Chapter 22: FutureGov - Transforming healthcare by prescribing information
Rajendra P Gupta.
(Mr Gupta is an international healthcare expert who sits on several advisory boards in healthcare organizations across the globe. Email: firstname.lastname@example.org).
Mr Sharma, an NRI living in the UK, required an operation for a deviated septum. His GP referred him to an ENT specialist at the local NHS hospital, where he could get this done free of cost. The NHS website (www.nhs.uk) provided him with comprehensive information on his condition. If Mr Sharma had done the same surgery in India at a government hospital, it would have been free here as well, but the quality of care delivered and patient satisfaction levels would have been very different. And Information Therapy would be out of the question! How can the Indian government learn from the governments of developed countries and provide effective, quality-focused Information Therapy?
When it comes to healthcare, the governments role is threefold: financier, provider, and regulator. However, the Indian governments efforts in these directions are far from satisfactory. Citizens spend for over 78% of total healthcare expenditure from their own pockets, and often get a bad deal in return. It is clear that the government is unable to finance the entire healthcare of the nation. Also, it cannot provide healthcare at all levels (primary, secondary, and tertiary care). Even as a regulator, the Indian government has not progressed beyond basic accreditation of facilities to ensure quality healthcare.
With a massive population of 1.2 billion, prevention appears to be the only cure. We cannot afford to build hospitals across India, and even if we did, it would be financially unviable to run and sustain them. So what can be done? If effective prevention has to be implemented, adequate, relevant, and comprehensible information must be provided to citizens.
Starting point of healthcare: Healthcare begins with awareness. In the absence of awareness, the healthcare system tends to be abused by providers and overused by patients! It is imperative that the government creates empowered patients, and the best way to do that is by providing information to citizens about their health and healthcare. The government must act as a catalyst and promote information dissemination about health and illness in simple, local language. Thanks to technological advances, there are now many ways through which the government can reach out to the common man. These are not only cost-effective, but also act as a visible indicator of the governments interest in the health of its citizens. The funding for such activities can come through private-public partnerships.
Toll-free health help lines: The government should set up toll-free help lines to answer citizens medical queries. These could be partly automated, using IVR, and run by call centres staffed with pharmacists, nurses, and doctors. India has approximately 800 million mobile phones, and it is believed that 70 percent Indians have access to mobile phones . directly or indirectly. Callers could be mapped from the location of the call, and guided to the nearest available facility should more tests or treatment be required. The option to remain anonymous must be available, should the caller so desire.
The government could mandate healthcare as a VAS (Value Added Service) for all cellular service providers. It is high time that the Ministry of Health develops information that is specific to diseases like obesity, diabetes, hypertension, and the like, and make it available for free download on all cell phones for its citizens. Another option is setting up a web-based SMS alerts service, to which people are able to subscribe free of cost.
Over 700,000 (seven hundred thousand) pharmacies exist across the country. Pharmacies are used as the first point of contact for a majority of healthcare problems by most Indians. Apart from being easily accessible, pharmacists are happy to provide solutions to common ailments, and visiting a pharmacy for minor health issues is also cheaper than going to a doctor. This national network of pharmacies could be effectively used to provide Information Therapy to every Indian! Pharmaceutical companies can also be encouraged to install point of care healthcare information kiosks at pharmacies. The pharmaceutical company can use this to advertise their products, and patients would benefit as they would have easy access to reliable information. Hopefully, these kiosks will become as popular as ATMs!
Incorporating health in the school curriculum: It is time to separately attend to both the urgent health challenges (to manage chronic diseases) and the important challenges (to address child health). By teaching children about their health, we can ensure that they are knowledgeable about basic issues related to good health and symptoms of sickness.
Online health Library: The government must buy copyrights of a few leading healthcare books and articles and make them available for free download at the Online National Health Library. We need to learn from the initiatives which the UK (http://www.nhs.uk) and the U.S. governments (www.medlineplus.gov) have taken!
UID Smartcards for Healthcare: The UID smartcard initiative by the Indian government also represents a huge opportunity. It is possible to store basic demographic data on these smart cards, and link it to EHRs (electronic health records), thus allowing us to deliver customized Information Therapy in regional languages.
In this digital age, where Information Technology drives down cost and increases speed and reach, the government must set the right priorities for encouraging awareness and education for healthcare. Information Therapy is a logical step in this direction. It is high time that every Indian receives quality healthcare, and the government must ensure that no stone is left unturned to achieve this ambitious, but not impossible, goal. Better governance in terms of providing quality public healthcare will result in healthy citizens who are more productive, and a prosperous, happier country.