Tag: healthcare system india

Why Online Reviews in the Healthcare Sector Should Be Championed

With responsible use and oversight, digital platforms can empower patients while mitigating the risks associated with the free flow of information. 

The National Medical Commission had recently announced guidelines, now held in abeyance, that placed several restrictions on doctors from participating in online review and ratings platforms. Preventing doctors and hospitals from participating in these platforms will severely limit access to information for patients and their family members.

User-generated information can empower patients to enhance their understanding of issues and can serve as a reference for other patients. In my experience, online information platforms have emerged as a safe place for patients and relatives to seek and share information . This is particularly true for chronic or rare diseases where patients need constant and continued support and information about doctors, hospitals and treatment centres. 

I have seen the evolution of healthcare and health systems. A new generation of highly educated and tech-savvy patients has arrived. It has a great understanding of information technology, uses IT tools to search for the best possible medical and clinical options for themselves, their parents and relatives, and communicate freely. 

Every patient has the unequivocal right to receive adequate and relevant information about their health journey. This includes details about the nature and cause of their illness, provisional or confirmed diagnoses, proposed investigations, management, as well as potential complications. Moreover, patients have the right to transparency regarding the expected costs of treatment as well. Doctors and hospitals must communicate these financial details and ensure that patients and their caretakers are fully aware of any additional expenses resulting from changes in the patient’s condition or treatment plan. The legal framework also ensures that the patients and their families know the identities and professional statuses of all care providers involved in their treatment. 

Gone are the days when patients solely relied on their family physician’s advice or word-of-mouth recommendations. The internet and the proliferation of social media have democratised access to healthcare information. Patients now actively educate themselves about various medical conditions, treatment choices, and healthcare providers. This collaborative knowledge-sharing empowers patients with a wealth of information, aiding them in making informed healthcare decisions. This transformation signifies a profound shift in the traditional doctor-patient dynamic, with patients transitioning from passive recipients to active participants in their healthcare journey.

Also read: How Much Do Indian Households Spend on Healthcare Every Month?

Studies have shown that greater patient involvement leads to improved decision-making outcomes as patients are more inclined to ask questions and collaborate effectively with healthcare professionals. Central to shared decision-making is access to the necessary information for meaningful discussions about options and preferences. Traditionally, decision-making has been confined to the consultation room, focusing on treatment options and single encounters. However, decision-making is now a multifaceted process and internet resources contribute significantly to it.

In the healthcare sector, where trust and confidence are paramount, the impact of online reviews cannot be underestimated. Online reviews and ratings are not limited to virtual anecdotes, they hold real-world consequences. 

These reviews act as potent social proof, cultivating trust and confidence among potential patients. Studies have revealed that a significant majority of patients/ caretakers consult these reviews before making a decision. A glowing review can be the deciding factor for a hesitant patient, encouraging them to choose a particular healthcare provider or service over others. Conversely, negative reviews can deter prospective patients, potentially leading to a decline in healthcare facility utilisation.

Besides, online ratings and reviews offer several advantages; firstly, they empower patients by giving them a voice. Secondly, businesses that pay attention to these reviews gain invaluable insights into patient preferences and areas that require improvement. This knowledge empowers healthcare providers to refine their services continually, ultimately leading to an enhanced patient experience and better healthcare outcomes. 

By actively managing and responding to online reviews, healthcare providers demonstrate their commitment to patient satisfaction and the delivery of high-quality care, further stimulating trust and credibility within the community. Lastly, by providing transparency and insight into the patient experience, they help reduce information asymmetry, where patients have less knowledge than healthcare professionals.

While online platforms are a valuable resource for patients, they are not without associated risks as unauthenticated or unverified information may mislead patients, leading to misguided decisions. Malicious or agenda-based content may create doubts or biases in their minds. 

However, technology has also provided us with the tools to filter, monitor, and moderate or delete such malicious content. Responsible digital healthcare platforms take measures to ensure the accuracy and authenticity of information, helping patients navigate the digital landscape safely.

Patients wield the power of information to make informed choices about their health with a strong legal framework that supports their right to absolute transparency. With responsible use and oversight, digital platforms can continue to empower patients while mitigating the risks associated with the free flow of information. 

Reviews and ratings of doctors, hospitals and specialities are critical pieces of information that help us in choosing the facility that will best serve our medical needs. This is in line with global practices with enough data to corroborate the usefulness of reviews and some countries like the US, UK, Germany, Netherlands and Australia have a variety of different review and ratings platforms. In the UK, the National Health Services (NHS) operates websites that include patient reviews and ratings for healthcare services. 

As we move forward and embrace healthcare technology, the government has to ensure that patients remain at the core of all the developments. For that to happen, it is essential to create a framework that encourages doctors and hospitals to participate in online review and ratings platforms. 

Dr Fauzia Khan is Member of Parliament Rajya Sabha from the Nationalist Congress Party. She is associated with healthcare related topics.

Will Politics Ever Overcome Its Apathy Towards Operative Healthcare for All?

While there is political consensus that a robust healthcare system is needed, it is rarely at the centre of electoral politics in India.

In 2005, I joined one of Mumbai’s largest suburban Municipal hospitals as a visiting surgeon. This institution treats a large number of accident victims on a daily basis and has treated a number of those injured in the riots and bomb blasts that swept Mumbai in the past few decades.

To my disbelief, I soon realised that our department’s capacity to treat these patients was being severely compromised by the absence of a CT scan machine in the hospital. I was also shocked to observe that patients were being sent to private centres nearby for a charge or to faraway public hospitals, resulting in huge delays in treatment.

