“Healthcare to me is delivery of quality service at various levels, depending on the clinical needs. But, even in 2019, I feel we don’t have a blueprint for effective delivery of health services to all in the country. However, I would like to add that we have achieved a lot and for the rest, the work is in progress. We have reached an international benchmark, but lot more has to be done to make healthcare accessible to all,” says Dr. Rupali Basu, Director & CEO, Woodlands Multispecialty Hospital Ltd
According to the World Health Organisation (WHO), health is a state of complete physical, mental and social wellbeing, and not just the absence of disease or infirmity. Proper access to various types of health services is one of the determinants of good health. At present, India’s healthcare system is composed of public and private sector providers of health services, and Dr. Rupali Basu has seen, experienced and contributed from both sides of the fence. During her eventful professional journey, she had been associated with R G Kar Medical College and Hospital, is a proud alumnus of Harvard University and had been the CEO and President of Apollo Gleneagles Hospital – Eastern Region for long 9 years.
Domestic health sector :
Given the huge population of India’s and its spread over a vast geographical expanse, it is only logical to have presence of both public and private players in the domain: while 70% of the populace is catered to by the public sector, nearly 30% depend on the private sector for their wellbeing. India’s healthcare plan has been envisaged in a way that for every 5,000 population, there would be a health sub-centre and for every 30,000 population, there would be a block-level health centre, followed by district and sub-division level healthcare outlets, then apex institutions and finally, medical colleges. And, in this very scheme of things operates the private sector.
“But, even in 2019, when technology is growing at rocket’s speed, the reach of health services is yet not all encompassing. It’s mostly due to a lack of proper blueprint of health services delivery in the country… We have a long way to go,” she bemoans.
On the track :
However, being a positive healthcare provider says Basu, she cannot always complain about what has not been done. There are a lot of gaps to be filled, but the country has come a long way on path to providing healthcare to all. At the quaternary and tertiary care levels, both public and private hospitals have done a lot to achieve international benchmark in certain segments of the domain. From cardiovascular graph to liver transplant, the Indian health professionals have moved remarkably well to reach the highest level, where affordable costs are an icing on the cake.
“It’s not that we haven’t done anything. We have done a lot. But, have we done it for all? The answer is no. But with the level of work being done, I believe in 2 to 3 years down the line, the accessibility of healthcare will be for all.”
In the same breath, she goes on to recall the steps taken by both the central and state government towards ensuring an inclusive healthcare system. “Both governments at both levels have implemented smart schemes. Every state has its own state health service, with ‘Swasthyasathi’ being the initiative of West Bengal. At the national level, it’s ‘Ayushman Bharat’. Such public health initiatives always complement the private healthcare services,” underlines Dr Basu.
Cost-intensive sector :
In a private setup, it works well only if there is someone to invest. Running a health facility involves major costs towards provisions like infrastructure, trained staff, senior specialists, consumption items such as medicines, sophisticated equipment, housekeeping, administration and finally the cost of transport.
After offering all this, she says, what a private healthcare outlet is left with is a meagre profit margin of about 8-10%. “That way, healthcare is not a profit-making business, if we can use that term. It doesn’t make that much money,” says the doctor, adding that in the absence of necessary infrastructure, one cannot expect quality care, more so because it is clinical outcomes that matters at the end of the day.
Patient safety vs count :
“Never ever in my 25 years of career, I have talked about numbers. How can I tell a doctor to get that many patients? But that doesn’t mean I am not a smart businesswomen. I understand business. The disease growth is 30%…cardiac diseases are growing by 30% and cancer is growing by 33%, but our healthcare facilities are not growing at par. So, if you provide quality care, your assets will be full.”
Lifestyle diseases :
Dr Basu says the nature of diseases have drastically changed over the years. “Around 3 decades back, people would mostly die of infections, but now it’s cancer and heart ailments, which are non-communicable diseases. NCDs couldn’t have even been imagined 3 decades back. But now it is the rule rather than exception due to irregular and unhealthy lifestyle. All these are preventable, but we are slipping more and more into it. And why not? By consuming fast food and unhealthy beverages, we are only giving them open invitation. Even young people are now dying of cardiac arrest.”
