HEALTH SE­CU­RITY FOR ALL

Assocham Bulletin - - HEALTH -

ASSOCHAM or­gan­ised its 3rd con­fer­ence on Health Se­cu­rity for All, on July 11, 2018 in New Delhi. Dr. Ra­jen­dra Sharma, Med­i­cal Su­per­in­ten­dent, VMMC & Saf­dar­jung Hos­pi­tal, ad­dressed the gath­er­ing.

He lamented that a vast ma­jor­ity of our hos­pi­tals and clin­ics still run on pa­per based sys­tems and have no cen­tral­ized sys­tem to store med­i­cal records. Na­tional Pol­icy for the same is also un­der con­sid­er­a­tion. Such sys­tems are presently be­ing adapted by larger cen­tral re­fer­ral hos­pi­tals like Saf­dar­jung Hos­pi­tal and AIIMS. "Were quire a reg­u­la­tory frame­work that man­dates and reg­u­lates the use of Elec­tronic Med­i­cal Records (EMRs) and other clin­i­cal ap­pli­ca­tions in­clud­ing Hos­pi­tal In­for­ma­tion Sys­tem (HIS)."

The cit­i­zens of In­dia will ben­e­fit from an in­te­grated health in­for­ma­tion sys­tem across all states. This sys­tem will aid in all as­pects of health­care plan­ning, de­liv­ery, and mon­i­tor­ing, in­clud­ing dis­ease sur­veil­lance, pa­tient med­i­cal records, plan­ning for hu­man re­sources, con­tin­u­ing med­i­cal ed­u­ca­tion, fa­cil­ity reg­is­tra­tion .....

The cit­i­zens of In­dia will ben­e­fit from an in­te­grated health in­for­ma­tion sys­tem across all states. This sys­tem will aid in all as­pects of health­care plan­ning, de­liv­ery, and mon­i­tor­ing, in­clud­ing dis­ease sur­veil­lance, pa­tient med­i­cal records, plan­ning for hu­man re­sources, con­tin­u­ing med­i­cal ed­u­ca­tion, fa­cil­ity reg­is­tra­tion, and telemedicine ini­tia­tives. The same has also been en­vis­aged as pri­or­ity area in the Na­tional Health Pol­icy 2017.

The first step in the process of tech­nol­ogy adop­tion will be to cap­ture all pa­tient health in­for­ma­tion at the point of care, es­pe­cially hos­pi­tals and clin­ics. This in­for­ma­tion may then be shared with health in­for­ma­tion ex­changes where it can be ac­cessed eas­ily by doc­tors and hos­pi­tals. It will save du­pli­ca­tion of tests, the as­so­ci­ated costs and pre­cious time, in in­stances where min­utes can make a dif­fer­ence be­tween life and death.

The next crit­i­cal step is to en­sure that the data is uni­formly cap­turetl, in­ter­preted and ac­cessed by all those con­cerned and given the sen­si­tive na­ture of pa­tient health in­for­ma­tion, data safety is the other vi­tal con­cern.

Hav­ing dis­cussed the mer­its of tech­no­log­i­cal trans­for­ma­tion in health­care, the emerg­ing chal­lenges in health­care start­ing with ac­cess to spe­cial­ist care in ru­ral ar­eas, skewed doc­tor­pa­tient ra­tios, com­mu­nity so­cial per­cep­tive con­cerns apart from alarm­ing in­crease in non-com­mu­ni­ca­ble dis­eases or NCD's needs to be high­lighted.

These prob­lems in In­dian health care sys­tem in­cludes lack of trust. The mod­ern so­ci­ety is pro­gres­sively los­ing the trust in the health­care ser­vice be it the doc­tors, hos­pi­tals or labs. Part of this prob­lem is due to in­creased costs which make a neg­a­tive out­come doubt­ful and the other part is be­cause of a sig­nif­i­cant part of health­care de­liv­ery chain is un­der reg­u­lated.

Un­for­tu­nately peo­ple are also wary of govern­ment health in­sti­tu­tions due to the large crowds and un­matched re­sources for the larger pop­u­la­tion base. Re­duc­ing the out-of-pocket ex­pense on health­care is likely to ad­dress this prob­lem and we may see it in time with the roll out of the Ayush­man Bharat - Na­tional Health Pro­tec­tion Mis­sion of uni­ver­sal health in­surance, added Dr. Ra­jen­dra Sharma.

The govern­ment wants to see more peo­ple come to its fa­cil­i­ties, but this will re­quire a fun­da­men­tal shift in think­ing. Asit stands health­care providers are not held ac­count­able for a lot of their ac­tions ex­clud­ing the doc­tors who are li­able un­der the Con­sumer Pro­tec­tion Act. In­tro­duc­ing ac­count­abil­ity into pri­vate and govern­ment health­care will re­quire a pro­found cul­ture change. Re­spect for pa­tients and a fo­cus on results will not be easy to achieve.

