Lessons from a Pandemic: The way forward for healthcare in India

The Coronavirus pandemic has exhibited the importance of healthcare (as well as the lack of it in our country). And though India may well be a case in discussion here, the truth is that even the Western world has truly struggled to get it right. A fundamental question that has emerged out of this crisis is how healthcare institutions should balance the different interests — and how we should provide the best healthcare to the vast population at affordable rates, and yet help our healthcare institutions make a profit.

I do not believe there is one answer that fits all, nor is there any one answer that maybe right at all times to come. But if we are to consider where we are today as a nation, our population, our economy, our financial strength (or the lack of it), our demographics and our large work force, one may be able to break down, at a macro level, that which could help get the formula right. At least for now.

Marrying the service of healthcare with the business of healthcare

Public-Private-Partnerships that are run transparently but allowed to make profits for the stakeholders will help bring bigger health care providers in the fold and willingly so. Health care is a proven profitable business. Health care is a proven needed service. Marry the two. Regulate it in a balanced manner – so as to not flout the law but to keep a hands-off approach, and accepting the reality – profits draw interest, profits draw in more investment and therefore will extend availability, in numbers and in quality.

We need to be more accountable

Do not make it free other than in extremely rare circumstances. Let these circumstances be those that are drawn out of purely financial factors which, among others, will consider the opportunity to earn a right as well as a duty.

Today, we have a more lax view of who the poor is – he is poor who can prove he is poor’. It is time that as a country that has come decades away from being owned by some other power and after years of funding benefits poured into education and social acceptability, the question that needs to be asked is not who is poor, but why is he or she poor? And more importantly, how long will he or she remain poor? To earn for yourself and your dependents is more than a right — it is a duty. Now you may think of this a very capitalist view, but accountability is just the other side of the coin. Yes, healthcare is the right of every citizen. But so are extremely good quality healthcare services a right of all. And to make that happen, accountability needs to form a part of our system first, and eventually a part of our DNA.

The problem of unregulated media trials

Whilst on the subject of accountability, there is one more lot that needs to be held accountable. The Doctors. And before the author bashing starts let me say this – before we talk about their accountability, some ground rule regarding this profession need to be brought in. Today, doctors are held accountable but more so by the media. A case is sensationalized, sometimes beyond repair, without ever checking the facts. Without understanding the complexity of medical science. And most reporting, sadly so, is irresponsible and damaging to a doctor’s repute, practice and morale.

And whilst freedom of speech is never to be undermined, it is and should be practiced with much more care and responsibility. We have laws curtailing wrong reporting in cases that may cause public riots or endanger public peace. Reporting which is damaging, untrue or just made of half-truths should be stopped. It should be made punishable. Let us protect the doctors from an unnecessary and eventually unpunishable media trial. Instead, let us work towards holding them responsible before the correct forums. Intertwine doctors’ duty and hospitals’ responsibility with the needs of the patient, and bring in a more enforceable regime through the judiciary. This will go a long way in creating more responsible health care providers and thus more responsible health care service being available.

Mandate investments in research

We should first accept that medical science is not an absolute science. It can never be. Those who believe diseases like Alzheimer’s and Cancer have no cure, know this, it is also the lungs, the heart and the kidneys and even the bones that have not truly been understood well. We have found ways to assist them in functioning in certain circumstances, but much is left unknown till date. Science again hasn’t even come close to catching up with our new realities, globalization, exposure to electromagnetic fields and newer faster stressful lifestyles.

The only way is to mandate investment in medical research. Let us not leave it to the pharma industries alone and then cry hoarse over over-pricing. A mandatory investment is required in various fields on medical science including, mental health. It is more and more research that will lead to newer and affordable cure being available.

One size does not fit all

A last but critical point, which to my mind is also the most difficult to implement.

Let us theoretically divide the country’s populace into three categories broadly. The employers, the employees, and the dependents. If we are to empower each of this category independently, not just with policies, but at the ground level, we could easily make the math work in favour of best health care available to most, if not all. And it is important to remember, it is not just empowerment of all but also empowerment of each which is not at the cost of the other. Each category needs to be capable and accountable independently. With capability will come outreach and with accountability will come responsibility. One who provides work should profit from it to provide more work. One who provides a service should be enabled with better skill sets and an environment that not just helps him or her provide more, but rewards him or her wholeheartedly. And those who are dependent, need the care and assistance to reduce their dependability wherever possible. And if not possible, they should be allowed to have access to good healthcare services nevertheless.

Concluding remarks

We need better infrastructure; we need more knowledge and we need a healthier and (dare I say), wealthier populace. While this may indeed seem like a discussion at the macro level, and most policies and laws have failed at the micro level and in implementation, if we can use these as a pillar of building better healthcare, we may well be able to tackle the needs of our people better. Each of the above of course need better explaining, discussion, maybe each one warrants a different elaboration in itself and someday I may myself get to it, but these could be, for now, taken as ideas that have the potential and benefit for all.