Friday, August 8, 2008

Is It Healthcare Or Sickness Care?

Medical profession is often described as ‘Healthcare Industry’. But today’s hospital centric, commercially orientated medical profession is more like a ‘Sickness Care Industry’. 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”. Let me try to explain it in simpler language. If you happen to get surgery done for a Gall Bladder or a kidney stone in any hospital, be it a government hospital or a private one, you are likely to get excellent quality medical care till the stage when your stitches are removed. All this is “Sickness care”. But unfortunately, no attention is likely to be paid to the reason for stone formation in the first place; other likely attendant medical conditions and towards preventive strategies/ interventions to ensure that it doesn’t happen again. Had the foregoing been done, it would truly have been “Healthcare”. But this exercise is almost never undertaken. Why? Because nobody asks for it. Whatever you get in life, the least you are required to do is to ask for it. How can something; which you have not even desired; be thrust upon you in a civilized society? Let us go back to the previous two examples given above: Gall bladder stones and kidney stones. Do you know that the basic processes that lead to stone formation may be such that stone formation itself may only be a tip of the iceberg, i.e. there may be many more likely complications due to the basic underlying defect/ malfunction; stone formation being only one amongst many? For example, people with gall bladder stones are more likely to have heart disease and diabetes in the future, if not having the same already. Similarly, there are some underlying disorders related to bones, to calcium absorption & metabolism and to phosphorus absorption & metabolism, wherein calcium rich or phosphorous rich kidney stones are formed. If these underlying conditions; which are not giving rise to any symptoms on their own at present; are not attended to properly, then not only will the stones come up again in the future, but many more troubles will erupt. When medical technology and knowledge is used to detect these ‘silent’ disorders, and proper treatment plan is instituted well in time, this is called “Secondary Prevention” (“Primary Prevention” is what the lay public can do on its own, without active participation of medical profession). But you do not see it being done anywhere, not only in our country but also almost nowhere in the world. Reason is that medical profession today is not controlled by doctors, but it is being controlled by big businessmen & industrialists, who also control other related, lucrative activities like diagnostic industry and pharmaceutical industry. A basic principle of business or commerce is that the client is supreme and his wish is a command for you. You give him precisely what he wants, only then can you hope to succeed in pulling the bucks out of his pocket. In ‘healthcare’ profession, the big business was quick to realize that people shell out money only when in trouble and big money lies in hospital admissions, lab tests and surgical operations. So they started pumping big money into setting up large, sophisticated and posh hospitals and diagnostic centres. Public was mesmerized & awed by the glamour & glitz. Gradually the good old family physician was relegated to the background; who could give sound & timely advice based upon a wealth of professional knowledge & experience and robust common sense. In the backdrop of a ‘quick-fix’ culture, in which the patient wants the stone out as quickly as pulling out a thorn and is least interested in finding out or bothering about it’s causation & prevention, and a pliant & compliant commercial healthcare provider ready to serve the ‘valued client’ eagerly; you have a fertile ground ready to spawn “sickness care industry”. But is it just a case of wrong nomenclature? What’s in a name after all, one may say. No, a lot more is involved. Huge amount of research based medical intervention in the form of “Secondary Prevention” is being wasted, most of it knowledge based. Is there any practical method of making the medical profession to apply this “Secondary Prevention” vigorously? Appeals to ethics, morality & conscience are woefully inadequate and application of administrative mechanisms is not practicable. One solution is to allow individual medical professionals to offer Health Insurance. Competition will take care of the premium rates and fear of claims will keep the doctors on their toes to ensure application of the best of “Secondary Prevention”. Role of Health Insurance companies should be restricted to offering “Indemnity Insurance” to doctors. As the financial burden for lab tests and hospital admissions shall shift to the medical professionals; use of commonsense, medical knowledge & clinical acumen amongst clinicians will automatically be encouraged and shall obviate unnecessary lab tests and hospital admissions. Accordingly, overall expenditure on healthcare will drastically come down, while improving the health status of society. Moreover, it will redefine the relationship between the public and healthcare providers; wherein peoples’ health will become directly proportionate to the prosperity level of the latter. At present, this relationship is rather awkward & embarrassing: peoples’ sickness is directly proportionate to the level of prosperity of healthcare providers i.e. sicker the people, happier & richer the healthcare providers and vice-versa.

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