The Indian healthcare sector is one of the fastest growing sectors. During the coronavirus pandemic, the country’s health sector has witnessed a renewed focus on leveraging digital technology. The sector comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment. For every health sector, a patient-centric approach is extremely important to achieve better accessibility outcomes.
Recently, the International Patients’ Union (IPU) organised a conference to to unite all healthcare stakeholders and provide patients from across the country with a platform to voice their opinions, suggestions, and concerns.
IPU is a platform dedicated to empowering patients and addressing their concerns. On the sidelines of conference, Financial Express.com got the opportunity to speak to Dr. Rajendra Pratap Gupta, the Founder of the International Patients’ Union (IPU). A public policy expert, Dr. Gupta played a crucial role in drafting the National Health Policy-2017, National Education Policy-2020, and other national policies. He talked about role of IPU, key issues faced by patients in India, and challenges among others. Exerpts:
What has been the role of the International Patients’ Union? What are your upcoming plans?
Healthcare fails to deliver health, and the general perception is that healthcare providers are out there to extract money from those in need on the pretext of treatment, but what the care seeker gets in return is overdiagnosis and inappropriate treatment with inflated bills rather than what is needed. Despite all this, there is no platform for the patients that gives them the place to vent their grievances and raise their voices. The Patients’ Union will help verified patients to share their views on improving healthcare, and we also intend to share their views and rank healthcare facilities. Also, the current quality standards organizations like NABH have been merely reduced to marketing tools and nothing more. We are going to disrupt this and move to patient-reported outcomes as the ultimate measurement of ‘outcomes-based – value-based care’.
What are some of the key issues faced by patients in India concerning healthcare accessibility, affordability, and quality?
Lack of transparency in the treatment process and pricing. A doctor can prescribe from ultrasound to MRI for pain, multiple anti-biotics for a paediatric patient, TB medicines when a patient is not suffering from it… the list is endless. You end up in a hospital being told that it will cost Rs.30,000, and then a doctor walks to you and says, ‘The patient has a complicated condition. It is difficult; we will need to rush the patient for urgent surgery’, and finally, you shell out between 5-6 lacs, and still, the problem remains. You will not be able to see a doctor when you want. Still, in your bill, you will be billed for multiple visits of various specialists without any justification, rich or poor – neither the diseases spare nor the healthcare- the twin challenge every Indian passes through.
Where have we defined the parameters of accessibility, affordability, and quality? When the baseline metrics do not exist, how can we measure them? At Patient’s Union, we will try to fix this through a bottom-up approach.
What needs to be done to make India’s healthcare system patient-centric?
Getting back to the basics. Hear the voices that matter -care seekers. Develop primary care, which is Case Management Protocols based (CMPs should be based for all levels of care). Create patient rights and create awareness about it. Ensure mandatory disclosure of treatment and success rates. Do a random audit of private and public facilities.
The cost of treatment should be based on the ‘reference pricing’ model, and it must be ‘package based.’The patient should know the diagnosis and prognosis at the time of admission, and this should be system driven. Let patients rank the facilities and doctors, and other healthcare professionals.
How do you see the role of patient-reported outcomes and user ratings in improving the quality of care and making it more value-based?
‘Patient-reported Outcomes’ will be the actual ‘quality standard.’ Today, how does a hospital market itself – ‘We are NABH accredited hospital with the latest 512-slide MRI and robotic surgery unit’. What does it have to do with quality outcomes? Most patients don’t even know the role of NABH on quality, and NABH has never done an independent audit on how its standards have improved healthcare outcomes. NABH has become more of a marketing gimmick than a tool for quality. When I was drafting the National Health Policy-2017, I mentioned that ‘all private and public health facilities should mandatorily disclose treatment and success rates .’This one step would bring out the best facilities that deliver outcomes for the price the care seeker is paying. We could calculate that for diabetes for what price how much is the reduction in HbA1C, and for angioplasty, at which price what is the success rate, and why people should pay 3-4 lacs in a facility when the same procedure can be done with a better success rate in tier 2 or 3 down. This will also lead to better facilities coming up in smaller towns. I see many people make a beeline to Mumbai, Delhi, and Bangalore for treatment; when we start the user rating and ‘patient-reported outcomes, ’ we will see a change in the pattern of care seeking and even how care providers provide treatment.
What are some of the challenges that the International Patients’ Union faces especially in countries like India? How do you plan to overcome them?
Funding will be the biggest challenge. Right now, I am funding, and we will need to invest substantially as it grows. We will have to find innovative financing models to fund it and keep our head and heart above the diktats of corporate healthcare providers. They can sponsor our activities without branding or corporate quip-pro-quo.
Let us see. But I am committed to flipping the current-supplier-driven model to user-driven care. Also, people will try to influence ratings, and we have to build checks and balances to ensure that we don’t become another Amazon, where ratings can be manipulated. These things require substantial investments in Information technology.
Since a patient’s organization has never been tried in the country, the facilities which are doing hanky panky will find ways to discredit us and level allegations. Since we will be driven by evidence and ‘real inputs’ from ‘verified users, ’ our work should stand up as our best defense. We have no personal agenda except to make health care outcome-based- value driven.
What are some key takeaways from the COVID-19 pandemic that can positively influence patient care?
People have become aware of the importance of health. Healthcare has become a focus area for the government and private sector. Yet, as humans, we forget after the worst is behind us. As a patient’ union, we will do our bit to run a campaign to strike a chord with the psyche of populations to nudge them towards better health.
Anything else that you would like to add?
For a LMIC country like India ( GDP per capita of about USD 2000), good health services will be critical to leapfrog into a middle-income and upper-middle-income country. Government should keep its commitment to invest heavily in the public health sector and not privatize healthcare. Else, we will move towards the US model, which the country can ill-afford.