31st December 2019 : The Hindu Editorials Notes in Hindi medium- Mains Sure Shot

No. 1.

Question – Critically analyse NITI Aayog’s proposed 15-year plan for Indian healthcare entitled “Health Systems for a New India: Building Blocks — Potential Pathways to Reform”.

Context – The plan.

Difference between personal and impersonal healthcare system:

Personal healthcare system – is focused on maximizing relationship quality and values such as trust. While impersonal healthcare system – is focused on embracing technologies and innovations that value speed, efficiency, and cost reduction.

Analysis:

The article focuses primarily on the human connection in healthcare—that is, the relationships and social bonds patients and healthcare professionals build together.
From virtual care technologies to mobile health apps, healthcare today looks much different than it did 10 or even five years ago.
These innovations aren’t the problem—it’s that our healthcare systems are relying too heavily on them, and not as much on building a strong provider-patient relationship. This flies in the face of what a healthcare provider learns from talking to patients and healthcare professionals, both of whom value that relationship and become dissatisfied when it falls short.
Technology such as electronic health records and mobile health apps can further the depths of an already solid provider-patient bond, but it can’t replace it.

Why in news?

The NITI Aayog’s proposed 15-year plan for Indian healthcare entitled “Health Systems for a New India: Building Blocks — Potential Pathways to Reform” outlines prospects of such an infelicitous turn in Indian healthcare.

Concerns:

While the report makes otherwise commendable proposals for health system strengthening — including elimination of informality, merging of fragmented risk pools, and reduction of out-of-pocket health spending — the proposal to consolidate small practices into larger business-like organisations appears problematic on multiple fronts.
In India nearly 98% of healthcare providers have less than 10 employees. This is identified as a negative trait, and the proposal sees this issue to be dealt with through a set of incentives and disincentives favouring consolidation. This points to a more impersonal healthcare system.
Apart from cost and competition-related concerns, an enthusiastic pursuit of it could portend an exacerbated commodification of healthcare from the bottom-up.

Issues with impersonal healthcare system:

Loyalty and longitudinality form vital pillars of the patient-physician relationship. The edifice of these is built upon a substratum of mutual trust, warmth, and understanding that accrues over time between a patient and their personal physician.
Momentary and haphazardly physician-patient interactions in a system that limits access to one’s ‘physician of choice’ are incapable of fostering such enduring relationships.
It is in this context that the role of a family physician becomes instrumental. Apart from providing comprehensive care and coordinating referrals, a family physician’s longitudinal relationship with their patient helps in a better understanding of the patient’s needs and expectations and in avoiding unnecessary clinical hassles and encounters — which in turn reflects in better outcomes and increased patient satisfaction.
Widespread commercialisation of care over the past few decades has entailed that the family physician is a dying breed in India today. And it would be of little surprise to learn that this has a sizeable role in impairing the doctor-patient relationship, manifesting popularly through violence against healthcare providers because there is no trust between the patient and the doctor – a sign of impersonal healthcare.
(but it is to be noted that violence against healthcare providers is not solely because of impersonal healthcare but also because in a setting of overcrowded public hospitals, and profiteering healthcare enterprises, where the patient-physician interaction is largely fleeting and transactional, mistrust in the healthcare provider and its gruesome implications are not difficult to anticipate.)

In this context, the advantages of small clinics:

Studies have demonstrated that healthcare received in small clinics scores higher in terms of patient satisfaction than that received in larger institutions.
This increased satisfaction manifests as better compliance with the treatment regimen and regular follow-ups, culminating in improved clinical outcomes.

Conclusion:

Kelley JM et al, in a systematic review and meta-analysis of randomised controlled trials, have established that patient-clinician relationship has a statistically significant effect on healthcare outcomes. Indeed, disregard for this aspect in health services design is bound to entail a sizeable cost to the health system.
The doctor patient relationship looks non-urgent in front of more pressing concerns in healthcare related to funds and manpower. As a result of which doctor-patient relationship considerations are largely neglected and not reflected in policy making discourse.
Time and again, however, this omission has surfaced in the performance of health systems worldwide. As India looks forward to a long-term healthcare plan, neglecting this consideration could be of sizeable consequence.

Way ahead:

The plan needs to be revisited to ensure that healthcare clinics delivering patient care don’t transform into veritable supermarket stores marketing medical services any further.

No. 2.

There is another article titled ‘Holding Mirror to our face’. The following are the highlights of the article:

The article says that The HDI rankings show that India’s demographic dividend is morphing into a nightmare
Malnutrition is rife, children continue to drop out of school in alarming numbers every year and millions of untrained young people enter the workforce unfit for anything more than manual labour of the hardest kind. So in a brake-less hurtle, India’s potential demographic dividend is morphing into a nightmare.
All this is best captured in the UN’s Human Development Index (HDI) rankings where India is a lowly 129th out of 189 countries. China, by contrast, occupies the 85th spot and Sri Lanka an even better 71st position.

Way forward:

We must focus on building more modern schools and universities that will open its children’s minds, make them more tolerant and respectful of one another, and helping them hold their own in the competitive globalised world of tomorrow.