Customisation, context, cost burden: Common hurdles to UHC

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Dr Avinash Phadke, Founder, Dr Avinash Phadke Pathology Labs and President – Technology, SRL Diagnostics speaks about the impact of Essential Diagnostic List (EDL) on the diagnostic sector in India

80 per cent of the healthcare in India is under control of the private sector. This implies an uneven financial burden on the population of India. In this situation, subsidies are imperative, but they cannot be borne by the private or governmental players entirely. The burden must be equally lifted by the government, the medical sector, and the patient. An example of such a scheme is the Ayushman Bharat, which has been initiated with an aim to reach a goal of universal healthcare. While this is a difficult process to implement because of the many elements associated with it, it is the road to a better, more inclusive healthcare system.

Globally, the push for universal healthcare is underway, but when you think about even the basic differences between countries, and their healthcare setups, you realise that it is a mammoth task. Take, for example, the Essential Diagnostics List (EDL) published by the World Health Organisation. The tests mentioned therein, are a result of a mean understanding of health concerns world-over. The law of averages instantly cancels out concerns like Zika, or Tuberculosis, both of which are contextually relevant within certain geographical boundaries.

Having said that, the EDL allows for one very key development: Amplification of the importance of pathology testing. It creates a setup that promises changes in the right direction. 70-75 per cent of all clinical decisions are taken as a result of pathology testing. Without diagnostics, the identification of ailments is impossible.

Working on the assumption that each country must assess their needs, gaps, and concerns individually, let us look at what India needs to move towards the 2030 Sustainable Development Goal of Good Health and Wellbeing. In my opinion, we cannot achieve much, without a few things:

Equal distribution of financial burden

Financial aid from the government is a must. A good model to look at here is Australia. Their model allows for large cuts in basic healthcare, which is borne by the government. For additional care, Australian citizens have insurances which cover the rest. It is a burden equally shared by the authorities and the people, easing financial burdens on each party. Since in India, the healthcare system is a state subject, national schemes must create a much stronger argument to ensure they are implemented. Additionally, the burden on medical organisations is large, since the cost of equipment comes with a hefty GST element. This cannot be transferred to the patient and must be wholly taken on by the medical teams.

Bringing the insurance sector into play

Another key element of the healthcare system in India is the lack of insurance penetration. We are a young country, with a population that does not need as much in terms of medical care. Effectively, in this situation, the younger population pays for the healthcare needs of the older population, through insurance networks. However, the need is to drive the adoption of this process, to make it a habit, rather than a one-off activity.

Geographically relevant technological development

Medical and diagnostic equipment is expensive, imported, and very sensitive. Large parts of India need to be covered by pathology test access, but with the kind of technology we have today, it is difficult. There is a requirement of pure, running water, along with a continuous electrical source, and a temperature of 22 degrees. These conditions cannot be replicated when taking the testing equipment to places where dust and extremes of temperature cannot be avoided. It is possible to invest in dry chemistry analysers, but the cost of these are three times as much as the regular equipment. There is a real need to bring in more preliminary testing techniques which can conduct an initial analysis. This can then be digitally referred to experts for assessment.

Take diagnostics digital

The doctor-patient ratio in India is not where it should be. We do not have enough doctors to cover all levels of the healthcare spectrum; from Tier I cities, down to the village level. However, with digital capacity increasing, it is possible for experts to be accessible, which is what we must increasingly implement. To implement new technologies, we must attain a level of basic digital presence, so that the need gap in the medical process can be assessed better.
While the United Nations and the WHO are working towards a world where universal healthcare is a reality, one governing body alone cannot implement change. Each country must take initiatives like the Essential Diagnostics List as a guideline, and work towards adapting them to their needs.

No developing country has managed to successfully implement a universal healthcare system. Indonesia had, but hit the same hurdles, of cost burden, subsidies, and access. We must begin with dialogue. Medical professionals, organisations and the government must work together to divide responsibilities, assurances, and benefits. The blueprint thus created will then need to be implemented slowly, to feed into the current system, without disrupting it.

Over time, universal healthcare is achievable, but we must all accept that the journey ahead is long. Conversations have begun with the WHO’s attempt to create a list of essential drugs, diagnostic equipment, and tests. We now need to adapt it to our people, and their needs. The best result would be a system that understands the Indian burden of disease, leading to an India-specific guideline for technology, and for essential diagnostic tests. There is a lot of work to be done, but there is also a lot to be gained at the end of the road.

 

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