Carpe diem and set things right in healthcare

Dr Arvind Balakrishna Kasaragod | Updated on June 05, 2020

What the Covid pandemic has shown us is that at least 30-40 per cent of doctor visits can be replaced by video consultation   -  Getty Images/iStockphoto

Covid presents the perfect time, if any, to reset and restart

‘Healthcare is broken and needs to be fixed” was the rallying cry in all parts of the world. It was the same in countries that had nationalised healthcare, private healthcare or a mix of both. This was even before the Covid pandemic.

The pandemic reinforced that belief even more — as no country was really prepared for what happened with the pandemic. Of course, some did deal with it better than others. But I would rather focus here on why everyone felt healthcare was broken and how the pandemic could be a time for us to hit the reset button and restart healthcare in a meaningful, safe and fiscally responsible manner in India.

During the lockdown, we saw outpatient visits drop significantly, emergency departments were empty, elective surgeries had not been done, laboratory tests had decreased and purchase of medications had come down.

In spite of this, the number of deaths decreased by 30 per cent compared to last year. Some of this could be because road traffic accidents had decreased due to the lack of vehicular traffic. However, this does not explain the decrease in deaths from strokes, heart attacks, pneumonia and other common illnesses that used to fill up our intensive care units as some of the most common causes of deaths. This definitely needs some thought, even as we learn to live with Covid.

Outpatient care

In India, there is an underlying need to fix the ailing healthcare system by providing comprehensive insurance, including outpatient insurance, ie any medical treatment that does not require hospitalisation or an overnight stay at a medical facility of any sort. This will help in improving healthcare indices and decrease the cost of healthcare in India. The only reason not to see a doctor is financial or the problem gets better before the doctor visit. All of us who have been practising know that most of these visits are more for reassurance and medication adjustments that can be done remotely.

What the pandemic has shown us is that at least 30-40 per cent of doctor visits can be replaced by video consultation and this is now an accepted new normal norm by patients and doctors. Video consultations will lead to a greater access to appropriate, accountable and much more affordable outpatient care for patients and will decrease the cost of providing care for the doctors and hospitals by reducing cost of infrastructure and manpower.

This should be the rule rather than the exception, going forward. These consultations should be augmented with home delivery of medications, lab sample collection, point of care testing and home therapy.

It is also well known that many of the tests done and medications prescribed are not necessary or inappropriate during outpatient visits. It has been noticed that with video consultations the number of lab tests done has come down and so have prescriptions for antibiotics, in particular, and medications, in general.

In-patient care

Indian in-patient care has been more regulated than outpatient care due to the various insurance policies and schemes. In spite of this there is very little standardisation of care. Covid has taught us that protocols are useful and are required to ensure that all patients get the same treatments that are considered safe and effective by professional bodies. We should do the same for non-Covid admissions as well. If most patients got similar care we will be able to standardise the cost of care for most of the common in-patient admissions.

We should also ensure that we make every effort to decrease the length of stays for in-patient admissions to what is actually required. The longer anyone stays in the hospital the worse it is for the patients medically and financially. Going forward, we should definitely try to decrease any extra hospital exposure to Covid for our patients by decreasing their average length of stay (ALOS).

Patients who are discharged early can be taken care of with video consults, remote monitoring using the technology available and provision of home care, if required. Insurance companies should incentivise early discharge and pay for post discharge care for at least for a few days as they will be saving money as home care will be significantly less than in-patient hospital care. Early discharge will help hospitals as well as they can turn around beds for more patients faster and hence can have fewer beds, thereby decreasing their capital expenditure without decreasing their capacity to accept more patients.

Intensive care

This is the most important care that a patient receives in a hospital as it is mostly lifesaving care. However, there is not much oversight as to how many invasive procedures and invasive monitoring methods are performed and if accepted protocols are used on a given patient.

The pandemic has taught us that even in ICUs, the appropriate protocols can be used successfully across countries. We should look at using digital clinical decision support systems in the ICUs to prompt doctors to use the right protocols and procedures for all non-Covid patients as well. This will help hospitals standardise treatment and costs for ICU care. This will help us calculate the exact cost that is required for most of the common ICU admissions. And that can further help insurance companies and the government to set premiums and reimbursement that are realistic and affordable for patients and fair to the hospitals.

We have also learnt that low-cost equipment can be manufactured and used during a pandemic. We should ensure that equipment like low-cost respirators that don’t have the bells and whistles are allowed to be used at least in low-resource settings and help save lives from non-COVID diseases as well. The pandemic has also highlighted the severe shortage of intensive care specialists like never before. The solution for this should be the widespread adoption of tele ICU, a technology that has been tried and tested and available in India for quite a while now.

Finally, to reset and restart the health care system in India post Covid, we will need help from stakeholders like the government and insurance companies to help care providers adapt to the new normal. The government will need to expand and clarify telemedicine guidelines, doctors and hospitals should be protected from medico-legal issues if they have followed the accepted protocols and guidelines.

There should be a clear framework regarding low-cost equipment, home monitoring and home healthcare. Insurance companies should be encouraged and helped to provide outpatient insurance and immediate post discharge insurance for all the above mentioned strategies to work.

It is quite obvious that there are many lessons that we can learn from the Covid pandemic. This crisis is a perfect opportunity for us to carpe diem. But will we?

The writer is Group Medical Director, Cloudnine Group of Hospitals, Bengaluru. Views are personal

Published on June 05, 2020

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