A Complete Abdication of Responsibility

The private healthcare sector in India is now increasingly being looked upon as a sector that should focus on doing good rather than being run as a responsible business enterprise. The government wants the private hospitals to be good Samaritans and treat patients at such low prices that the business itself becomes unviable!!!

Essentially, the government wants its duties to be discharged by the private sector.

This is a complete abdication of responsibility on the part of the government and totally unfair to the private sector players and their investors. It is a well-known fact that public healthcare expenditure in India remains abysmally low at under 1.4% of the GDP. This compares poorly even with countries in sub-Saharan Africa. According to the WHO World Health Statistics 2015, the public sector in India spent 1.16% on health as a percentage of the GDP, ranking 187th among 194 countries. A recent report in The Wire says ”global evidence on health spending shows that unless a country spends at least 5-6% of its GDP on health, basic healthcare needs are seldom met”.

Another recent report in The Mint pointed out ”The World Health Organization estimates that India spent about $267 per capita on health care in PPP adjusted terms in 2014—China spent three times that amount, Brazil five times, European nations 10 times and the US 20 times” 

To make matters far worse is the fact that much of the funds allocated to the sector remain unutilized. This is nothing less than criminal negligence. Sample these facts reported in The Hindustan Times in August 2017.

”More recently, in a performance audit of the Reproductive and Child Health scheme under the National Rural Health Mission (NRHM) tabled in the Parliament last month, CAG said the cumulative unspent amount in 27 states increased from Rs. 7,375 crore in 2011-12 to Rs. 9,509 crore in 2015-16.”

Since the government allocates a minuscule amount for public health and even spends less, the out-of-pocket (OOP) expenditure in India remains high. In the year 2014-15, 62.42% of health spending was borne by the citizens themselves. Unexpected medical expenditure remains the single largest cause of individual families being pushed below the poverty line. The National Health Policy Draft of 2015 estimated that ”nearly 6.3 crore people are faced with poverty every year because they do not have financial protection for their healthcare needs“.With the OOP remaining high, there is a sense of anger and frustration amongst the consumers and the politicians have been cleverly channeling this palpable anger towards private healthcare providers by painting them as uncaring, profiteering and worse.

Now compare this with what is happening in the private healthcare space in India. A recent report (August 2017) in The Scroll cites a PwC study saying that private health spending in India was more than double the government’s expenditure, at 3.3% of the GDP in 2014. The private sector consisting of individual doctors, clinics, nursing homes, diagnostic chains, trust hospitals and corporate hospitals provide care to more than 80% of our people. A report by the India Brand Equity Foundation (IBEF)  published last month points out that healthcare sector in India is the largest employer in the country. The sector is expected to record a CAGR of 16.5% between 2008-2020 and the industry size is expected to grow to USD 280 bn.

The same report quotes Department of Industrial Policy and Promotion (DIPP) ”The hospital and diagnostic centers attracted Foreign Direct Investment (FDI) worth US$ 4.34 billion between April 2000 and March 2017.”

A mere glance at this data indicates that while the government has wantonly abandoned its duty of providing good quality healthcare to the citizens of the country, the private healthcare sector continues to make significant investments. Private investments are by definition ”for profit” investments and are made in the rightful expectation of a reasonable return on the capital employed.

Instead of spending scarce public funds on building new infrastructure, decongest government hospitals, ensuring efficient and smooth management of these hospitals and providing greater access to the citizens to public healthcare, the government is busy pandering to the masses through populist measures and what may even be called as bullying.

Populist policy announcements, which are not even clearly thought through are being made every day. It has been announced yesterday that any citizen in the city of Delhi who fails to get timely medical attention in a Delhi government hospital can approach a private healthcare institution and avail of cash-less services, which will be reimbursed to the hospital by the government later at rates, which are very low. The private hospital has no choice but to accept the patient and treat him at government-mandated pricing.

This kind of policy-making, akin to shooting from the hip must stop.

The government should define its own role in the healthcare sector in the country.

It must be said, even though it may sound harsh that the responsibility of providing good quality healthcare to those who cannot afford private healthcare squarely lies with the government.This is a responsibility, which it must not attempt to shirk or palm off to the private sector.

The views expressed are personal

 

 

Advertisements

The Winds of Change

With the trust levels between clinicians in private practice and their patients plummeting to what many would call an all-time low, many clinicians have been wondering what they need to do to regain the lost trust.

In a recent interaction with some senior clinicians, I found that many are reflecting deeply on things that they perhaps need to do differently and maybe unlearn some of what they learned early on in their careers. The new skills they felt they needed to acquire lie not in the domain of medicine but in the areas of patient communication, documentation and even bed-side manners.