In view of the shift in emergence and pattern of the diseases, the way healthcare providers look at them has also undergone a sea change. Now, apart from the medicines, they have an enhanced focus on the patient’s lifestyle and suggest them doing yoga, other exercises, and provide them tips on how to regularise their food habits as well as daily routine, more than ever before.
Mental health issues :
India is a young country, but youngsters are increasingly falling prey to serious mental ailments, like depression, anxiety, etc. According to Dr Basu, there are many factors behind this. Penetration of digital medium into the society and huge aspirations due to the internet age and worries about the uncertain future are some of the reasons. Inculcating a sense of contentment and imparting lessons in deriving pleasure from what we have among the younger generations is a necessity to undo the damage caused due to unrealistic aspirations.
“These days, the children in schools are constantly under pressure. Parental counselling is also not working. Their exposure to the dream (internet) word makes them dream of becoming a Priyanka Nick Jonas or a Hrithik Roshan. This constant growth of aspirations and their eventual failure to realise the same is also leading to such mental health issues.”
To address this issue, Dr Basu says, “We have many helplines, which do not reveal the identity of the person concerned. One can call and take their help. Apart from this, we have clinical psychologists and psychiatrists… Things are changing.”
Although human intervention is a must in healthcare sector simply because 100% digitisation is not possible here, yet technologies have a crucial role to play as the matrix is very large. “So, to make standardised care, digitisation is required. Technologies like laparoscopy and robotics have come. Today, there are even actual protons to kill cancer cells. IT and bio-technology help to a great extent in these diseases. Nonetheless, these can’t eliminate human intervention entirely. Both health human resource and technologies go hand in hand.”
Hurdles in healthcare
On a broader scale, the entire health ecosystem has deficiencies and the right approach is still amiss, says Dr Basu. “Health human resource is a huge challenge, but things are gradually falling in place. We are recruiting registered medical practitioners and also training the less skilled, as there is a deficiency of manpower. We can’t bring efficient people from outside India, so we need to train these people to bring them on par with others.”
She further says, “Another bigger challenge is the quality of service. Sadly though, quite a few in the trade have poor understanding of quality. The people at large also don’t understand the health ecosystem. If there is a death, we blame the doctor in charge, but there are a thousand other factors associated with it and sometimes it is the disease process. Thus, there is a gap of understanding at various levels.”
But, with the presence of good healthcare providers like Dr Rupali Basu, there are hopes for positive changes, and not too far away, in the healthcare ecosystem.
“Never ever in my 25 years of career I have talked about numbers. How can I tell a doctor to get that many patients? The disease growth is 30%…cardiac diseases are growing by 30% and cancer by 33%, but our healthcare facilities are not growing at par. So, if you provide quality care, your assets will be full”
“Even in 2019, when technology is growing at rocket’s speed, the reach of health services is yet not all encompassing. It’s mostly due to a lack of proper blueprint of health services delivery in the country… We have a long way to go. There are a lot of gaps to be filled, but the country has come a long way on path to providing healthcare to all. At the quaternary and tertiary care levels, both public and private hospitals have done a lot to achieve international benchmark in certain segments of the domain”
“Both governments (Centre and states) have implemented smart schemes. Every state has its own state health service, with ‘Swasthyasathi’ being the initiative of West Bengal. At the national level, it is ‘Ayushman Bharat’. Such public health initiatives always complement private healthcare services. Youngsters are increasingly falling prey to serious mental ailments, like depression and anxiety. Penetration of digital medium, huge aspirations rising due to the internet age and worries about the uncertain future are some of the reasons for the same. Inculcating a sense of contentment and imparting lessons in deriving pleasure from what we have among the younger generations is a necessity today.”