A man in his early 40s hurt his shoulder while playing cricket. When the pain did not subside, he sought an appointment with an orthopaedic doctor. A battery of tests later, the doctor advised him to consider steroids or surgery. Unsure of the options offered, the patient sought secondary opinion from his doctor friends, who advised against any invasive treatment unless all other treatments were tried. The patient returned to the doctor and requested for steroids instead of surgery. The doctor asked rhetorically, "What will happen to us if our patients don't get surgeries done?" True story.
This story seems jarring when millions of healthcare workers are putting their heart and soul into saving the lives of Covid-19 patients, throwing up widespread debates about professions that truly matter. Medicine is no doubt an honorable profession. The long hours and the odd hours put in by healthcare workers need to be honoured and never forgotten.
Yet, there is a darker side to healthcare. While healthcare practitioners are part of it, they certainly did not create it. Understandably, private healthcare in many countries is a commercial business that involves doctors, labs, hospital rooms, intensive care units, pharmacies, pharma companies and insurance companies. Amidst all of that you wonder if the doctor recommended a surgeon or a test in return for a commission.
Healthcare became the domain of private enterprise as governments found it difficult to manage the health of its growing population. Single provider systems in the UK and Canada have long wait time. Higher costs were meant to encourage good health habits and reduce unnecessary treatment. Did that really happen?
Many doctors feel morally compromised by the new provider-in-triage system that focuses on tests, which puts speed and profits before care. AI machines can easily take over ER if this system is perfected. Why bother with doctors? If tests are the basis of diagnosis, then patients can simply rely on an AI algorithm.
While health insurance ensures universal coverage, practitioners are caught in the systemic web of demands for more tests and treatment to maximise profits. What use is the Hippocratic oath? While hospitals are subjected to stringent audits, the nexus between hospitals, labs and pharma companies is often overlooked. Healthcare providers are also encumbered by doctors who charge an exorbitant amount as though they run a business.
When providers and practitioners become overzealous about profits, they are not just bad, they are plain evil. The line of trust between the patient and the doctor is broken. Diabetes medicine insulin has been at the epicentre of controversies. One simply does not know whom to trust.
Aside from the ethical question, a market-driven approach to healthcare is bad economics. The efficiencies of a free market economy do not apply here because patients do not have the knowledge to discern a great provider from an evil one. Had the patient with the shoulder injury opted for surgery, he would have never known that it was unnecessary. The surgery could have even been life-changing and rendered him unfit to play cricket for life.
Private healthcare providers often behave like the hospitality industry, focusing on 'customer experience' at the cost of fair treatment. Healthcare needs to align with a growing number of consumers who are becoming life-simplifiers.
In developing countries like India, private healthcare is unable to cater to the large multitude even though healthcare is a basic human right. According to OECD, the bed-population ratio is 0.53 per 1,000 persons as of 2017. The WHO's recommended ratio is 3. But in India, if 10,000 people need to be hospitalised, only 5 people can get access to a bed in a hospital. The Covid-19 outbreak has shown the inadequacy of basic healthcare infrastructure. The pandemic has highlighted the important role of governments in healthcare.
Government also needs to play a greater role in funding healthcare research, particularly technologies that focus on the core issue of simplifying healthcare, such as affordable treatment and critical care.
The Covid-19 pandemic has shown that governments that have a scientific temperament are better prepared to deal with it. No doubt, healthcare is a business. But in the light of Covid-19, we need to pull back and consider what truly matters.
Shalini Verma is CEO of PIVOT technologies
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