The clinicians are increasingly realizing that treating patients and saving lives is much more than just wielding the knife or taking life and death decisions based on their clinical acumen and skills. The clinicians feel that they need to engage with their patients in multiple ways to earn the patient’s trust once again.

The good news is that they are more than willing to do so.

The new age clinicians are learning lessons in patient communication (pun intended) as they deal with Google strengthened patients, who have dozens of questions on their differential diagnosis, tests needed, treatment plans and even backup plans if things go wrong.  The patients are asking questions on drug reactions, likely side-effects and how would one cope with them if God forbid, they occur. They want to know why a particular implant is being recommended, what are the chances of an allergic reaction from the metal used in the implant and what can be done about it!!! From the clinician’s point of view, this is many worlds’ away from the time when they were treated like demigods and their pronouncements considered to be almost divine.

The clinicians are getting used to the new reality and many are keen to be trained in being able to address these questions adequately and in a manner that the patients understand. The clinicians are trying hard to learn the language of their patients. Many do not shy away from passing on patient literature developed by hospitals, especially for this purpose. Many are equipped with videos of past patients, which they happily handout to their new patients. Some, direct the patients to check out authoritative resources on the web and satisfy their thirst for knowledge. Clinicians are writing blogs and creating web content for patients to read and understand their conditions better before they decide on surgery.

In India, very few clinicians are as digital media savvy as say their colleagues in management. I reckon this is primarily because many senior clinicians are still from a generation when they never had social media when they were growing up or training in medical schools. They became professionally busy well before the advent of the smartphone and the 24×7 assault of the Facebooks, the Linked-Ins, and Twitters of the world. Thus, they hardly had time to get used to the tremendous power these digital tools wield in engaging with consumers today.  This too is now changing. Many clinicians are now harnessing the power of these social media platforms to engage with their patients. That the mediums allow for a continuous engagement, which is way beyond the episodic nature of a surgery or hospitalization is an added advantage. Many clinicians in a sincere effort to shed the old world aura of being  Gods are also sharing snippets of their personal lives, hobbies, family pictures and vacations to connect better with their patients.

The doctors are also trying to be nicer to their patients and are even considering sartorial changes to make them look smarter and more approachable. It is now quite usual to see smartly attired,  doctors welcoming patients in their OPD chambers. Some are even spending time in the gym, making them look fitter and healthier. They are certainly willing to spend more time with the patients and their attendants. The clinicians are also realizing that patients admitted to the hospital under their care look forward to seeing and hearing from them at least once a day. Many now hold conversations with their patients on their medical rounds, which are far more reassuring than in the past. Some clinicians are also sharing their phone numbers so that patients can WhatsApp if they need to reach out for anything.

These are all welcome developments.

However, the biggest change, which appears to be happening is in the area of documentation. Unfortunately, medical education and training in India, which is still largely in government-run institutions does not equip doctors with the meticulous documentation needed, while working in large corporate hospitals. The clinicians need to learn to work on HIS systems of various degrees of complexity, put in orders in the system, prescription have to be recorded in electronic formats and the smallest of thing needs to be properly documented. The days of the clinician’s iconic scrawl are well and truly over. Verbal orders barked to nurses no longer suffice. The culture of documentation and the use of technology allows for significant reduction in medication and other errors. It leads to far greater patient safety and protects everyone from doctors to nurses to hospitals from disputes and legal action.

These are welcome changes. That the clinicians are thinking about ushering in these changes to help reach out to their patients better is indeed reassuring. I am sure these will go a long way in bridging the gulf that now divides patients and their doctors.

A Letter to my Readers

Dear Readers,

Many of you would have noticed that I have hardly been writing this year.

Almost a year has gone by, without a single new post on this blog. Some of you might have wondered, where have I been hiding. Well, to tell you the truth, for most of the year I have been incredibly busy, mostly chasing business for Fortis Healthcare. Till recently, I was heading Sales and Marketing there and this involved a lot of travel, a daily commute from my home to work and, which would easily top 80 kms a day and would gobble up at least 3 hours on the roads in Delhi. Now, anyone who lives in Delhi, knows what this means both on a good and God forbid on a bad day. All this added up to a 12 plus hours a day of work and travel, which left me no time to do anything else.

And than, there was travel in India and abroad. This in a given month would easily consume a minimum of 10 days. While, I love traveling and usually find it uplifting, it would still leave me with even lesser time home, where I mostly write. While on long plane journeys pretty much around the world, I learnt I could easily read, but unfortunately, I also learnt on these journeys that writing inside an aircraft  is not my cup of tea. For me it is a solitary vocation, to be pursued in the privacy of my home.

Thus, over the year, as I read and traveled and toiled at Fortis, I kept accumulating new experiences, great insights and thoughts, that I knew would one day be shared with many of you on this blog.

