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The Dichotomy of Indian Healthcare

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The Indian Healthcare Ecosystem is as diverse as its other attributes – food, religion, culture, etc. Healthcare varies irrespective of upbringing, education, income, and faith. For people looking through the lens of structure, it is chaos, and “Indian healthcare has failed and needs a desperate fix.”

Certainly, change is essential and inevitable. Below are a few facets, reflecting the different dichotomies in our healthcare system.

Urban versus Rural Healthcare 

Access to a facility is a critical variable while measuring the efficacy of healthcare systems, worldwide.
Rural India’s access to healthcare is limited to government-operated PHCs/PHUs, riddled with insufficient doctor count and equipment, limited medicines,  outdated techniques, and almost no opportunity for continued education.
Whereas, Urban India’s healthcare access is amazing even compared to developed countries. The ample choice of practitioners, labs with the latest instruments, a plethora of medicines delivered home, and an ongoing feed of new treatment techniques, is the proof.
Due to limited access in rural India, the doctor-patient trust levels are strong, unlike in urban areas where choice dilutes the doctor-patient relationship.

The Split Between Public & Private 

The cost of healthcare is another key factor to consider while valuing a healthcare system.

Public hospitals, barring a few, struggle for infrastructure, processes, skilled staff, technology adoption, continuous learning, etc., resulting in poor patient experience. Yet, public hospitals get the highest number of patients.
Private hospitals, mushrooming mostly in metros, invest in infrastructure, advanced devices, care facilities, skilled personnel, enterprise automation, and many more. However, the patient experience suffers due to affordability.

While the government fails to deliver in public hospitals, the private ones suffer from the business objective of ROI, a lose-lose proposition for patients.

Presence of Alternative Systems

The choice is not limited to the practitioners but the practice system itself.

Allopathy is the globally dominant healthcare system with widespread research, well-documented evidence, demonstrated success, and continuous advancements. India is however different. Allopathy is consistently challenged by the traditional Ayurveda and Siddha systems and even the relatively recent Unani and Homeopathy.

The practitioner count in AYUSH exceeds Allopathy, reflecting the patient’s choice for the alternate systems. While Allopathy is the most widely visible system, AYUSH has its fair share of patients due to their confidence in the treatment outcome, at least for OPD patients.

The Business Aspect

Patient care is supposed to be the fundamental goal of all healthcare systems. In the public system, the cost is not a factor but the priority of care is for the ones with connections or corruption.
‘Ayushman Bharat’ has improved healthcare access to millions, but patient care to a common citizen is still at a much lower priority. 
In the private space, however, priority care depends on the customer value to the business of health, almost similar to the hospitality industry.
Health practitioners are bound by business rules, driven for profits. Patient care, the most critical part, is compromised in both public and private systems, due to the innate character of the system and its policies.

Uncertified Practitioners 

Qualifications and accolades are a necessity to demonstrate skill sets. Patients vouch for certified professionals as the foundation to practice outcomes. The more qualified, accredited and publicly recognized a practitioner, the more confident and comfortable are the patients.

India being an old civilization has its history of traditional healthcare practices, not recognized by certified professionals for valid reasons. The evidence of patient recovery poses a challenge to both Allopathy and AYUSH practitioners.

Also referred to as quacks, patients throng for treatments via informal referrals or simply faith. Discrediting uncertified practitioners is a challenge to both government policymakers and certified bodies, due to the patients’ attitude towards an uncertified practitioner.

Policy versus Practice

The presumption is, policy guides the health practice to a safe/scalable system. India’s healthcare philosophy is muddled due to the difference in AYUSH systems and the Allopathy approach. The policy challenges posed by different systems confuse even the most certified practitioners.

Practice, on the other hand, is patient-driven, utterly based on the belief system. Health policymakers struggle to comprehend and manage the age-old traditional approach, resulting in a heterogeneous arrangement between practitioners and patients.

Blaming the policy paralysis and its decision-makers is quite easy, but from the bird’s eye view, fixing an inherently diverse system is an immense challenge.

Many other variables underpin the core Indian health care system. The question is Where does one start the change?

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