What you need to know about Healthcare in India

[sumachechi]

The current thread discussing this in detail anecdotal accounts made me feel I had to give my insight for what its worth.

Healthcare in India

Can vary hugely- no consistency. You can get the very best or the worst. How to know the difference?

Factors that create this
[LIST=1]

Lack of a system- most developed countries have a referral system which also packs in relevant measures to be undertaken prior to referral which is lacking in India. Referral is based on the nature of the doc u see who might be feel he /she can treat anything ( fallacious thought) and not borne out of an accountable responsibility towards doing the best for the patient. By luck or fate however if you land up referred to the right doctor, you will get treatment on par with anywhere in the world.

Emergency services are definitely better in developed nations. I would wince to the general default that US is better because I definitely do not think so. The Swedish systems are far superior to anywhere else. But we are improving. In Kerala, ambulances are always given priority on the road. However, many hospitals compromise on maintaining quality ambulances which should be something the government inspects and forces them to improve. Why would anyone do something unless they do they will get penalized if its not right? My advise to all of you is that the good ambulances are called cardiac ambulances- they have good facilities, including oxygen, better paramedics and often will also come with a doctor. The good corporates advertise these and its worth paying for them if you can. I would not recommend small hospitals or nursing homes for attention to significant trauma or any serious problems. Get to the good corporates. Small nursing homes are ok for minor fevers, minor aches and pains, diarrhoea needing short duration iv fluids etc. they are rarely set up for much more though they themselves are not aware of their inadequacies.

Doctors in India tend to see huge numbers of patients- hence don’t give much time. Partly the reason for this is the low consultation fees . Esp in Kerala, no hospital I know charges more than Rs 350 for an OP consult or in private outpatients ,perhaps Rs 500/- . Patients crib even to pay this. In the US , a patient is billed at least $600 to meet a subspecialist .Do your math.

The biggest issue- I think nova2blr touched on this mildly. The bulk of healthcare in India is still paid at point of delivery by patient out of pocket. Insurances cover only a small number of patients. Good healthcare is not cheap and if you want the advantages of modern medicine , they are expensive. Unless there is better provision or people start planning with private investments towards healthcare costs like house mortgage etc, it will keep hurting

Health insurances in india- not very well developed. Still largely only for inpatient admissions and expenses. Chronic disease care which is a very common problem these days and mainly managed through outpatients is not even considered by most insurance agencies. Who needs to be convinced for all this? ESI, CGHS and governmental schemes seem better. IT companies seem to offering more reasonable insurance coverages

Our people do not budget for health. They still live in denial that anybody can get anything and that nasty things only happen to others and not to them

Their kids will not get chronic diseases, their youngsters will not face infertility or premature births or cancer or need prolonged intensive care for a bad accident and in their old age they will not need joint replacements, state of the art cataract surgeries, prostate surgeries, prolapse surgeries etc etc. Heart attack is the only serious illness they will budget for-for that one cardiac surgery. These are all facts, they happen to many and it is really important that we are prepared to face all this. There are good doctors everywhere – if your general physician recommends you travel to another metro to see a rheumatologist- go see them instead of compromising on someone less qualified locally. People are far more willing to spends huge amounts on their kids wedding/capitation fees than pay for health.

Our people have an unsubstantiated faith in alternative therapies which is completely unjustified in todays world. If you go to right allopathic doctor, you can get far better quality treatment that addresses your illness with all the level of modern understanding of the disease. Be it Ayurveda ,homeopathy, Siddha, Unani are all based on ancient knowledge ,unprogressed and totally out of comparison to what allopathy has to offer. My husband (Orthopaedic surgeon) advised my aunt knee replacement surgeries 15 years ago- she continued going to ayurveda doctors getting massage and other stuff and paying huge sums each time. Finally after 15 years with legs totally bent and not able to go out of the house even for her own children’s/ grandkids pleasure, she finally underwent knee replacements and is very very active now, travelling and in a ‘punarjanmam’(new phase of life). Of course if you go to a surgeon who will operate you for Rs 10,000 less and has less experience or proper training you will get a raw deal, but the fault goes to the treatment rather than the cause for bad treatments unfortunately. Everyday in my OPD I see kids disfigured, disabled and sometimes serious illnesses missed by alternative practitioners( at least once a month I see missed leukemia in kids mistaken for arthritis) and also children with psychological aches and pains who have no organic medical disease wrongly treated as arthritis.

I would recommend ayurveda only for wellness and not for illness- I know that this statement will shock and insult many ,but I do have enough knowledge to back what I say. I will not recommend homeopathy or Siddha or Unani for anything. Naturopathy is very good for getting weight down and can thus help with lifestyle diseases( along with allopathic medication) but the patient needs to have the will to continue that naturopathic recommended diet else all will be of no use.