Last month, I left Fortis, and returned to work at Max Healthcare, which has been a happy hunting ground for me in the past too. Returning to Max Healthcare, also meant less hours commuting to work (the office is 15 minutes away from home), less travel (at least in India, all of our hospitals are in North India, most of them in the National Capital Region) and hence, I am now hopeful of putting together more posts and the output here should go up.

Well, from the point of view of the journey of this blog, this year has just run away too quickly. As I recommence this journey, I shall look forward to your usual comments, feedback and encouragement.

Sincerely,

Anas

 

Managing Swine Flu in India.

swine-flu1The world is all agog with the global spread of the swine flu. The outbreak first reported from Mexico has rapidly spread to the United States and Europe. Countries the world over are rushing to identify people with flu like symptoms and those who have a history of having been in Mexico or in certain parts of the United States in the recent past are being carefully screened. The airport officials have been alerted to be on the lookout for people with these symptoms and medical personnel have been stationed at the airports to screen travellers arriving from these parts of the world.

In India a person arriving from the US with flu like symptoms has been  detained and admitted in an isolation ward in a local hospital in Hyderabad. The government is busy procuring millions of Tamiflu pills and the drug manufacturers are rushing to cater to this unexpected demand. The newspapers, TV and the digital media is busy putting out stories on swine flu, highlighting the emergency measures being taken the world over to combat the resurgent rogue virus. Theories are being propounded on the impact the virus is likely to have on the economies across the world. The general refrain seems to be as if the recession was not enough, we now have to deal with a real virus running amok.   Continue reading

Pricing Healthcare Services

healthcare-pricingThe pricing of services in a hospital is perhaps one of the most complex and difficult exercise undertaken by the hospital managers. Pricing is  usually a Marketing function in most industries and the final call would usually rest with the Marketing chief. However, in hospitals this seldom happens. Pricing issues are generally discussed and debated in the executive committees and the leadership teams, views are sought from senior medical leaders and usually a consensus is arrived at. l,

Many hospitals follow a ‘market based’ pricing model, which simply means they comb through the pricing policies of their competitors, get pricing data from various labs and other diagnostic centres through their referral sales teams and establish their pricing either basis a premium or a discount from their chosen competitors.

Very few hospitals have a ‘cost plus’ pricing system. Developing an accurate costing of all medical procedures is next to impossible. This is simply because the medical consumables used vary from doctor to doctor and also depend on the complexity, age and general condition of the patient. The cost is also invariably a function of the training and competence of the concerned doctors and medical staff attending on the patient. Thus the cost of a bypass surgery may vary dramatically depending on the condition of the patient, the competence of the surgeon and his team and co-morbidities like diabetes.

The calculation of a price is usually based on a ‘surgeon’s fee’. On top of this is added the cost of anaesthetic gases, the anesthetist’s fee, an OT fee and OT consumables. The surgeon’s fee is usually checked with the hospital’s surgeons and if it is Rs. X, the fee for surgery inclusive of gases, anaesthetist’s fee and the OT charges usually adds up to Rs. 2X. 

The patient on top of this is charged room rent depending on his choice of the hospital room, the cost of medicines and room/ward consumables and all diagnostics. The hospital also charges exorbitant consultant’s visiting fee every time he/she visits a patient in the hospital. (Some hospitals like Artemis cap this to a maximum of two chargeable visits). Strangely all hospitals charge a premium on all services if a patient chooses a single or higher category rooms. This simply means that if one opts for a single room one pays higher for everything, the surgeons fee, the cost of surgery and diagnostic tests. Most people do not know this and believe that the hospitals charge a premium only on room rent. Many would consider this a pernicious practice simply because a surgeon’s skill and time, which are the determinants of his fee has nothing to do with the room category a patient is in.   Continue reading

Driving OPD’s

opd

Outpatient Department or the OPD is critical in the marketing of a hospital. It is the OPD, which drives the admissions in the hospital and the diagnostics including the pathology and imaging. It keeps the doctors busy and the hospital buzzing. The success of various Marketing activities is usually measured by the number of incremental patients who walk through the hospital doors during the promotion.

Here are some ideas on driving the OPD volumes.

Marketing Promotions

I know, many people believe that for a hospital to be involved in Marketing promotions is a strict no no. Offers like free consults and 30% off on all diagnostics somehow seems too much like a ‘Sale’ at the neighbourhood supermarket. However, the truth is that promotions work. Many people like to avail of the promotional offers, walk into the hospital to see a doctor for a long ignored niggling problem and many like to avail themselves of a discount on a CT or MR. The trick here is not to overdo it and to ensure that the communication is not overtly commercial or over the top. I would reckon 4 big promotions a year, (one a quarter) would be fine.   Continue reading