What Future Of Healthcare Economics Looks Like After Coronavirus
Do you wake up every day intending to do the act of preventive dentistry or do you simply just brush your teeth, because - hygiene after all? How bizarre to suddenly view it as anything apart from our mundane routine. Isn’t it? It has never managed to muscle into our consciousness that we begin our day with an act of preventive healthcare every day. And this very mindset is what we need to extend to our health overall.
We shouldn’t let it come to a situation of pharmaceutical aided restoration. It isn’t just beneficial to our overall well-being but is also easy on the pocket. Let us suppose an instance that corroborates this hypothesis.
PCOD/PCOS is a largely occurring lifestyle disease that has been affecting an alarming number of women in recent times. 1 out of 15 women worldwide and 1 out of 5 women in India are diagnosed with this chronic disease. Naina, a 25-year-old working professional, was recently diagnosed with PCOS. It is crucial to practice good nutrition, reduce stress, and exercise to prevent or control PCOD/PCOS. Now, let’s say we give Naina Rs 2500, which she can spend on whatever she pleases.
In Scenario A, she uses the Rs 2500 to order food from outside and opts to lead a sedentary lifestyle. Now, after being diagnosed with PCOS, Naina had to spend over Rs 2000 on doctor consultations, Rs 800 on medication every month, Rs 3600 on lab tests and nutritionist support, Rs 1000 on gym membership and another Rs 2500 on some other lifestyle swaps. The total costs come out to approximately Rs 10,000 every month.
Whereas in another scenario, had she invested Rs 1000 on a gym or online yoga class and the remaining Rs 1500 on healthier food options she wouldn’t just be healthier but would also be saving over Rs 7000.
This points to the need for the pendulum to swing back to preventive healthcare. Invest a nominal amount in taking measures to build a healthy lifestyle than to spend huge sums when health is compromised later on.
More than two-thirds of all deaths are caused by chronic diseases like diabetes, cholesterol, asthma. The latest statistics show that diabetes is fast gaining the status of a potential epidemic in India with more than 62 million diabetics in the country. And it is predicted that by 2030 diabetes mellitus may afflict up to 79.4 million individuals in India. According to the International Diabetes Federation (IDF), 1 in every 10 adults will have diabetes in 2030.
Imagine, being diagnosed with a chronic medical condition and to add to your woes know the cost of the treatment to be skyrocketing. In India, the rate of medical inflation stands at 15 per cent per annum compared to 6-7 per cent overall inflation per year.
Price-Waterhouse-Coopers predicted that in 2025, an estimated 18.9 crore people in the country will be more than 60 years of age, needing higher healthcare expenditure. By the end of 2025, India will need as many as 17.5 crore additional beds according to a combined study by an industry body and Ernst & Young. In India, 3.2 crore people go below the national poverty line by spending on healthcare out of their own pockets in a single year.
The poorest 10 per cent of the population rely on sales of their assets or borrowings, entailing inter-generational consequences on the family's ability to access basic goods and affecting their long-term economic prospects. Out of total expenditure on healthcare, more than 70 per cent goes out of the patient's pocket. The rest is probably paid by the Government and insurance companies. Through a healthy diet, regular physical activity, avoiding the use of tobacco and alcohol abuse, and preventive screening at least 80 per cent of premature deaths from heart diseases and strokes and 40 per cent of cancer can be prevented.
If present times have taught us anything, it is that to lead a healthy life one needs healthy surroundings too. And creating a healthy nation needs efforts beyond just on an individual level. Not all preventive healthcare is as easily accessible or understood as toothpaste or a mosquito coil. Therefore, in a country, especially India where people have such low disposable income, Government and communities must step in to do some heavy lifting.
To do the same, economic assessment, in particular, cost-analysis must become a fundamental tool of healthcare assessment for governmental agencies.
Cost-effectiveness, simply put, refers to the comparison of the cost of investment with the number of healthcare services that can be purchased with it. To identify interventions that bring the highest health benefits at the lowest cost. Let us say that there are 2 treatments for treating diabetes effectively.
Treatment A: costs Rs 100 & cures 70 per cent.
Treatment B: costs Rs 120 & cures 90 per cent.
Now, if in a village 10 people are administered treatment A, the total expenditure comes out at a total of Rs 1000. However, only 7 patients of the 10 are cured of the chronic disease. Hence, the cost per patient cured comes out at Rs 142. On the contrary, In the case of treatment B, 10 people are treated for diabetes at the cost of Rs 120 per patient, so the cost of administering them all would be Rs 1,200. But now, 9 of the 10 would be cured, and therefore, when we spread the cost of Rs 1200 amongst 9 people, the cost per patient cured turns out to be only Rs133. So in this case, even though treatment B initially appears to be more expensive than A, it turns out that B is rather more cost-effective given its higher rate of positive results.
A compulsive focus on improving the per capita number is where the government must step in. Besides, a leaf from the healthcare playbook of Nordic countries can be of immense help. Access, treatment and public health are the three key dimensions of healthcare policy in Nordic countries. Adult patients in these countries share the cost of prescription drugs with the state. Such patient payments are capped at modest levels or are waived for low-income and certain chronic conditions. Dental services are free for children and adults are insured for them.
Non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Some of them are Cardiovascular disease, cancer, chronic respiratory disease, diabetes, etc. Certain conditions, called metabolic risk factors, can lead to metabolic syndrome. Metabolic syndrome is linked to heart disease and diabetes.
A person with such risk factors should address them through medical treatment and lifestyle modifications to lower the risks of developing a non-communicable disease. Risk factors a person can’t change include age, gender, race and family history. These are long-term conditions that often can reduce one’s life expectancy, they can be managed with medical treatment and lifestyle changes.
The cultural differences and way of life of people have a great impact on the way they assess their health and well-being as well as their attitude towards healthcare. It affects their attitude and understanding of the cause of an illness and how to manage them as well as the consequences of medication and medical treatments. This also affects people’s expectations of healthcare delivery.
Healthcare is nothing less than an investment and you need to start investing in it right from the start and not only when the need arises. Simply put, high-quality healthcare is having access to effective treatment at an affordable cost.
It would be wise for both governments and individuals to consider health as an investment, not cost. Individual ‘investment’ in self-care and preventive health yields returns by lowering the need for, and spending on curative care.
"The goal of real healthcare reform must be high-quality universal coverage in a cost-effective way." - Bernie Sanders, the famous American politician and activist.
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