After weeks of interviews of physicians, hospital administrators, pharmaceutical company employees, and even a reporter and a “whistleblower” of pharmaceutical practices, I have learned a lot during my time in India. What I gained from this summer – in addition to data I can use for continuing research – was a lot of general insight into India’s health care system. While I had read about a lot of these issues prior to coming to India, being on the ground and speaking to people really helped understand the severity of the problems and gave me some ideas about how people are working to fix them.
Some overall findings on the Indian health care system:
1) There is excellent health care available in India – if you can afford it. Some private hospitals I toured had top-notch physicians (many who had practiced overseas), brand new medical equipment and impressive facilities.
2) Even in these private hospitals, for which there is a great demand, there is still a great emphasis on low prices, given that most patients do not have health insurance and are paying out of pocket. One solution to keep costs low is a high-volume strategy, with a quick turn around. As one hospital administrator explained, his hospital paid the same amount for an MRI as any other hospital in the US, EU, or elsewhere. However, his hospital could not charge the same prices as, say, an American hospital. So to recoup the cost of the machine, his hospital would have to perform 30 MRIs a day as opposed to the maybe 6 MRIs a day that an equivalent hospital in the US would perform. Another strategy is tiered pricing where costs are different depending on the room a patient is in. A patient in a private room (versus a shared room or a ward) would pay more not just for the room, but also for medication, procedures, and surgery.
3) Quality care is not just an issue in pharmaceuticals, but also an issue with physicians and hospitals. Despite spending significantly out-of-pocket, an estimated 70% of Indians do not have access to high-quality medical care. High-quality private hospitals are, not surprisingly, normally located in larger cities. In rural areas there is demand for high-quality care, but little availability. A lot of primary care doctors, especially those operating in rural areas, are “quacks” who are do not have sufficient (or any) medical training. To get any sort of specialty care, people living in rural villages often have to travel for hours or days, not to mention cover the cost of the care, which makes this out of reach of a lot of people. Proposed solutions currently being tested have included call-in medical centers (often linked to a mail order pharmacy, which could distort incentives), remote care, and a model in which physicians are trained to recognize the most common diseases and then follow a standard protocol (an example of this is the Glocal network of hospitals).
4) Public hospitals suffer from low budgets, supply shortages, corruption, absenteeism, and poor quality of care. While I had read about this prior to coming to India, the reality was further hammered home by people I spoke to in India. Said one physician, who had spent four years working in a public hospital after completing medical school, “If I got in a severe car accident, I would rather die than be taken to a public hospital.”
5) Corruption is an issue at every point in the health care system. Every person I spoke to at a management level told me about the issues they had preventing corruption and each one had put into place checks and balances to prevent bribes, whether direct or indirect (for example, free drug samples a physician could resell).
5) As elsewhere in the world, medical care costs in India are rising. The same pressures faced globally – increased costs of diagnostics, medicine, and technical equipment, are felt very strongly in a country where the majority of people pay for medical care out-of-pocket.
6) The Hindi word/concept “jugaad,” which essentially means an innovative and simple solution to a problem, is very prevalent in Indian health care and constantly impressed me. For instance, one hospital administrator for a very large facility explained to me that many of their patients were illiterate and would get lost trying to find their ward, not being able to read the signs. The hospital’s solution was to give each ward a color (cardiology, for instance, was red). All patients pay up-front in a central check-in area and then are given a card with the name and color of their ward. There is colored tape running from the central desk throughout the hospital, so a patient can follow their tape color to their ward, helping them find their way regardless of whether they could read or not. So simple, yet so genius!