Everyone reading this would agree that we lack “proper” healthcare, both in quantity and quality. There is a serious lack of transparency. According to WHO, our per capita spending on healthcare is in the bottom quartile amongst all countries, we are in competition with the likes of Nigeria, Rwanda and Uganda (never a good list to be in). This has resulted in an appalling lack in basic government healthcare infrastructure (the only hope for millions). More than 15k people die of negligence every-year, and more than 10 times that number die because of lack of access to even those “negligent” facilities!
At this point of time, you would probably laugh at me if I told you that there is also a problem of plenty! Yes, you heard me right, a problem of plenty. One that we have been so used to that we don’t even cringe about it, or rather, we cringe every-time but have accepted it as the new normal, just as the success of Sajid Khan – Farah Khan movies. A problem of unnecessary and excessive diagnostic tests, a minor visit to the doctor ends up costing a minimum of Rs.1500 (Consultation – Rs. 300, Diagnostic Tests – Rs. 1000 & Medicines – Rs. 200), and since our health insurance doesn’t cover visits or preventive checks, people have started ignoring minor conditions leading to a snowball effect later.
So who should we blame? Doctors?? Why not! easy targets, seem to charge exorbitant consultation fees, seem to prescribe the most expensive medicines and almost always prescribe unnecessary tests. So why do they do it? For starters – they do not want to be beaten up by the family members and want to be on the safe side by prescribing a test even if it has a 0.01% chance of being the cause, secondly (and probably the more important reason) – they get commissions on each of the 3 charges: Fees – Obviously, Medicines – Medical Representatives from Pharmaceutical companies (the ones who can almost always be seen waiting outside a doctors chamber) with a ‘black’ bag full of promising gifts, and last but not the least, Diagnostic tests – Most Diagnostic centres give “commissions” to doctors for “referring” patients, sometimes even to the tune of 50% of the price of the test.
So by now almost every doctor should be a millionaire, no!!
Let’s take the example of Anand, a topper in his state, now is the time where he has to choose from the only two options available for “students like him”- IIT or Medical. Although his parents, influenced by the 2 crore packages that seem to be the “norm” at IIT’s, want him to alleviate them from their middle class life and choose IIT, Anand on the other hand, wants to serve the sick and save lives, and in the end prevails over his parents. He completes his MBBS, then intending to go for specialization, looks for options. To his shock, there are only 650 seats for post-graduation in his specialization (with over 100,000 doctors competing, and those seats being auctioned for 4cr). Private colleges charge capitation fees starting from 50 lakhs to over 3 crores. He, like more than 100,000 MBBS graduates, is petrified of the huge “investment” and prepares very hard for the next couple of years. After 2 unsuccessful attempts, under social pressure, his parents liquidate their retirement savings to pay for the down-payment of his education loan. His younger brother, in the meantime has cleared IIT, and although could only match a fraction of his parents expectations, now seems to be their favourite.
Now, the installments on the loan have started to cloud over his “noble” ambitions. He still enjoys his job, loves saving people daily but now the repayment of the loan has started to worry him. It is in the midst of this that the medical representative with the “black” bag visits him and also the marketing agent of the “friendly” neighbourhood diagnostic centre, luring him with promises of “hassle-free” clearance of all his debts, all he has to do is send his patients to them and while parting reminds him that “the more he sends, the faster he will repay his loan”.
Anand’s journey is not unique, more than 90% of the doctors that graduate every year have spent a huge amount of money on their education, and most of them although start with noble intentions, are not all saints nor have they inherited millions, they have to manage their family expenditures. They would prescribe tests that they themselves know have no relevance but (with a sad heart, hopefully) are doing it because they have no other option. The diagnostic centres keep the commission to the doctors in mind while pricing the tests, it’s a vicious cycle. Just imagine the waste of capital this is resulting in, conservative estimates peg these excessive tests to comprise at-least a quarter of the $5+ Billion Indian diagnostics industry.
So, we come back to the original question, whom should we blame?? Diagnostic centres and hospitals? Not really, the competition there is very severe and to exist they have to be a part of this bigger systemic issue; so consistent with our usual habits, let us blame the “system” and the “government”. Unfortunately, this allegation bears serious merit here. The government has to step in, start more medical colleges, create more doctors who will be empowered to follow their dreams of “serving the nation”, and hopefully in 20 years from now, the “savings” proposition on this website would not be as ridiculously awesome as it is now.Visit: www.medyog.com