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Right care, at the right time

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While my grandmother was denied a bed in National Heart Institute, Delhi due to unavailability, another person (patient) was denied treatment for a cardiac arrest unless “full” payment is deposited.

Doctors take pledge to treat their patients and this pledge is taken by their own choice of getting into this noble profession. They do deserve the praise that they are getting today as COVID 19 is an extraordinary situation. COVID-19 is not a seasonal or an every year disease like dengue, viral, etc that we are used to in our lives here in India and have a standard medical procedure for the cure. These are unprecedented times, but not unanticipated ones. As our ever increasing wants and greater need to subdue nature is anything but steps in the direction where we find ourselves today.

COVID-19 does not seem to disappear anytime soon, atleast until we have a vaccine or herd immunity.
Therefore, we should take this situation as an opportunity to mend our ways of living as individuals, government should invest more in health infrastructure not just for now, but a sustained roadmap be prepared for an efficient health system and to restructure the fallacies coming out to be more visible today, internationally – the priority of the world should be to work out a vaccine dissemination plan for the whole world. The vaccine is in the process of development. This spread between vaccine development and when it is ready should be used to strategise how it shall be made accessible to the whole world.

Incidents mentioned in the beginning are the trigger of my thoughts for writing this. It is the side that need wide circulation and utmost importance. As emphasising on good things may not bring change where we lack, looking on this dark, sad, negative side of our health infra. would help us in policy restructuring.
Our health policy focus should first be of saving a patients’ life. Person dying due to complications, critical diseases require medical sciences analysis. However, if a patient die due to denial of admission to a hospital is a legilsative – executive policy loophole. Therefore, our aim should be to zero down on death due to lack of hospital admission.

Following are some suggestions which government may work upon –

1. Like a good samaritan law for individuals, there can be a similar law for the hospitals, as well. Hospitals should not be reprimanded for providing care to a critical patient by the family later on. Maybe some application can be signed by the family for the same.
If it is already there, then it should be implemented in spirit, than only in letter. As news articles show family of patient thrash doctors, medical staff deteriorates the doctor-patient relationship.
To instil confidence, care and security in our medical system shall be the duty.

2. Every hospital very well know what facilities they lack. However, a list of the same facilities available in the nearby hospital should also be available with them. So that rather than denying admission, hospitals provide the advise and recommend another nearby hospital to the family for the patient.
In other words, admission should not be denied , except for lack of the required facility in the hospital, for which recommendation of nearby hospital equipped with the same facility be provided to the patient/patient’s family.

3. Essential/life saving  equipment should be available in every hospital. Other major equipments that are expensive, but equally important should be made available in atleast 1 hospital within 1 km to 5 kms range.

4. Denying care for lack of money where that care can be a matter of life and death, the care shall be provided.

While life is more important than money, one cannot discredit the role of money in getting efficient and better facilities. Therefore while hospitals should not deny admission for lack of money with a person. For hospitals to continue to provide efficient and state of art health care, they require funds and they are to be paid for their services. Which is also how the whole world functions.

We do have health insurance policies, however not everyone subscribes to it. For which behavioural change in people and the importance of a health insurance should be widely disemminated and be taken up as a campaign. While at the same time survey from households who are not covered under any health scheme of govt or under any public or private health insurance, be taken and their reasons for the same be assessed. After which they can be better addressed.

The economically weak class is well covered under the Ayushmann Bharat Scheme.

For those who are capable to pay, must develop the disciplined financial behaviour where they are able to pay. But imagine someone with ₹30000 – ₹40000 income and has to shell out ₹80000 for a surgery, might face liquidity crunch and would either delay the treatment or take a loan at high interest rate. A layaway plan (a system of paying a deposit to secure an article for later purchase) on a pilot basis by private hospitals can be tried targeting such customers. Hospitals may provide a free health check up half yearly or annually and discount on bills or lab tests. This can aim for the class that is capable of paying, sometimes not immediately though or because of the sudden/unaccounted high cost.

5. Every state shall have an app/website, providing the list of hospitals in every city and the facilities available in every hospital. Number of beds available, specialised doctors and their timings. Hospitals running out of beds should be updated on the app in every 30 minutes. So that the family can save the critical time and reach the right hospital. If we can have apps that deliver our food, groceries and also inform of the unavailable stock in the inventory, if the hotel we book provide us full view of the room on our phone, infact for buying a home we are informed of its amenities. Then hospitals are for care of people. People should have a right to right information at the right time.

Moreover if people would be able to review the services of hospitals on such an app. It would lead to a competition to provide better services sometimes at competitive cost too.

For not abiding by the above provisions, following procedure may be followed –

  1. The hospital personnel shall be suspended until further inquiry, who deny admission for grounds other than mentioned above.
    If further such cases come from the same hospital decision should be taken to cancel the license of that hospital

2. Instead of a lump sum compensation, the family who lost their member due to such negligible behaviour or because of denied admission or for not getting any recommendation as mentioned above shall be provided for a lifetime of compensation in case the member was sole bread earner and had minor children. If not then the owners of the hospital shall make sure that another family member gets an employment, until then they should continue to get compensation.

The latter two points points can be improved, as the aim is not to discourage capable members of the family from getting employment and to become dependent on the compensation.

Ultimately in the health infrastructure time is of critical importance, followed by right care. To aim for futuristic technologies, we must be able to solve classical problem that our hospitals are ridden with.

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