Ensuring Good Health: Reducing Medical Costs
High out of pocket expenses on health is impoverishing some 55 million Indians annually, with over 17 per cent households incurring catastrophic levels of health expenditures every year, according to a World Health Organization (WHO) report from March 2022.
What can be done to decrease this load? Many Indians are worried as the Covid epidemic cost them dear. However during that very epidemic the owner of a small nursing home pointed out that admission in his set up would cost much less than the big structures that have come up.
The Government has set the ball rolling with the generic drugs initiative. The public unfortunately ignores this thinking that the products are of low quality. They are not because a chemical remains the same whether generic or under a brand name.
The Right to Health Act of Rajasthan envisages increased role of the public sector infrastructure in health. It will seek to improve the quantity and quality of clinics in the Government sector.
It was in Rajasthan that an exercise in prescription audit was carried out in government hospitals that revealed more drugs were being prescribed than needed. There is also the issue of irrational drug combinations. These add to the costs without much benefit and are associated with adverse effects. We should also have outcome audits to eliminate harmful drugs and procedures.
Currently many governments are trying to provide health care at a lower cost. The hospitals under the AIIMS banner are providing good care at a very low cost. However the long lines to claim the benefits deter patients. This can be done away with by a system of bank transfer.
Even with all of this there is a problem; the huge rush in the government hospitals. The sight of patients queuing up from the previous night is common.
To really reduce costs the flow of patients must be reduced instead of trying to serve the sick population.
Thus there is need to think about keeping people healthy. More thought must be given to this neglected aspect. There is no dearth of knowledge as to what ensures health and what does not.
There is also the need to take care of patients at home through neighbourhood doctors. This tribe is disappearing. A group of doctors are reviving the family medicine practice. It needs encouragement. The family practitioner must ensure good health instead of attending to sick people.
The major part of family health expenses is expenses on medicine. Thus there is need to think about drugless approaches. Naturopathic practices and herbal/ kitchen remedies must be integrated.
Before the era of specialized doctors, the MBBS practitioners were known for their reluctance in prescribing medicines. They rarely prescribed. They realized the value of acute diseases, nutritious food, getting rid of addictions and lifestyle changes. They knew how the body worked to keep itself healthy. They preferred to facilitate this process rather than medicating and increasing the chronic disease burden. They had the same medical education but they had not lost their common sense nor the sense of responsibility towards their patients. When the world was flooded by chronic disease, the MBBS doctors had pointed out that suppressing acute diseases would invariably lead to chronic disease.
The very high cost of medical education drives medical cost as the pass outs will seek returns. The private medical colleges are a great challenge. Medical education must be state sponsored and heavily subsidized. The curriculum must be thoroughly examined from the perspective of health and wellness. It should reflect the ongoing research and be freed from the influence of the industry and its lobbyists.
Medical costs climbed after the entry of medical representatives employed by the drug industry. They directly approached the doctor and enticed him with targets and commissions. This has led to unnecessary medication and increase in incidence of disease. When this system was introduced, the senior doctors of the day had protested. They knew that medicine would soon become a business. The medical professionals are also targeted by the consumer goods industry that encourages credit purchases. The EMI load on the professionals also pushes them towards irrational practices.
Medicine has become a career option. This approach makes it an earning opportunity. Young people are attracted by the income and not by their capacity to heal. Medical education adds to the problem by normalizing disease and encouraging disease management.
Medicine is today about marketing. There is a huge 3 to 4 trillion dollar industry manufacturing drugs, devices, products, and services, and the rest are busy profiting from marketing them. There is no scope to focus on health and cures. There are instances where industry giants have protested when innovators have tried to stress on cures. They have been ticked off by saying that cures are not a good business strategy!
Governments worldwide have failed to control the private sector. People must think a thousand times before stepping into the 5 star hospitals. As doctors working in them have revealed in a book called Dissenting Diagnosis by Drs Arun Gadre and Abhay Shukla, all corrupt practices imaginable are employed in these loot centers. All discerning people should get a copy of the book. https://www.amazon.in/Dissenting-Diagnosis-Arun-Gadre/dp/8184007019
There are many ills in society, many hindrances to health that can be tackled with willpower only if the value of good health is realized and becomes the objective. The disease and medication approach allows the hindrances to remain unchecked. The current system of medicine feels that prescribing medicine is the one and only route. It has lost touch with reality.
