Shahid Akhter, editor, ETHealthworld spoke to Dr. Naresh Shetty, President, Ramaiah Memorial Hospital, Bengaluru to know more about the role that technology can play in improving healthcare management by way of access and affordability.
Impact of changing regulations on private hospitals
Over the past decade, a lot of things have happened in the healthcare sector and this is because the government is increasingly looking at making healthcare affordable to a lot of people and have also committed to ensuring that healthcare reaches underserved people. When this becomes a policy, there are lot of things that are going to change, and it will also impact the private sector. In India, 75% of healthcare is taken care of by the private sector, only 25% is taken care of by the government sector, and hence there is a huge burden on the private sector which is to ensure that the task given is done well. However, the charges against the private sector were that expenses were high and a lot of these patients could not afford this kind of quality healthcare and so the government is trying to bring about some amount of regulation into the costing associated with the private sector and has said that they must charge only so much and not more than that. It could go two ways- It will probably help a lot of people but alternately, it may not bring new technology, new innovations into the healthcare sector. So, I think we need to tread this path very softly, very carefully to ensure that the patients continue to get the best; as well as our healthcare remains as one of the best in the world.
One of the areas which the government is actively looking at is quality healthcare and for that they are trying to enforce NABH accreditation to most of the hospitals, either NABH or NABL depending whether it is hospital or a lab. This, in other words, is to ensure that not only do people get the best of healthcare but also to reduce medical errors which happen in most hospitals. Medical errors are not negligence, they are by themselves some of the aspects which need to probably be taken care of and has not been given as much importance, like the infection control in an ICU setting, like monitoring of a critical patient which really needs to be done on a regular basis, like whether the nursing supervision is adequate enough, or in an emergency situation whether things are done as per the standard norms. Whether we are doing it: yes or no. These are the areas that I think we need to look at and once an accreditation comes into the picture, all these things are taken care of. The most important thing in an accreditation is to ensure good outcomes for the patient and quality healthcare to the patient and these two will enable the hospital also to do well.
Role of technology in increasing access and affordability
Technology has always been there, and every day newer technology is being added. Technology could be right from smartphone technology to otherwise. There are areas, especially the rural areas or the hinterland of India which have not been taken or are underserved, where this technology will help in identifying the patients who need to be treated there and the patients who probably need to be going to a tertiary hospital or a secondary group of hospitals. A standard blood test, a standard requirement that is normally done could be done by a person there. A nurse or a paramedic could actually look at the reports or the report could be looked at here, and we can probably filter most of the patients, who require basic care which can be done there itself. The rest of the patients who require adequate care need to then be shifted to a district hospital or a tertiary hospital and there, technology can help to a large extent. This is one of the most important tools which the government must use to ensure that rural healthcare is taken care of. This may not be required in major cities as the technologies there are quite different, where the parametric of an individual person can be controlled by a smartphone and it tells them some details: what their sugar level is, what their blood pressure level is. And otherwise, these parameters are well checked and sent to the doctor who can probably say whether they are adequately dealt with: yes or no.
Impact of technology on patient care
With more and more costly technology, patient healthcare is going to take a beating because all technology comes with a price. We need to sit in India and look at how we can do it better. So, we must use tried and tested technology as much as possible, try to Indianize as much as possible and that’s one of the area which I keep on saying, it is time that Indian doctors and Indian engineers join together to create an innovative group which can bring frugal innovation into the country. We do not have to pay for the innovations that are there in the western world at that price. We need to look at whether we can do it at our price, so the third world countries can also take advantage of it.
Ramaiah Memorial Hospital as differentiator
If you look at our hospital, we are almost a 1600 bedded hospital and we also have 3 primary centers all round this particular hospital. We work on a hub and spoke model, where we look at primary care being given at 3 rural hospitals and whichever patient requires adequate care such as cardiology, neurology, strokes, they are brought here. Between the two hospitals, one takes care of the medical college hospital, where the students are also learning, and one is the corporate hospital. 80% of the patients in the teaching hospital are on subsidized healthcare, while in the corporate, they are all insurance patients, public sector patients or the patients who are paying from their pocket. We are classically using the Robin Hood theory of ensuring that the cost here is higher and the cost that we make, that excess surplus, is passed on as a subsidy to those poor patients. In fact, I think that’s one of the ways that we can look at to ensure that healthcare is equal. The same group of surgeons, same group of cardiologists work at both places, but the cost is different. One has to pay hardly anything, one has to really pay for the real cost of what he is undergoing.
So, I guess, we have made this kind of a transition where we are looking at the people who need to be treated well but cannot afford it and the patients who can afford it but are living differently.
My hospital today has got some USPs, we conduct the highest number of heart transplants from this part of the country. Now, we also have a bone transplant unit where we get patients from outside the country. We are looking at a few key USP’s – to ensure that people walk in here not for just general medicine surgery. We are working at a higher end where patients come only for that selected group of activities which are endocrinology, acute strokes, cardiac myopathies, pediatric cardiology. So, those are the issues that we are looking at and of course, patients like total joint replacements, spine injuries and cosmetic surgeries.