Cutting the clutter in healthcare

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Abundance is not necessarily wholesome in healthcare and crowding the order-sheet with drugs of presumed benefit and many tests is wasteful and makes treatment expensive.

There comes a time when one must pause to review the past, revise the present and reboot the future. Such a time has come for healthcare, with its sands slipping through the hourglass of an unprecedented pandemic. COVID-19 has exposed the unseen vulnerabilities of our healthcare system.

The turmoil that followed has churned the conduct of our workplaces as well as our social and personal lives. Priorities have changed, healthcare taking the centre stage with the realisation that health is truly wealth. A new world order with the spotlight on health is in evolution. Governments around the world are now looking at their policies of governance through the prism of health. Corporates have repositioned employee health as a key metric of institutional well-being. Health is now recognised as a marker of economic progress. This focus has attracted a host of new stakeholders into the healthcare space wanting to redefine its structure and form. Innovators have already unleashed a plethora of healthcare options birthed out of digital technology. Wearable devices, medical apps, wellness programmes, immune boosters and alternative medicine have flooded the retail market, with many over-the-counter options for the health-seeking public. Whether these will truly make a difference is a question worth asking. Very few of these will stand the test of time, but they have, for the time being, contributed to making healthcare cluttered, complex, confusing and costly.

With the rising expectations of a net-informed public, medical practitioners find it easier to comply with their demands rather than offer rational therapy. In the post-COVID world stricken with panic and paranoia, healthcare practice will change significantly. In the abundance of options, over-investigation, overdiagnosis and overtreatment will become routine. Long prescriptions with multivitamins, immune boosters, steroids, antibiotics, antihistamines and antidepressants as part of a defensive ‘take-no-chance’ approach will become commonplace. Indigenous medicines, pushed by the government, have found a niche in the allopathic repertoire. The resulting poly-therapy will amplify the perception that healthcare is prohibitively expensive.

Healthcare over the years has been cluttered with needed and unneeded additions. The exponential growth of research and development in medicine, biotechnology and pharmacology have undoubtedly transformed it. With artificial intelligence and other techno-tools promising a revolution in healthcare, one could argue that health for all would be achieved soon. On the threshold of this new dawn, the pandemic struck, the learnings of which have unmasked a different story. The upheaval experienced was due more to the lack of simple and basic layers of care than the limited techno-heavy facilities available. This reality must prompt stakeholders to qualitatively declutter the spectrum of healthcare that is dense in our cities but sparse in towns and villages.

Abundance is not necessarily wholesome in the world of health, austerity is. Optimising  healthcare delivery by offering evidenced, essential care is the way forward. Crowding the order-sheet with drugs of presumed benefit is wasteful. Costly antibiotics, steroids and antibody infusions must be used conservatively and with clinical discretion. COVID-19 is a good example. Thousands ran helter-skelter chasing Remdesivir, Favipiravir, Ivermectin and Plasma, only to be told in hindsight that these offer no significant benefit. Repeated CT scans, D-Dimer and CRP pushed more and more people into unnecessary in-hospital care. A significant few in India are fighting black fungus and bone death due to the injudicious use of steroids. COVID survivors are latching on to the myriad measures advertised on social media. Non-validated virus attenuation technology, fancy masks that claim to save oxygen and UV light therapy are just a few examples of the clutter that has made healthcare look formidable. The truth is that most diseases need simple interventions done at the right time by the right caregivers. In our pursuit of health as the ultimate goal of human welfare, it is time to retain what is essential and discard the wasteful paraphernalia that is making healthcare an expensive novelty. It is time to cut the quantitative clutter in healthcare.

Today, healthcare is a complex matrix of systems – multiple investigations, imaging, diagnosis and treatment options that may take you into the most convoluted corridors of a hospital. The accuracy of diagnosis and the speed of therapy notwithstanding, it is not an experience that most would like to remember. The rapid growth of this domain has changed its identity from a service to an industry. Healthcare costs are known to push people into poverty. The frontrunners of health are no longer doctors, but doyens of the industry who influence the policies of health in India. With a CAGR of 20 per cent, this is the industry of choice for venture capitalists, software firms and entrepreneurs. The purity of medicine has been replaced by profits. The cost of care has risen correspondingly. Healthcare is too cluttered to be a care-giving entity.

Human clutter was held responsible for the rapid transmission of the COVID-19 virus. Reducing human density was the mantra behind social distancing, quarantine and lockdowns. If decluttering was the way to prevent the spread, cutting the clutter in the core of healthcare could be just as beneficial.

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