Spe­cific train­ing in pa­tient safety is­sues, mak­ing pol­icy and im­ple­men­ta­tion of pa­tient safety stan­dards is cru­cial to

im­prov­ing ac­count­abil­ity.

There is a sig­nif­i­cant em­pha­sis in the govern­ment try­ing to in­crease the health out­lay but the prob­lems re­main in the im­ple­men­ta­tion of schemes pri­mar­ily due to lack of trained man­power and in­abil­ity of the so­ci­ety to bear the higher cost as­so­ci­ated with bet­ter level of train­ing.

This qual­ity per­cep­tion is ex­ag­ger­ated by the fierce com­pe­ti­tion among pri­vate providers, which com­pels them to sat­isfy cus­tomers by fo­cus­ing on the im­me­di­ate re­lief of symp­toms rather than the most ef­fec­tive treat­ment.

The use of pub­lic sec­tor, be­comes at times, chal­leng­ing due to huge num­bers, time taken in de­liv­ery and com­mu­ni­ca­tion is­sues. The other ex­treme of this spec­trum who are will­ing to pay an arm and a leg only to take treat­ment at the most ex­pen­sive pri­vate hos­pi­tal, think­ing that that the price cor­re­lates to qual­ity. Peo­ple need to in­formed and ed­u­cated to take bet­ter de­ci­sions and hav­ing a long term vi­sion on their health con­di­tion rather than look­ing only at the emer­gent treat­ment.

The govern­ment hos­pi­tals are now cov­ered un­der a di­rect pa­tient feed­back sys­tem by the name of' Mera Has­patal'.

The pa­tient is di­rectly in­vited to give a quick feed­back and score the ser­vices us­ing their reg­is­tered mo­bile num­ber. Such sys­tems should be adapted by all hos­pi­tals and even shared with pol­icy mak­ers to help bet­ter plan health­care de­liv­ery. Fur­ther qual­ity cer­ti­fi­ca­tion au­thor­i­ties, in ad­di­tion to their man­date should reach out to the in­sti­tu­tions in fa­cil­i­tat­ing and help­ing them de­velop and adapt stan­dard op­er­at­ing pro­ce­dures and other qual­ity re­quire­ments.

The feed­back also has to mat­ter, be­cause if it is not acted upon, cit­i­zens will lose in­ter­est. It must be in­te­grated into the hu­man re­sources man­age­ment sys­tem of the staff, in­clud­ing an­nual per­for­mance re­views, pro­mo­tions and trans­fers. But there is no com­pa­ra­ble plat­form in In­dia today that reaches the three­quar­ters of In­di­ans who live in ru­ral ar­eas.

There are other con­cerns that are be­ing a. ddressed at some level. A lot of po­ten­tial ex­ists in in­creas­ing the par­tic­i­pa­tion of pri­vate sec­tor in these roles like re­duc­ing the cost of con­sum­ables and de­vices - price cap­ping, best prac­tices, and has it re­ally re­duced the cost of treat­ment. In­creas­ing train­ing fa­cil­i­ties un­der skill In­dia at an af­ford­able cost and in­crease par­tic­i­pa­tion in com­mu­nity health pro­gram­mers maybe through CSR ac­tiv­i­ties.

(L-R) Mr. Nayan Shah, MD, Para­mount Health Ser­vices TPA, Mr. Ravi Bhat­na­gar, Di­rec­tor - Ex­ter­nal Af­fairs & Part­ner­ships, Asia Mid­dle East & South Africa, Reckitt Benckiser (I) Pvt. ltd., Padma Bhushan (Dr.) B. K. Rao, Chair­man, Na­tional Coun­cil of Health­care and Hos­pi­tals, ASSOCHAM, Mr. Ra­jan Subra­ma­niam, CEO, Vipul MedCorp In­surance TPAPri­vate itd., Mr. D. 5_ Rawat, Sec­re­tary Gen­eral, ASSOCHAM, Ms_ Mo­hini Dal­jeet Singh, CEO, Max In­dia Foun­da­tion.

(L-R)Mr. Rawat, Sec­re­tary Gen­eral, ASSOCHAM, Mr. Ra­jan Subra­ma­niam, CEO, Vipul MedCorp In­surance TPA(P) Ltd., Mr. Ravi Bhat­na­gar, Di­rec­tor - Ex­ter­nal Af­fairs & Part­ner­ships, Asia Mid­dle East & South Africa, Reckitt Benckiser (I) Pvt. Ltd., Or. Ra­jen­dra Sharma, Med­i­cal Su­per­in­ten­dent, VMMC & Saf­dar­jang Hos­pi­tal, Min­istry of Health & Fam­ily Wel­fare, Gol, Padma Bhushan (Dr.) B.K. Rao, Chair­man, Na­tional Coun­cil of Health­care and Hos­pi­tals ASSOCHAM, Ms. Mo­hini oal­jeet Singh, CEO, Max In­dia Foun­da­tion, Or. Nayan Shah, Mo, Para­mount Health Ser­vices Pvt. Ltd.

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