Thursday, October 13, 2011

The Indian patient - lots of choice , but not enough choices !

I was talking to a doctor who was visiting from the US . Much to my surprise, he was quite impressed by how much choice Indian patients have !

In the US , most patients belong to a HMO , because they are covered by a health insurance plan which is usually provided to them by their employer. Health care is very expensive and they require health insurance coverage to be able to afford medical care. In order to keep costs down , the HMO allows them to see only a limited number of doctors , whom they have empanelled. Typically , they first have to see a primary care physician who acts as a gate keeper . It’s only if the primary care physician decides a referral to a specialist is appropriate will the patient be then able to see a specialist. This means that even if the patient has a lot of money , his ability to be able to see a specialist doctor of his personal choice becomes fairly limited in real life.

In India, things are completely different. For patients who can afford private medical care - the booming middle class , which is now more than 300 million strong- because most medical care is provided on a fee for service basis, they are free to choose whichever doctor they want to go. This means they have a lot of choice , and they can choose any specialist they want, if they can afford his services.

While it seems quite exciting that Indian patients have so much choice , the flip side of this is that they really aren’t that many choices in real life. Let me explain this paradox. While it’s true that they can choose any one they want to, it’s also equally true that the number of leading specialists who have a good reputation is very limited. This means that anyone who requires cardiac surgery for example, will often be compelled to wait for hours on end to see the cardiac surgeon he selects, because the busy ones are so busy that they just do not have enough time to spend on providing personalized care for individual patients.

This is actually an opportunity for clever technological solutions ! The fact is that there are lots of cardiac surgeons ( and other specialists ) who are very competent. The tragedy is that most patients are not aware of the existence of these specialists simply because these doctors do not get a chance to advertise their specialized services. This results in the grey-beard syndrome , in which only senior doctors ( like me !) who have been established for many years and have built up a lifelong reputation of being experts , end up attracting all the patients.

The clever use of technology can change this equation very quickly. Young doctors who are starting practice and who have a lot of expertise , skill and spare time can use a website in order to display their skills to potential patients . This will make it possible for patients to be aware of the fact that they do have choices ! Once they know equally skillful alternative options exist, they will no longer be forced to wait for hours on end in the waiting rooms of the 2 or 3 top names in an individual city.

Not only does technology empower Indian patients with choice , it also offers them more choices as well ! This kind of competition is actually good for senior doctors as well , who will then become a little more respectful and polite to their patients , because they will understand that they can no longer afford to be arrogant or get away with rude behavior , just because they have long lines of patients waiting for them !

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  1. I totally support your opinion sir. Indian system is spoiled by choices. They say healthcare is free in India. But how come it can be said to be free if you get a date of 4 mnths waiting for a simple CT. Is there any justification in maintaining such a Healthcare system where u can see it through the window( i mean the CT machine) but u have to wait for 4 months to cross over. ridiculous!!!!
    I seriously think we should stop this mockery make medical Insurance compulsory then give free medical Insurance to BPL families and Students.

  2. India has lessons to learn from the experience of Chile. India
    too has a dual system of care—a private fee-for-service based
    sector where the money is paid out-of-pocket by individual
    households and a tax-based public sector where the providers
    are salaried. Utilization of insurance under both these systems
    is partly restricted and rationed by the affordability of the
    individual household and availability of the budget.


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