A Model of Health Care?

Donna and I visited the pediatric ward today, and while we were there we struck up a conversation with one of the residents there. He asked us if the recession had affected health care in the United States. Like most things, the recession has indeed affected health care in many ways. One major way is through the loss of health insurance benefits brought on by job losses. In a very real way, this recession has brought to the limelight the major problems with American health care that have been brooding for over a half a century.

This conversation set me thinking about what the Indian health care system could offer us as we struggle to modify the American health care system. On first glance, I figured that the Indian system wouldn't have much to offer us. After all, the quantity of treatment is abominably low, as most people get as much treatment as they can pay for out of pocket. In a very limited capacity, the government has stepped in to provide basic health care (e.g., providing vital vaccines for the entire population). However, when it comes to full blown treatment, often times there's nothing a poor family can do, even if there is a relatively simple (if expensive) treatment. Yet at the same time, I think there are things to take from the Indian health care system. Though I risk sounding like I'm writing for the opinion page of the New York Times, I thought I'd devote this blog to some of the observations made in light of this idea.

After reading several articles about the state of American health care, I realized some of the blame in our health care crisis rests with the doctors. Some doctors, with the mindset of capitalizing on their "business," often overtreat their patients through unnecessary tests and procedures. I think a better mindset is captured in a specific scene today in the clinic of Dr. Joshi, one of the pediatricians here. A little 10-year-old boy came in this morning having never spoken before. Along with the obvious mental problems, he was short and underweight for his age and had suffered emotional trauma through the loss of a brother. The boy obviously came from a poor background, and had he been born in the United States, doctors would probably already have run a series of tests to identify his problem. Here in India that was hardly possible, and indeed, given the family's limited resources, his disease would probably end up going undiagnosed and untreated without financial intervention. Yet Dr. Joshi referred the boy to another doctor to begin the series of tests to discover his problem and saying, "This boy really needs to have these tests done and I refuse to just sit here and not treat him. If the tests have to be done free of charge, they'll be done free of charge." My first thought was that our health care system might be considerably better off if all doctors shared his passion of putting the patient first.

With that being said, we all know that while ideologically simple, it is practically complex. Insurance companies, pharmaceutical companies and the government are just a few of the players in complicating the system to the point of incomprehensibility. Not surprisingly, the same players exist here in India. Health insurance hasn't really caught on, and perhaps India can find a way to build their growing health care system with a different approach to insurance that doesn't create the massive disparities present in our own system. However, one big problem with health insurance right now here is that it doesn't treat preventatively. So if a patient wants to go in for a series of preventative tests and vaccines, it's all out of pocket. However, if you get the disease that vaccine could have avoided, the insurance company will start chipping in.

Occasionally during Dr. Joshi's clinic, pharmaceutical representatives would line up outside the door to try and sell their products. One by one, they file in, make their case for whatever drug they're trying to market as the doctor listens. Often, the doctor simply waves their product off, leaving the rep emptyhanded. However, the usual calendars, posters, and pens emblazoned with drug logos are always left behind in the clinic as friendly reminders of the proper drugs to prescribe. Drug reps perform a similar role in the United States, as their companies seem to alternate between the life-saving angels and the money-sucking demons of the health care system.

Together, drug companies, insurance companies, doctors, and many others are important players in our health care system, and each of their needs will have to be addressed in any new system we implement in the United States. Ultimately, I hope that whichever system we move towards finds its highest goal in doctors giving patients the best possible care. With all the competing parties, that often seems impossible, but perhaps we as (aspiring) doctors can take the attitude exemplified right here in India. The United States probably won't want to adopt the Indian health care system, but certainly we can be inspired by the way these Indian doctors treat their patients.