Regarding medical education- more than the education, its evolution of a system of medical practice that is superior in the developed world. Most tertiary centres will practice similar steps or protocols and results will be the same. In Kerala- children’ s cancer can be treated at Govt medical colleges- here medicines are free but tests/ consults/drugs used in complications like infections are not free and can be quite expensive and transfusions are also not free. Moreover, the treating doctors are just general paediatricians who have no additional training in paediatric oncology ,which is terrible. One govt based tertiary cancer centre- facilities are better, doctors are trained- but expenses the same as above plus patients need to rent places and live nearby for several months while treatment goes on, plus so overwhelmed in numbers they’ve not got the infrastructure to deal with it- hence patients are admitted on floor beds for chemotherapy, nurse patient ratios for chemotherapy etc are positively dangerous etc Private corporates- several are well equipped, personnel to treat adults and kids, better facilities overall. But obviously expensive. In a condition like the common leukemia of childhood where cure rates are currently > 85% ,one can achieve these rates only in these recommended private corporates. The govt medical colleges have cure rates of 20-25% and the tertiary govt centre 50-60%, but do people even know to ask such figures before they decide on treatment. As I said before, people will mortgage their land for daughter’s marriage but not to treat her leukemia- we need as a population to change the way we approach health

Education- MBBS is largely fine. Postgrad –is variable. Superspecialties-also depends on institute. Unfortunately while healthcare is largely more progressed and better quality in private corporate hospitals, one cannot say the same of medical education. Paying crores does not guarantee that the student is motivated or that they will actually learn and the govt trained doc is often better.
[/LIST]

The greatest problems facing Indian healthcare are


[LIST=1]

​Lack of a system and inconsistency in quality- which I see as detrimental to lay patient

Need to pay at point of delivery which very often causes a doctor to compromise and cut corners which can also impact quality

Don’t even compare costs between India and the developed world- our costs are miniscule in comparison!!!!

It does help in India if you have a good doctor as a friend or relative to guide you through the labyrinth and help you choose who where and what for.
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[R2I-Admin]

Q: Thanks for the write-up. Very informative.

What are psychological aches and pains?

A: Psychological aches and pains when a child complains of pain but there are no findings on examiantion or investigations to suggest any significant medical disease. Very common- these kids usually have some stresses in life or do it for attention seeking or secondary gain(get off from school or activities etc) . The idea is not to medicalise them but to introduce psychological input and change aprents response to these kids -will usually elimiante problem succesfully. Infact along with our psychologist we are presening a series fo 50 kids from the last year next month.

Important typo- my aunt got her knee surgery done after 15 years of alternative treatments and a miserable life, not 1 yr.

[nova2blr]

Excellent post Suma. Thanks for taking time to write this lengthy and useful blog. Provides a lot of information and also makes us come back with questions/discussion areas.


I concur with you that for most part (volumewise across India), the medical payments are still borne by individuals out of their own deep/shallow pockets, it is encouraging to know that many hospitals are accepting Insurance plans and it would be nice to see this grow across different sections of the society and healthcare in India reaches far and wide.


Whats your take on mis-use of health care plans? Is it rampant or benefits outweigh the cons?


This discussion also reminds me of a episode on Health Care in India from the popular Satyamevjayate show by Aamir Khan titled 'Every life is precious - Does Healthcare need healing?'


https://www.youtube.com/watch?v=1Lg0kUtS8ic&list=

I know it is a very loaded question...whats your take on this episode? Is it so bad or this gives a glimpse of healthcare in India. I completely agree that it is not correct to paint it with a broad brush and say everything in healthcare of India is messed up based on few examples....every country (developed or developing or any country for that matter) has its share of situations and examples.

What is it for a common man?

How about the example of health insurance that Dr. Devi Shetty talked about that his team piloted for farmers in Karnataka and is being adopted in other states. Seems like a novel idea - Volumes bringing cost of care down..


Sorry..too many questions. Appreciate your insights.

[sumachechi]

Thanks R2i Admin
Have edited it which I couldnt do on the blog post- too many spellos.

[Plan2010]

Excellent post Suma?Some of them are common sense points ? like going to the referred specialty doctor instead of going to another GP to get second opinion, wasting time and efforts and prolonging recovery.

