Monday, November 28, 2016

Does India really have a shortage of doctors and hospital beds?

One of the commonest solutions which is proposed to treat India's ailing health care system is creating more medical colleges to churn out more doctors ; and building more hospitals. The standard  party line seems to be that we don't have enough doctors , given the large number of patients we have ; and there aren't enough hospital beds. It's usually WHO recommendations which are used as a standard metric to prove that India is short of thousands of hospital beds , as well as hundreds and thousands of doctors.

This is the argument which is trotted out when justifying the need to allow private for-profit companies to start medical colleges; and why funds are used to create brand new hospitals.  However, the fact that these solutions are usually proposed by doctors ( who have a vested interest in creating more work for themselves) should make us wary about accepting these fixes at face value.

This reasoning is flawed for many reasons. It's easy to create more doctors, but the problem today is not a shortage of doctors - it's the way they are distributed. Even if we start new colleges, the newly minted  doctors will continue flocking to the large cities, which already have too many doctors. No one will go to the villages , which is where the shortage of doctors creates the biggest problem.

Similarly, creating more hospital beds is not an effective solution because of the problem of supply-induced demand.  If there is a hospital, hospital management will not allow its beds to remain empty, so they will pressurize their doctors to fill up their hospital beds by creating more patients.  This is something which is fairly easy for doctors to do. You just do lots of tests, and you are certain to pick up lots of abnormalities. You thus convert a person into a patient and create many more " worried well" people, who don't really need medical attention.

Often it's doctors who contribute to the problem . We don't have a healthcare system - we have an illness care system, because doctors specialise in treating diseases. We want to increase our work load; and because we look at the world through the prism of  our special interest,  we see potentially sick people everywhere, which is why we create new disease labels such as pre-diabetes.

Another problem with doctors is their medical hierarchy. Superspecialists are at the top rung, because they are the most highly educated . However, they end up knowing a lot about a very  tiny slice of medicine and this is where they focus all their time and energy.  This ends up being a drain on limited resources ,which get diverted into gratifying the specialist's ego.  They love playing with the newest medical technology and want to buy the latest and most expensive medical gadgets and toys - and this ends up making medical care needlessly expensive.

Using a doctor-patient ratio , or a hospital bed : patient ratio as a metric for judging health care services is flawed. It's high time we moved on. Thus, there's really no need for lots of these patients to be in the hospital in the first place. It's much more effective to provide them with the  care they need either in community centers , or within their own homes . Mobile health technology allows doctors to go to where the patients are, rather than force patients to go to where the doctor is. This is far more convenient for everyone and is much more cost effective as well. This in itself will reduce the number of hospital beds needed , because they won't be occupied by patients who don't need them. These expensive limited beds can be utilized far more intelligently only for critically ill patients.

Similarly, the doctor's precious time is not utilized well. A lot of it is wasted in commuting from one clinic to another. By using mobile health technology, doctors can reach out to patients without having to travel.   This way, he does not have  to twiddle his thumbs while waiting for the patient to come to his clinic . This way, you're optimizing the use of the doctor's time , and making the best use of his expertise, because he can then  reach out to many more patients.

We need to make better use of the resources we already have by optimising their use, rather than chasing after pointless metrics.

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