How can we incentivize the medical profession for keeping us healthy?
Can
we find a way to pay our doctors for keeping us out of hospital?
It
is not easy to market preventive medical service as it is difficult to convince
customers of the efficacy of what is being offered. For example, I cannot with
confidence tell a 65-year-old man that I have succeeded in averting a premature
heart attack in him – when I might have done that with years of careful
monitoring of his risk parameters, corrective counseling and simple maintenance
medication. Such a claim may not be appreciated, and the patient may
be wont to dismiss it with light hearted derision. He may even suspect that I
suffer from an excess of narcissism.
On
the other hand, there is nothing more marketable than relief of pain or other
forms of distress. That is why hospitals in general seem to do well. Hospitals
may do nothing to prevent diseases, but this is hardly ever an issue with most
patients. When you have a serious problem like a heart attack, a
stroke, a bad infection resulting from uncontrolled diabetes - and you are
admitted in a hospital for several days and then get discharged in a better
condition, you will be naturally grateful to the hospital and the doctors. You
will not, in the normal course, hold them accountable for not having taken
adequate measures to prevent you from getting these conditions.
Health
is integrally bound to balance, lessening of inequality – within the individual
as well as in society - and needs to be measured in terms of health and well-being
of individuals, cleanliness, beauty and lack of pollution of the environment
and the happiness of those who live as a community.
Everything
that leads to 'feeling healthy' needs to be consumed only optimally –
and this includes food, medications, health supplements etc. Even time spent
with a healthcare professional or in a hospital, invasive tests and
interventions and so on.
Now the
problem is that healthcare having become an industry has adopted the strategy
of maximizing consumption of health services by the
community. Effective community health care needs to have a system
that is completely outside the business structure and should aim at optimizing
the utilization of services and medicines instead of maximizing consumption.
Unless we devise an economic system where what is valued in healthcare is not
profit, but the health of every individual in society itself - where the aim of
monetary profit or a better bottom line is replaced by health of the community
itself - there will be no future for healthcare.
The aim in
medicine is to treat people who are ill, not organs with disease.
Organs don't develop disease, it is the whole individual who does. A disease
may signal its presence mainly through symptoms that appear to center in a
specific organ, but it would be inaccurate to say that the organ is diseased when
it is the whole organism that suffers. Organs and systems are not
discrete ‘things’ but only concepts that we have developed for the
convenience of articulating and teaching.
Every ‘organ system’ can
be seen to integrate seamlessly with other ‘systems’ to make up the organism -
so that anything that happens to an organ tend to initiate a cascade of events
involving all organs to variable extents. The current practice of
specialization in specific organs is therefore fundamentally
flawed. Doctors cannot afford to become specialized in individual organs,
they can only be skilled in procedures of treatment – such as endoscopy,
angioplasty or surgery. Procedures play a part in holistic healthcare, but
cannot substitute the care of the individual – and this is an indivisible
process that every doctor regardless of specialization should be expected to be
skilled in
Society
should aim to create a sustainable service that doesn't treat healthcare as a
consumer service in the same way as other goods and services are dealt with in
the free market. We therefore propose that only thing that can be consumed
maximally in the field of healthcare is 'optimal care' itself.
Dr G Ramesh Kumar
http://www.watchmyhealth.com
9895372550
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ReplyDeleteI do agree with these points brought up by Dr Ramesh. We need to bell the cat. Much to be done in the present scenario of medical practice and public health . Proper awareness to the reading public is a good start. Wishing you all the best
ReplyDeleteDr A Rajkumar MBBS MD MFAMS
I read sonewhere that in the New York State health system, there is a proposal to make hospitals bear the costs in the case of readmission within a certain period after discharge, if it is for the same complaint.
ReplyDelete