Healthcare(ful) in India

'Satyamev Jayate', Aamir Khan's television show, has been touching upon several issues in the society. Female foeticide, dowry system, child sex abuse....issues that we all know about and have been among us since ages. The show has been getting a lot of attention and I hope it is able to make some changes, at least in the way we think.

Today's episode was on the medical/healthcare system in India. Among the four topics that the show has discussed so far, this is the topic that I could relate to the most. I have worked in the healthcare space in India and am also a fairly unhealthy person!

In my previous job, I was working in healthcare consulting and as part of my work, I interacted with a lot of representatives of pharma companies,  health insurers, third-party administrators, government officials, patients, hospital administrators and most importantly, doctors. I learnt a lot about the healthcare system in India and it was fairly depressing. I thought I will share some incidents, interactions, personal experiences....

1. As per a representative of a leading pure-play health insurer, "our job is to sell as many policies as possible and settle as little claims as possible. We do our best to create issues for the claiming customer and show that the case is either not part of the cover or it is a pre-existing condition"
2. The CEO of a leading global medical devices company once asked us to take up a project that would involve giving 'training' to some of the leading doctors in India!!! He wanted the training to be conducted abroad....China, Mauritius etc. The plan was to have a 7-day training that would have involved 1-2 hour optional sessions on each day. The trainer would have been some leading doctor from US or Europe to ensure that we do not hurt the egos of the participants by calling an Indian doctor as the trainer. Remaining hours would have been spent on sightseeing and parties. Each doctor attending the training would have got a laptop as a gift. All (I mean ALL) kinds of requests and needs of the attending doctors would have been taken care of. Participation would have been taken care by the client and their medical representatives. The client did not want their name to be published in any training material, banners/posters but they wanted us to ensure that the participants know who is funding this 'training'. For this, they wanted us to quote an all-inclusive figure; there was no need to submit any bills. He indicated that we can charge our commission on this..."whatever it is...30-50%". I must say it was pretty tempting and I did consider leaving my job and starting my own company for handling such trainings!!! 
3. Some of the leading doctors have daily slots for meeting patients, meeting medical representatives and meeting research and consulting firms
4. Everyone knows that the job of a Medical Representative is not to talk to doctors and tell him/her the benefits of the products but to ensure that the doctor prescribes the product. No matter if it is effective or not. However, once we were approached by a leading global pharma company to do a study in order to find out if the doctors are 'actually' prescribing the products or not!! We did not take up the study but I know of a case where a young medical representative of a leading pharma MNC in India barged into the room of a doctor and scolded him when she found that the doctor was not prescribing the products of her company even after promising her!!!
5. Satyamev Jayate talked about a scheme in Karnataka called Yashaswini. There are several such schemes in India, which have been initiated by Central government and various state governments. The idea is to help the people, who cannot afford medical treatment, in getting decent to good medical services. Such schemes are called Mass Health Insurance schemes or Macro Insurance Schemes. Some of the other examples are Rajiv Aarogyasri (Andhra Pradesh), Rashtriya Swasthya Bima Yojana (BPL families), Rashtriya Arogya Nidhi (BPL families), Janani Suraksha Yojana (rural BPL women in Andhra Pradesh), Ayushmati Yojana (Chhatisgarh), Sarv Swasthya Mission (Jharkhand). There are several such schemes and these are definitely a step in the right direction. However, an ICICI bank employee who was dealing with tie-ups with such schemes in eastern and north-eastern states once told me that there is a lot of corruption happening in such schemes. Rightful members are often denied treatment citing unavailability of doctors, equipments, facilities and medicines. And membership cards are often 'sold' to people who are not eligible for such schemes. So, though the direction is right, the steps are not always correct
6. The  entire healthcare system in India has become too commercialized. Doctors often behave like agents selling bus tickets. Around 5 years back, my father needed a spine surgery. It was a complicated procedure with high risk involved. Hence, we were looking for the best possible hospital in India. Not essentially in terms of facilities but in competence. Some suggested NIMHANS in Bangalore, someone suggested Escorts in New Delhi. I went to Escorts (New Delhi) to show my father's reports to the doctors and get their opinion. I explained the situation to the receptionist and she called a doctor. The person who arrived did not look like someone with a lot of experience. He took me to his chamber and complimented me on my intelligence as 'I came to him'. He told me about several cases in which he saved the life of the patient. He also told me that though it is a tricky case, it is pretty straightforward for him. He indicated that the surgery would cost a few lakhs (NIMHANS, though it has a different model, had indicated 30-40 thousand for the surgery). He noticed my confusion and then he took out his mobile and showed me videos of various surgeries (it was not clear who was performing them but it did look like a hospital in US). I did not like all this "marketing" and told him that we will think about it. His tone suddenly changed and he started telling me that I am going to put the life of my father in danger. He started to emotionally blackmail me. I was feeling disgusted and thankfully walked away. Finally we got the surgery done in the Research & Referral Hospital (Armed Forces) in New Delhi. It was successful and it was free of cost
7. Once we took my mother to Image Hospital (Madhapur) in Hyderabad. She was not feeling well and had become very weak. The doctor told us that they would have to put her on drips (intravenous fluids). It was pretty straightforward; you take fluids and you feel better. No need for any extensive care. They took her to a general ward, which was extremely dirty. We asked for a private room. It was no better but at least it gave her some privacy. Soon a doctor came and asked how was she feeling. Out of courtesy, she said, "I am feeling better". He went away. After a while another doctor came and followed the same process. Then a junior doctor came.  Later, another guy came. This went on for few hours. We started getting scared due to all this attention as we wondered if the doctors are not telling us everything. In the morning (around 5-6 am), my mother told us that she is feeling better and wants to go home. The staff was reluctant. They told us that discharge formalities can be processed only after 11 am. They also said that after 9 am, we will be charged for another day for the private room. This became ugly as I started shouting at everyone in sight. Later, they quickly processed the papers and gave us a bill of INR 8,400!!! In that, the room charges were only 1,600. IVF was INR 150. Remaining were the charges of all the doctors and their uncles and aunts who came to say 'Hi'!!! I did tell the main doctor and the hospital administrator that they should get out of this profession and start looting people on the highway. They gave me a smile
8. I once got a routine check-up done in a hospital in Hyderabad and the results indicated that there was almost nothing right with me. Instead of getting panicky and getting started on treatment, I thought I will get another test done but at a different hospital. The new hospital asked when was the last time I had got the tests done. I told them 6 months back and the tests were absolutely normal. I also told them that I do not have any health issues and I am just getting the tests done to check if there is any issue. Few hours later I got test results and it indicated I was fit enough to climb Mt Everest or go on a space mission!!! It did not help. I was not sure which test result to trust!!!

(Picture Courtesy: Grinning Planet)