Transforming healthcare: Why America should learn from AAP's Mohalla clinics in Delhi

Revolutionary healthcare-related ideas are going to come from the developing countries, and not the developed ones. Resources – manpower, infrastructure and financial – are all restricted in developing countries. Countries like India, Brazil, Latin American countries, China, etc are going to be at the forefront of innovative healthcare strategies, because reach and affordability is going to be paramount in these countries.

Despite Arvind Kejriwal’s, and by extension his party AAP’s, political histrionics in New Delhi, they have been on point as far as education and healthcare is concerned. Credit must be given where due, and they certainly deserve every bit of praise that they have received for their healthcare reforms in the capital.

The introduction of free health clinics in New Delhi, known as 'Mohalla' (community) clinics – equipped with smart-tablets that collate data from several medical devices like ECG, pulse oximeter, glucometer, BP monitor, etc – have cut down on manpower costs and have increased efficiency.

The Swastha slate is a revolutionary new healthcare tool.

The Swastha slate, is a $600 device (roughly Rs 40000), the size of a cake tin, that performs 33 common medical tests. Source: Swasthyaslate website.

Moreover, the consultations are now paperless and completely digital, making the entire exercise environment friendly as well. All this, at nearly 1/20th the cost of a fully fledged clinic. The medical details of every patient is available (on cloud) at the touch of a button.

The success story of these community clinics was recently featured in the Washington Post, and is what prompted the question at hand: What New Delhi’s free clinics can teach America about fixing its broken health care system.

The technology that made the instant diagnosis possible at Peeragarhi, a West Delhi district, was a medical device called the Swasthya Slate. This $600 device (roughly Rs 40000), the size of a cake tin, performs 33 common medical tests – including blood pressure, blood sugar, heart rate, blood haemoglobin, urine protein and glucose.

It also tests for diseases such as malaria, dengue, hepatitis, HIV, and typhoid. Each test only takes a minute or two, and the device uploads its data to a cloud-based medical-record management system that can be accessed by the patient.

A proposal to open thousand of such clinics in New Delhi has been made. This simple yet effective technology can teach the developed world a thing or two. Solutions are often simple, if our hearts are in the right place.

This success story also highlights the developed countries (especially the US) disincentivising the reduction in healthcare expenditure, as exemplified by the experience of the man who developed this tech, Kanav Kahol.

Kanav Kahol was a biomedical engineer and a researcher at the Arizona State University’s department of biomedical informatics, until he became frustrated at the lack of interest shown by the medical establishment in reducing the cost of diagnostic testing. He worried that billions of people were getting no medical care or substandard care because of the medical industry’s motivation to keep the prices high. In 2011, he returned home to New Delhi to develop a solution.

It is plainly visible that the American free market enterprise in healthcare is out of control. There are just too many middlemen (read salespersons/companies, and insurance companies) who make huge profits while patients end up paying five to ten times the real cost of surgery/treatment.

The big difference in corruption in healthcare between India and the US is that while in India kickbacks are unregulated and unequal, in the US it is institutionalized and legal (in different forms). For example in India it is often seen that a salesperson of a machine/instrument/drug/implant is often several times richer than the doctor he is selling it to.

Very rich doctors making a killing off the kickbacks do exist in India, but they are such a minority that it just exemplifies the inequality. The biggest kickbacks I have got till date are pens, writing pads and laptop-bags with company logos. In the US, the bounty is shared in a more egalitarian manner in the form of consulting fees, speaking fees, travel scholarships and royalties. In other words institutionalized.

The US is far from a model healthcare system; as this recent article by The Guardian, that tries to determine which country has the world's best healthcare system, states: The US scores poorly on many fronts, ranked 11th out of 11 in the Commonwealth Fund 2014 list. And yet it far outstrips all its peers in terms of the amount it spends on healthcare – a whopping 17 percent of the GDP.

Almost all visits to the doctor (often a specialist, rather than general practitioner) will generate “co-pays” for the patient and revenue streams for the physician that some fear encourages excessive testing and intervention: a consumer, rather than care-led, culture.

Preventive medicine and public health are harder to incentivise. Patchy access to insurance can leave emergency rooms clogged with chronic conditions. Obesity and mental illness often go entirely untreated.

Though the system fosters excellence and innovation in places, the messy combination of under-insurance and over-insurance has left the US with the highest healthcare costs in the developed world and some of the worst overall health outcomes. But of course, the pitfalls of the US in healthcare does not necessarily mean Indian healthcare is particularly awesome.

India neither has a capitalist driven private healthcare model like US nor a socialized universal healthcare program like UK, France, Scandinavian countries, etc. Our government hospitals are terribly staffed, have poor infrastructure and are maintained worse than public toilets. Only the middle class and the elite can get some form of treatment, if they can afford it, in private hospitals (80 percent of healthcare expenditure in India is private).

The very poor are left to the mercy of government hospitals’ machinery. They can get lucky sometimes but again it is a matter of luck. The government spends a little more than 1 percent of the GDP on healthcare, which is among the lowest in the world.

While New Delhi’s healthcare model brings in some cheer, it is just a small change in a huge nation. There is still a very long way to go. Before we can start comparing our healthcare to developed countries, we have to fix the rot in our own system – where we spend more on politicians, corruption, defence and freebies than on healthcare.

Our healthcare system would truly be great the day the best medical professionals/infrastructure/facilities are available to everyone, and not just those who can pay for it!

This article originally appeared on Quora and was written by Dr.Raghuraj Hegde, an Ophthalmic Plastic Surgeon based in Bangalore, India.


Published Date: Jul 21, 2016 07:13 pm | Updated Date: Jul 21, 2016 07:13 pm

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