It is good that many states are now waking up to the value of holistic systems. There should be more budgetary provision and better monitoring of the facilities available. As I keep on stressing there should be investment in the herbal resource that is key to the holistic approach.
The dominant system must get over its animosity towards the healing methodologies. Currently just talking about health and wellness raises heckles. Why should it be so?
Thus the remedy in a nutshell is;
- Reducing the quantum of sick people by focusing on health
- Teaching people to be healthy by disseminating knowledge on the basics of good health
- Ensuring health of populations through drugless measures
- Kitchen and herbal gardens for all possible households
- Integrating holistic systems into the healthcare system
- Improving the government infrastructure to have low cost services as well as medical education
- Having an aptitude test for aspiring medical students to assess their capacity and intent to heal
- Introducing mandatory courses on medical ethics and patient rights
- Introducing the basic determinants of health as the main module
- Encouraging small nursing homes for short stay and small surgeries
- Introducing the system of family medicine. The culture of MBBS doctors should return
- Introducing audit of prescriptions and processes to eliminate unnecessary medical tests/ interventions
- Check the activities of medical representatives.
- Providing more stress on generic medicines and eliminating irrational drugs
The above process requires conscientious doctors and an awakened civil society. Mercifully the number of such doctors is increasing and the public is slowly realizing what goes on. We must also hope against hope that there should be a watchful eye on the private sector.
It does not cost the earth to keep people healthy. It does not cost much to cure people either. We only need to step out of the drug & devices trap and start thinking about the basics of health and how they are being violated. The body must be detoxified, nourished with appropriate nourishing food, acidity must be countered, and the oxygenation and alkaline needs must be ensured. As vitality and energy level improves, and with a little exercise, the body will start healing. Obstacles can be addressed by experienced naturopaths, ayurveds, and homeopaths. Hospitals do not ensure health.
What can the individual do?
- Concentrate on the basics of health; real food, sufficient water intake, maintaining timely routines, good sleep, exercise, pranayama, being happy and contended
- Avoid what will hamper health
- Don't be worried by acute diseases; often rest, fasting and water intake is all that is needed. They are called self limiting and resolve on their own. They are in fact the detoxification attempts of the body. By suppressing these attempts we encourage serious chronic disease which then leads to astronomical medical bills
- Know that the body is designed to heal itself and that disease is primarily caused by waste accumulation and toxicity. Repeatedly suppressing the healing attempts of the body also leads to loss of vitality and things become difficult
- Avoid injections containing heavy metals, and human and animal serum into your body. These practices have resulted in venereal diseases spreading to the general population increasing the intensity of their suffering and making cures exceedingly difficult. Homeopathy becomes the only viable approach in such cases
- If you follow health norms and avoid toxicity in all forms the acute diseases will become few and emergencies rare
- Learn about holistic methods; naturopathy, herbs and homeopathy
- Learn enough to treat yourself and family members
- Visit Govt ayurvedic and homeopathic clinics/ hospitals
- Visit yoga/ pranayama/ meditation centres, indulge in morning and evening walks
- Make a naturopath your friend and guide
- Do an ayurvedic/ naturopathic detox once a year. Take aloe vera, wheat grass, noni juices regularly for nutrition and detoxification
- Teach your family members about health
- Stay out of the toxic approach that is dominant today. It destroys health
- Health is the individuals own responsibility. It should not be delegated to others
- Money is best spent on ensuring good health and not for managing disease
To quote from another article of mine;
"We are currently disease focused leading to the stress that affects both patients and physicians. Such a focus also leads to disease complications leading to deterioration in health leading to emergency situations; the cause of stress.
"If we are health focused we can avoid the stress. Hospitals ought to be lifestyle and nutrition correction centers. Diseases can be detected early by noticing changes in circadian rhythm, rise in stress, feeling of unease, and fall in hunger levels. That ought to be the intervention point so that diseases do not progress further.
"If people can visit wellness centers once a year for detoxification, meditation, exercise, and education on nutrition and lifestyle, this will be a great preventive measure. This should be accompanied by sanitation, hygiene, provision for safe food and water, health focused housing, and safe livelihood options.
"The environment is very important. Industrial, vehicular, and electricity/ wireless pollution is behind many of our ills as well as lack of diversity in food, plummeting nutritional values, and extensive poisoning of the food chain. These issues should be actively flagged by the doctors."
The perception that health cannot be ensured by medicalizing the process has been there since Ivan Illich pointed it out with his informative writings. It is time to put into practice the ideas which can truly benefit the common mass. They need help.
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