I?m not sure how Insurance works. In U.S it is generally considered as a necessary evil increasing the general cost of medical practice. I read in a recent article in Time(I think) that a group of doctors are trying to create an alternative system to Insurance where the costs are paid upfront by customers and in turn they get quick access to the doctor. The reason being to cover the cost of Insurance and make money, doctors can give just about 10 mts to each patient and with all the paperwork and everything there is a higher burn out among doctors, less satisfaction in treating patients etc forcing them to retire much earlier. The new system addresses all this at a lower cost to the patient and is being tested out by many corporates on a trial basis. Some say it is a fad and will not have mass popularity and there is some controversy also about this kind of practice.

With my experience with insurance, I don?t like it since in an uneventful year you end up paying for the insurance as well as most of the medical expenses as deductible. Insurance is useful in case something really bad happens, and even then I am not sure how much coverage it provides denying payment for pre-existing conditions etc.

It?ll be good to hear which insurance policies are good in India, what kind of overage etc - doctors opinions as well as general info. I've heard CGHS is very good, but only defense people have access to it is what I understand. And in Kerala my FIL can get it but he says the paperwork or something is done in TVM and he has to go there every three months for some reason. So he opted out of it.

[vizagdesi]

Suma, thanks for taking the time to write this. This is a great primer especially for people who are outside of India.

[sumachechi]

QUOTE]Whats your take on mis-use of health care plans? Is it rampant or benefits outweigh the cons?




I dont come face to face much with health care plan misuse which is likely happening, but see a lot of requests overturned by insurance especially in my specialty because of the niche nature. Several times I have the agents ringing up and providing clarifying letters etc.

[QUOTE]This discussion also reminds me of a episode on Health Care in India from the popular Satyamevjayate show by Aamir Khan titled 'Every life is precious - Does Healthcare need healing?'




I felt that episode was not well researched. Part of the problem is the wide inconsistency in healthcare that Ive already alluded to. By pointing out kickbacks, sink-tests etc, which Iam sure exist, there is an unfortunate supposition that everyone /most people do it. Now it remains that I do know a good number of doctors who practice quite ethically and it seems unfair that in the general mud-slinging, everyone's shirts get stained.
The transplant example- the real story is quite different and the family were also trying to get publicity out of the whole thing is my understanding.
More than anything else, his simplistic solutions were plain ridiculous. in a country where any tiny pharma gets approval to bring out any medicine, and quality control is such an issue, he wants us to write generic medication!. The biggest lesson and change in practice for me after retuning from the UK was to precribe specific brands and not generic so I know what quality my patient is getting!!! Many many such niggles- sadly, there is no way we can claim that everyone in the system is good, weither. But I firmly feel that whatails our healthcare is aprtly the 4 points a the bottom of my article above

[QUOTE]How about the example of health insurance that Dr. Devi Shetty talked about that his team piloted for farmers in Karnataka and is being adopted in other states. Seems like a novel idea - Volumes bringing cost of care down..


I think there's more spoken about this than really achieved. Iam told that the money runs out pretty quick when patient needs ICU etc and then they have to pay out of pocket etc etc.
personally, I dont trust anyone who wears surgicals crubs(with cap and loosened face mask) for TV appearances on the lawns of 5 star hotels.

[Veekay]

Should the doctors in India like the west explain each drug - it effects and side-effects and what its for or just prescribe. I have seen both type of doctors and in my experience can be differentiated by age. One doc did not even want me know that one was an antibiotic and the other was a ibuprofen. Since he didn't tell me what they were, I asked him for its side effects he just brushed it off by saying that he's prescribing it because effects out-weighs the side-effects. With google its becoming easier to look-up the medication.

The second question is, should the pharmacists keep possession of the prescription, once its dispersed either partially or fully - like the west.

[4mpardesi2desi]

Thank you for this post.very very informative.Back to my country soon!!!!

[okonomi]

[QUOTE]The greatest problems facing Indian healthcare are

[LIST=1]

​Lack of a system and inconsistency in quality- which I see as detrimental to lay patient

Need to pay at point of delivery which very often causes a doctor to compromise and cut corners which can also impact quality

Don’t even compare costs between India and the developed world- our costs are miniscule in comparison!!!!

It does help in India if you have a good doctor as a friend or relative to guide you through the labyrinth and help you choose who where and what for.
[/LIST]
I like this summary. One might say that this would discourage those who might want to come back to retire in India, after a couple of decades of getting used to different, and phoren things.

In the USA, there is a convoluted system of access to healthcare. Steven Brill, who has written a special report on the cost of healthcare in the USA, has written another book on how convoluted and expensive it is. Listen to Steven as he talks to the National Public Radio.

For those who had gotten used to whatever system, going to a different scheme-of-things would be tough. The devil-you-know versus some-unknown-angel with a few provisos...

I am reminded of "Life is tough, and then you die".