Four years ago, in my desire to do something for my domestic help's future, I bought him medical insurance. Alas, he didn't consider it a perk and asked me if he could get the cash instead. "Anything that is free is not valued," I rationalized. When the next help came along, I tried to convince him to buy health insurance, from many of the newly launched government schemes. One year on, I have still not succeeded! His argument has a point. No one in his village trusts that in the hour of need, they will be able to use this insurance. Previous experience of abuse of government subsidies has led to this gross mistrust.
In another incident, my gardener preferred to sell off his only mode of transportation -- his second-hand two-wheeler -- to pay for the treatment of his brother at a private hospital, rather than use the free government hospital. With a government spending of US$30 billion on healthcare, is such a state of public healthcare acceptable? It is easier to blame it on lower spend as a percentage of GDP compared to global average, than worry about losses. Though difficult to estimate, leakages in the public healthcare system is a recognized phenomenon globally; more so in the developing world. According to Transparency International, "...in some countries, up to 80 percent of non-salary health funds never reach local facilities." This implies that even if doctors are willing and able, patients are likely to suffer due to a lack of medicines or infrastructure.
In the private healthcare sector, there are plenty of stories of unneeded surgeries, medical negligence or keeping a patient on a ventilator unnecessarily. These incidents make news, with hospitals being called "profit-hungry corporates" -- where corporatisation symbolizes "evil". Is this a fair description?
Can we expect the medical profession to maintain the highest ethics when violation of ethics in daily life is becoming a norm?
Corporates try to maximize profits, but within acceptable business practices. Those who don't are called unethical. No corporate can hope for a sustainable future by destroying the trust of their customers, which is earned with great effort. Now compare this with healthcare. First of all, most customers don't see healthcare as a business, but as a noble activity where welfare comes way ahead of profits. Secondly, there are no customers; there are patients who often don't even know what they want, don't necessarily understand what is good for them and many don't care about the intensity of treatment, as the costs are covered by insurance or the employer. Lastly, the "trust" of the patients is a given; next only to what a child would place in a parent. A higher moral responsibility for private healthcare providers is implicit.
We should be asking a different question: "Can we expect the medical profession to maintain the highest ethics when violation of ethics in daily life is becoming a norm?"
We have learnt to live with cratered roads, overflowing sewers, overloaded polluting commercial vehicles, construction in designated green areas, and so on. Being cheated by the auto driver or offering bribes to avail even of basic rights are a part of life. In such a scenario, a rub-off effect on the "noblest" of professions should not surprise us. Now, we are all used to appalling standards at government hospitals, but the fact that we get pained when private doctors or hospitals betray us shows a silver lining in an otherwise sordid tale. Perhaps the medical profession is still in its early stages in this downhill journey, so it still shocks us when our trust is violated. The Hippocratic Oath still means something and we don't think that a disregard of it is a "way of life". I shudder to think of the day when the medical field stoops to the lows set by some others.
Instead of lamenting the corporatization of healthcare, we should be worried about moral corruption spreading its wings.
Instead of lamenting the corporatization of healthcare, we should be worried about moral corruption spreading its wings. If done well, corporatization should help in raising accountability, giving power to the consumers, reducing leakages and bringing pricing transparency. In its current form, this cannot become a reality even for the people who have the ability to pay. For the poor, even the most well-intended government schemes for increasing access and affordability will face the challenge of adoption due to lack of trust. The growing discomfort with the healthcare system will eventually challenge the very existence of the current model.
When there is sustained public outcry, tighter regulations come into force to counterbalance the violation of ethics, as we are seeing in the real-estate sector. This is not the best approach in all situations. Certain delicate relationships -- teacher-student, parent-child, doctor-patient -- should be driven by self-discipline and morals rather than external pressure. It is impossible to define a universe of dos and don'ts for something as complex as healthcare. Doctors need freedom, and not fear to exercise their best judgment. If the healthcare system doesn't self-regulate in time, the day is not far when doctors will need to advise patients in legally correct language (as one might notice in the United States) and be more worried about the lawsuits than treatment. It will add to the cost of the healthcare system and potentially choke it. No one wins.
Certain delicate relationships -- teacher-student, parent-child, doctor-patient -- should be driven by self-discipline and morals rather than external pressure.
Yet, it's not enough for the medical profession to be its own conscience-keeper. We also need to revitalize the moral fabric in our regular life. The risk of "contamination" will always loom large until this happens. It is difficult to say if the pain caused by knowingly constructing an unsafe bridge or a building is any less than that caused by wrongdoing by medical professionals.
If it pains when a loved one is hurt while seeking medical help, if the healthcare system wants to expand its reach while being able to self-regulate, then we need to together become intolerant to the corruption of a nation's health and wealth.
Written by the author of The Ninjja Sutra- Surviving the healthcare web. Views expressed are the author's own.
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