Thread by @docbhooshan

Chakravyuh called Indian Healthcare.

Why nobody will be happy and everyone will die miserably in the end.
#thread
1/n

When you develop a complex system for large number of users, it is best to keep it uncomplicated and have NO conflicts in the basic principles that govern the system.
2/n

When conflict is present in basic principles, all components of the system try to get best for themselves AT THE COST OF OTHERS. So everyone ends up unhappy.
Speaking of healthcare, unless building blocks are well fitted and aligned, system will collapse.
3/n

What are the building blocks?
1. Patients
2. Health care workers
3. Regulatory systems

Hang on, I am putting cart ahead of the horse here.

Horse - What is health care?
It is a fundamental right. At least this is what we believe.
4/n

What is provision of health care?
? social service/charity
? Profession
? Business
? Industry

Unless we answer these basic questions and develop a system based on those fundamental answers, we are bound to end up in a mess.
5/n

Let's look at what system we have in India.

We have accepted healthcare as a basic right of people.

If anything is fundamental right, it is government's responsibility to make sure that it is delivered and guarded.

6/n

Govt can either produce all the necessary materials itself or procure it from private producers at market prices and deliver it to citizen. E.g. food grains are produced privately but purchased by govt and made available to needy for free.

7/n

Here govt decides the poverty line and who can get it for free. So inspire of it being a fundamental right, govt doesn't provide it to all.

For healthcare no such line is decided. Anybody can walk into a government clinic or hospital and demand healthcare.
8/n

So you have rich politicians and government officers being served at govt hospitals while the poor wait in line for days.
9/n

What is nature of healthcare?

If it is social service/charity, there should be no education, qualification or regulation for it.
Anyone can distribute food/water/clothes to people as "social service/charity" no regulation / quality control / monitoring exists.
10/n

All is free. Nothing monitored or mandatory.

Do you think that is how you would like to receive your healthcare? Unregulated and unpredictable charity from your fellow citizens?

11/n

If it is a profession, then it requires specified education, qualifying exams, formal registration with a professionally managed regulatory body.

Our lawyers, architects, CAs are professionals and their profession is ENTIRELY managed by them.
12/n

Govt can't even tell lawyers what to wear in courts, Bar Council decides these things. Govt has almost 0 role in managing these professionals.

Even supreme court judges are afraid of Bar Council.

Do you want your doctors to be self-regulated like lawyers?

13/n

Business - activ for profit motive. Govt can not decide the selling cost of anything. It is regulated by market forces. Govt's job is to make sure that there is level playing field, customer is adequately protected, national security interests are protected. Not more/less.
14/n

Industry- similar to business but run with longer term goals and at much larger scale.

How does Indian healthcare look like when compared to these existing models?
15/n

1. Production of trained manpower - run as industry that has govt manufacturing as well as private manufacturing

2. Providing services - a mix of govt services, business, industry, charity and private professionals too!

16/n

3. Regulation - professionals regulated by govt regulatory bodies, businesses regulated by city and state level rules, Industry - no effective regulations.
So we have large corporate hospital chains, drug and equipment manufacturing all of very dodgy and uneven quality.
17/n

4. Grievance redressal system - owned and operated by government in usual government way of doing things. Same like our judiciary. If you have money, you can buy justice. If you don't have money you sort it out yourself.

18/n

With this level of confusion created in healthcare how will anyone feel that it is a fair system?
Every component - healthcare professionals, manufacturers and most importantly patients feel shortchanged.
19/n

Patients suffer the most.

Professional healthcare workers are hurting as well.

Happy people are - manufacturers (colleges and industries), rich individuals and powerful government officers (who get best service due to their ability to hurt service providers)
20/n

And you know what is the saddest part?

There is no enemy action behind this chaos.

Our own people - politicians and highest ranking govt officers have created this elaborate and useless system since Independence.

21/n

Not out of malice! No, you can't credit them with so much intelligence and sense of purpose.

They created it with their neglect, lack of any interest in India and perpetual liking for "jugaad" Indian way of coming up with superficial solutions to deep problems.
22/n

Small components of such chaotic systems become selfish and focus on one's own immediate interest. They have no bandwidth to focus on long term good of system. They just focus on surviving at least possible cost.
23/n

That's why doctors and patients are at loggerheads with each other. Hurting and losing faith in each other.

Because of a series of serious mistakes forced on us by those who rule over us.

24/n

Here we are. Like Abhimanyu trapped in a chakravyuh of his own kinsmen.
He will die now.
And everyone else will die soon too.
No happy ending for soldiers in this Mahabharat created by the blind and powerful.
#JaiHind