Though, one barely cares about some random index, but World Happiness Report has been pretty relevant in last decade. India with a huge GDP and progressive industrial development could have sailed ahead, but sadly it scores low on social support and healthcare systems. With strong healthcare and social support, the welfare states of Scandinavia have been toggling around in top four slots, Norway being a close second this year after Finland made it to the top. Even the countries like USA have dropped down in ranks, but India has plummeted down to 133 rank, way behind Pakistan grabbing the 75th spot. Does it worry us? Shouldn’t we just cast away this entire ranking debacle? We aren’t a welfare state, and rather its not feasible to provide healthcare and education free to this huge population. Privatization of healthcare as well as education has leaped to its decade maximum. At least the middle-class, which constitutes roughly 3/4th of the population has already shifted to private institutions. And the lower class may well be supported by ‘Modicare’, an Indian replica of ‘Obamacare’. Things look pretty positive ahead.
But, still, It might be worthy to compare the healthcare in two starkly contrasting worlds- Scandinavia and India. Let’s begin with a simple scenario, when one gets ill. In India, you just take an appointment and walk done to the nearest available or some ‘trusted’ doctor, and get a treatment. You are free to chose your care. In Norway, everybody has an assigned family doctor, who is your primary physician irrespective of illness. One can’t just walk down to an Orthopaedic doctor for a back-pain, bypassing the primary care. In this scenario, India seems to be in advantage where one can directly land in a superspeciality cabin. But, from resource management perspective, the healthcare pyramid is redundant in India. Its a standard pyramid of primary, secondary and tertiary care, which ensures efficient healthcare.
Long queues of patients in the apex institution AIIMS is quite easily explained by this pyramid-bypass theory. Not everybody with minor ailments or even secondary level ailments, need to report to AIIMS. One can’t move to Supreme Court directly, for every civil case. This ‘pyramid- bypass’ is indeed a major caveat, which needs to be streamlined for efficient specialist services. Obligatory assignment of family physician and planned referral system would need a major healthcare reform, albeit feasible.
Another obvious difference in two worlds is public healthcare versus privatized healthcare. Scandinavia has the top quality inpatient healthcare free for everybody. India too has a three-tier public infrastructure, with specialized healthcare but it suffers from financial crunch (low GDP contribution), disease overload and organizational mismanagement. Private healthcare is even more chaotic, and not linked efficiently to public healthcare. There are plenty of private specialized facilities in Norway, who have strong ties with public hospitals, essentially under one roof of state regulations. This regulatory bonding between private and public services is need of the hour in India. This has already been implemented as PPP (Private public partnership) model in most states, but needs to be more collaborative, inclusive, economical and regulated.
One more aspect is growing lack of trust among patients in India, seeking for many second, third and plenty of opinions. In protocol-based healthcare like Europe, treatment guidelines are internationally standardized, and they don’t vary much between specialists. One may of course seek a ‘second opinion’ but the licensing system of doctors is so stringent that the quality of healthcare remains almost at same level. Medical Council of India needs to assure a similar uniformity of quality among doctors having equal qualification and experience. A system, where patient can trust a licensed specialist to be qualified good enough for treatment, that they don’t keep on changing it.
There are other relevant issues too. But, in a nutshell, India has an efficient pool of healthcare workers, and an existing infrastructure. All it needs is a reform to streamline, link and regulate the healthcare pyramid. Raising healthcare standards alone can certainly make the country happiest in the Asian continent in next decade.
(Author Dr. Praveen Jha is a Norway based radiologist doctor, a columnist and an author.)