My colleagues and I soon raised this matter through multiple letters and meetings with the administration, but to no avail. We were told that a demand for a CT scanner had been pending for years. Meanwhile, patients continued to suffer and I suspect many young lives were lost due to the delay in obtaining CT scans.

Finally, with what I imagined at that time as my ‘political’ insight, I decided to use a different approach. There was a local corporator who used to meet us to inquire about patients from her constituency and seemed concerned about the hospital’s services.

Also read: What Indian Healthcare Has Looked Like Under Five Years of the Modi Govt

I suggested that she could take up the issue of the lack of a CT scan machine as a public campaign. I tried to convince her that this could help her win the elections to the Mumbai Municipal Corporation due that year. To her credit, she took up the issue, fought it out in the public health committee of the corporation and finally persuaded the authorites to procure a CT scanner.

On the day the machine was installed, she put up posters around the constituency, claiming victory in her fight for better healthcare for the citizens. We organised a small thanksgiving ceremony where I remember talking about how we could transform the hospital if healthcare becomes a local political issue.

A doctor looks at a monitor displaying a donor kidney. Credit: Reuters

The elections were soon held. She lost by a huge margin to a new candidate largely known as an organiser of the local Ganesh Festivals. When I bumped into her later, she, looking dejected, tried to explain:

People don’t necessarily vote on such issues. There are many other issues that overwhelm people when they press the button in the polling booth. I have learnt a lesson.

The dysfunctional and broken state of India’s healthcare system is there for everyone to see. All opinion, analysis and data over the years have repeated ad nauseum that across political parties, healthcare has been given low priority. As a result, India performs poorly in care delivery – our health indices are some of the worst in the word.

Healthcare as an electoral agenda

There is also consensus from the right to the left that without a well-funded and robust public health system, no country can provide decent healthcare to its citizens. The experience of some states in India and other countries is very clear on this. With so much consensus and evidence, what then is the missing link that prevents change?

We saw a substantive amount of scholarly analysis around healthcare during the build-up to this election. This was partly due to the Centre’s staging of Ayushmaan Bharat. In a piece I wrote a few months ago, I reflected on the experience of a public health insurance scheme similar to Ayushmaan Bharat as it had played out in the same public hospital.

Also read: Budget 2019: Ayushman Bharat Gets Rs 6,400 Crore, But to Benefit Private Sector

I ended the piece on a note of cautious optimism, wondering whether with Narendra Modi pushing Ayushmaan Bharat as a game changer and Rahul Gandhi responding to it with an alternative policy for universal healthcare, we were finally seeing a serious focus on health-related policy in national politics. Following that, the Congress manifesto went a step further by proposing the idea of a Right to Healthcare Act, while the BJP promised more funding for healthcare. But alas, all this was a few weeks ago.

In the meanwhile much else was blowing in the wind. Healthcare soon had to compete with Pulwama, Balakot, Chowkidari, the NRC and dynastic politics. As far as eyeballs and emotions are concerned, a powerful and unequal competition had emerged.

What the local corporator had realised after her experience, our astute political class had, perhaps, understood long ago. There are easier and quicker pathways to electoral success.

Narendra Modi and Rahul Gandhi raised the issue of healthcare, but it was soon overshadowed by other issues. Credit: Reuters

Middle class and political apathy towards healthcare

As we enter the last lap of the electoral race and await the results, I almost have a sense of déjà vu. Notwithstanding the results, what role did issues like healthcare and education finally play? And if they didn’t, will anything change at all?

Do we need to dig deeper and raise uncomfortable questions rather than just lament over the state of healthcare through op-ed pieces? Is there something more at work here? For example, is it the fact that the elite, which includes many of us, have resolved their own healthcare issues through the creation of a private sector and while we all pay lip service to it, we are no longer invested in change?

In other words, as Taleb puts it, is it that those who can change health policy no longer have “skin in the game” of public health? Shall we also question why our ordinary citizens do not force these issues to the forefront during election time and hold candidates accountable? Is there something about our cultural capacity that internalises death and disease as our fate and destiny? Are other daily challenges too overwhelming for us to notice the inequity in healthcare?

Or is it that having been chronically exposed to a certain system that passes for healthcare, ordinary people cannot even fathom an alternative? How will they know that there is an alternative that currently works in many countries which guarantees immediate, decent care that is worth fighting for?

Also read: Are Political Parties Serious About Healthcare Promises?

I am aware that, in many states of India, ordinary people have indeed fought remarkable struggles for health rights. There is also a growing national movement comprising largely of the middle class against, what is nothing but, the predictable excesses of an explosion of market medicine.

Maybe these movements will converge and see through the structural discrimination within the healthcare system which has created ‘state of the art’ hospitals where one can get a CT scan within minutes at an astronomical cost while large public hospitals exist without CT scans for the grievously injured. For someone like me, who has witnessed the havoc that illnesses cause on a daily basis, I cannot but be cautiously optimistic about the future.

As for our hospital, the CT scan unit is currently facing a lack of staffing. Many patients still have to be shifted for emergency CT scans. Once again, we made an effort to highlight the issue, this time, by approaching corporators across political parties. We were largely ignored. One of them even told us curtly, “Doctor you don’t understand politics; we are in an electoral battle, this is not the best time to raise such issues.”

Sanjay Nagral is a surgeon practising in Mumbai and the publisher of the Indian Journal of Medical Ethics.