From UPSC perspective, the following things are important :
Prelims level : Nothing much
Mains level : Personalised Health care - importance of family physician
As the Mayo brothers’ initially modest set-up (Mayo Clinic) prolifically expanded into the ‘multispecialty group practice’ in the U.S., concerns that such arrangements would be bereft of the personal touch in patient care were raised.
- This continued through the evolution of more and more organised structures like Health Maintenance Organisations (HMOs).
- They were criticised for turning healthcare into a marketable commodity sold by healthcare providers in supermarket-like institutions.
- U.S. healthcare ended up as one of the most impersonal healthcare systems.
- The NITI Aayog’s 15-year plan for Indian healthcare entitled “Health Systems for a New India: Building Blocks — Potential Pathways to Reform”.
- The report makes proposals for health system strengthening — including the elimination of informality, merging of fragmented risk pools, and reduction of out-of-pocket health spending.
- The proposal to consolidate small practices into larger business-like organisations appears problematic on multiple fronts.
Challenges with the proposition
- Nearly 98% of healthcare providers have less than 10 employees. It is identified as a negative trait.
- Apart from cost and competition-related concerns, it could portend a commodification of healthcare from the bottom-up.
- The report’s bent towards the U.S. HMO model adds to such a foreboding.
- Loyalty and longitudinality form vital pillars of the patient-physician relationship.
- The edifice of these is built upon mutual trust, warmth, and understanding that accrues over time between a patient and their personal physician.
- Momentary and haphazardly physician-patient interactions in a system that limits access to one’s ‘physician of choice’ are incapable of fostering such enduring relationships.
- The role of a family physician is instrumental.
- Apart from providing comprehensive care and coordinating referrals, a family physician’s longitudinal relationship with their patient helps in a better understanding of the patient’s needs and expectations.
- It avoids unnecessary clinical hassles and encounters — this reflects in better outcomes and increased patient satisfaction.
Commercialization of care
- Widespread commercialisation over the past few decades has entailed that the family physician is a dying breed in India today.
- This has a sizeable role in impairing the doctor-patient relationship, manifested through violence against healthcare providers.
- In a setting of overcrowded public hospitals, and profiteering healthcare enterprises, mistrust in the healthcare provider and its gruesome implications are not difficult to anticipate.
Advantage of small clinics
- Studies have demonstrated that healthcare received in small clinics scores higher in terms of patient satisfaction than that received in larger institutions.
- This increased satisfaction manifests as better compliance with the treatment regimen and regular follow-ups, culminating in improved clinical outcomes.
- A meta-analysis of randomised controlled trials has established that patient-clinician relationship has a statistically significant effect on healthcare outcomes.
- Disregard for this aspect in health services design is bound to entail a sizeable cost to the health system.
The need for empathy
- A popular myth often floated is that considerations regarding emotive aspects of healthcare such as empathy and trust are disparate from health policy and system design considerations.
- In reality, these are entirely amenable to cultivation through careful, evidence-based manipulation of the health system design and its components.
- It would necessitate installing an inbuilt family physician ‘gatekeeper’ in the health services system who acts as the first port of call for every registered patient.
- NITI Aayog’s long-term plan provides a good opportunity to envisage such long-called-for reforms, but that would require not the U.S. model but the U.K. model to be kept at the forefront for emulation.
- A step of sorts is taken in introducing Attitude, Ethics, and Communication (AETCOM) in the revised undergraduate medical curriculum.