Mains Paper 2: Health
Prelims level: Health Maintenance Organisations
Mains level: Role of Health Maintenance Organisations in India
The evolution of more and more organised structures like Health
Maintenance Organisations (HMOs) in the forthcoming years, which were
criticised for turning healthcare into a marketable commodity sold by
unfeeling healthcare providers in supermarket-like institutions, destitute
of traits like empathy, regard and loyalty.
That such concerns didn’t pick up systemic momentum in the U.S. is
axiomatic, as much as the fact that U.S. healthcare ended up as one of the
most impersonal healthcare systems.
The NITI Aayog’s proposed 15-year plan for Indian healthcare entitled
“Health Systems for a New India: Building Blocks — Potential Pathways to
Reform” outlines prospects of such an infelicitous turn in Indian
While the report makes otherwise commendable proposals for health system
strengthening — including elimination of informality, merging of fragmented
risk pools, and reduction of out-of-pocket health spending — the proposal to
consolidate small practices into larger business-like organisations appears
problematic on multiple fronts.
That nearly 98% of healthcare providers have less than 10 employees is
identified as a negative trait, to be dealt with through a set of incentives
and disincentives favouring consolidation.
Apart from cost and competition-related concerns, an enthusiastic
pursuit of it could portend an exacerbated commodification of healthcare
from the bottom-up.
The report’s bent towards the U.S. HMO model further adds to such a
Role of Loyalty and longitudinality:
Loyalty and longitudinality form vital pillars of the patient-physician
The edifice of these is built upon a substratum of mutual trust, warmth,
and understanding that accrues over time between a patient and their
Momentary and haphazardly physician-patient interactions in a system
that limits access to one’s ‘physician of choice’ are incapable of fostering
such enduring relationships.
It is in this context that the role of a family physician becomes
Apart from providing comprehensive care and coordinating referrals, a
family physician’s longitudinal relationship with their patient helps in a
better understanding of the patient’s needs and expectations and in avoiding
unnecessary clinical hassles and encounters — which in turn reflects in
better outcomes and increased patient satisfaction.
Widespread commercialisation of care over the past few decades has
entailed that the family physician is a dying breed in India today.
And it would be of little surprise to learn that this has a sizeable
role in impairing the doctor-patient relationship, manifesting popularly
through violence against healthcare providers.
In a setting of overcrowded public hospitals, and profiteering
healthcare enterprises, where the patient-physician interaction is largely
fleeting and transactional, mistrust in the healthcare provider and its
gruesome implications are not difficult to anticipate.
Advantage of small clinics:
Studies have demonstrated that healthcare received in small clinics
indeed scores higher in terms of patient satisfaction than that received in
This increased satisfaction manifests as better compliance with the
treatment regimen and regular follow-ups, culminating in improved clinical
Kelley JM et al, in a systematic review and meta-analysis of randomised
controlled trials, have established that patient-clinician relationship has
a statistically significant effect on healthcare outcomes.
Disregard for this aspect in health services design is bound to entail a
sizeable cost to the health system.
However, the subtle, fuzzy, and perceived non-urgent nature of this
problem keeps it from assuming significance to policy- makers — as a result
of which doctor-patient relationship considerations are largely
invisibilised in the policy discourse in favour of more pressing concerns
like lack of funds and manpower.
Time and again, however, this omission has surfaced in the performance
of health systems worldwide.
As India looks forward to a long-term healthcare plan, neglecting this
consideration could be of sizeable consequence.
The need for empathy:
A popular myth often floated is that considerations regarding emotive
aspects of healthcare such as empathy and trust are disparate from, and thus
cannot be realistically factored into, hard-headed health policy and system
But, in reality, these are entirely amenable to cultivation through
careful, evidence-based manipulation of the health system design and its
It would necessitate, among other measures, installing an inbuilt family
physician ‘gatekeeper’ in the health services system who acts as the first
port of call for every registered patient.
The NITI Aayog’s long-term plan provides a good opportunity to envisage
such long-called-for reforms, but that would require not the U.S. model but
the U.K. model to be kept at the forefront for emulation.
We have already taken a minor, yet encouraging, step of sorts by
introducing Attitude, Ethics, and Communication (AETCOM) in the revised
undergraduate medical curriculum.
One hopes that the pronouncement of this long-term healthcare plan
doesn’t indicate adoption of U.S.-like healthcare policies.
The plan needs to be revisited to ensure that healthcare clinics
delivering patient care don’t transform into veritable supermarket stores
marketing medical services any further.
Q.1) Which of the following is/are the salient features of ‘Reforms in
Exploration and Licensing Policy, for enhancing domestic exploration and
production of oil and gas’? 1. Shifting of focus from ‘revenue’ to ‘production maximisation’.
2. No Revenue Sharing with Government in Category- II & III sedimentary basins.
3. Boost to exploration activities by assigning greater weightage to exploration
Which of the statements given above are correct? (a) 1 only
(b) 2 only
(c) Both 1 and 2
(d) All the above
Q.1) Describe the major challenges of the health system for new India.