this opportunity to make a couple of humble suggestions to this august gathering.
Our first step has to be a change in the mindset. We have to become ‘Healthcare’ providers in true sense of the word, and abandon our fixation on ‘Sickness- care’. In this direction, the initiative has to be taken by the insurance industry. At present, you are approaching us to seek therapeutic intervention to treat/ cure established diseases. My profession is doing a commendable job of it; I am proud and happy to say. But we are doing that and just that-no more & no less. We have lot more to offer; probably the insurance industry does not know this. We can predict diseases and we can prevent them well in time. Our capabilities & competencies in this field are much more refined than curative therapies, esp. for modern day diseases/ disorders. There is an enormous amount of research data available (wastefully unutilized) as to how much hypertension causes how much damage to the ‘end organs’ like kidneys, eyes, brain and heart in how much time and how to effectively prevent it. The same goes for Diabetes Mellitus and for Rheumatoid Arthritis and so many more medical conditions. But we are NOT doing it, because no one seeks this service from us. Almost none of us is monitoring and treating Diabetes Mellitus as per the recommendations of the expert committee, which deliberated upon the findings of a research study called ‘UKPDS clinical trial’, published in 1996. Almost none of us is following the recommendations & guidelines of JNC-VII committee on detection and treatment of hypertension. I can unabashedly state that almost none of us is monitoring lipids as per recommendations made by the NCEP-ATP III. But medical professionals cannot be blamed for the foregoing. We can offer only that which is sought from us. In our professional capacity, we cannot be expected to go around thrusting clinical research findings upon an unwilling public/ insurance companies. We are aware (this is one of the basics taught to us in medical schools) that when we break the news of a diagnosis to a patient and his family, they go through five stages before coming to terms with the ground reality: Denial, Anger, Blame, Dejection and finally Reconciliation. To take the patient and his family though this quagmire needs enormous amount of resources in the form of clinicians’ time and time & efforts of paramedical counseling staff. In addition building, furniture and communications equipments are required. Also required is software of various types (recorded dramas, skits and messages from leading expert authorities in respective fields) prepared by professionals, to effectively communicate the message. But who will pay for these resources? After all, there ain’t no free lunch, as Americans say. At present, no one is paying, neither attention nor money, to this vital service we are crying ourselves hoarse to offer to a needy but unaware public. Neither the Governments, nor the Insurance companies and of course nor the public. Now, the public cannot be faulted, because they shall do whatever the leadership decides is good for them. And Governments in democracies cannot be expected to take the initiative because in a popular democracy, the public is not lead by leaders but by vote seeking petty politicians, whose vision beyond the tips of their noses extends only to as far as the outer limits of their cherished vote banks. That leaves only the two of us in the field, to take up this challenge. At least a hundred times more revenue generation is assured. Are you a game? If yes, we are ready to play ball, most enthusiastically. *******************************************************************