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The AmbuPod Project: Learnings of a Government-Certified, Telemedicine-Enabled, Rural Healthcare Startup in India
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Publication date (Electronic):
23 April 2021
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Telehealth and Medicine Today
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Open Academia
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Abstract
The Government of India (GoI), during the past 8 years, has been encouraging and supporting start-ups with various schemes, for the purpose of wealth creation, improving economic growth, and employment. There is also a growing support system in India, in the private sector, for funding, mentorship, and techno-commercial support for telemedicine-enabled start-up projects. In practice however, there are many critical decisions that need to be taken and pitfalls to be avoided, for start-ups to achieve success, as envisaged by the GoI.
Objective
This paper shares the challenges encountered so as to help upcoming healthcare start-up’s navigate this route skilfully, avoiding pitfalls.
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Telemedicine in India: Where do we stand?
Vinoth G. Chellaiyan, A. Nirupama, Neha Taneja (2019)
Telemedicine is considered to be the remote diagnosis and treatment of patients by means of telecommunications technology, thereby providing substantial healthcare to low income regions. Earliest published record of telemedicine is in the first half if the 20th century when ECG was transmitted over telephone lines. From then to today, telemedicine has come a long way in terms of both healthcare delivery and technology. A major role in this was played by NASA and ISRO. The setting up of the National Telemedicine Taskforce by the Health Ministry of India, in 2005, paved way for the success of various projects like the ICMR-AROGYASREE, NeHA and VRCs. Telemedicine also helps family physicians by giving them easy acess to speciality doctors and helping them in close monitoring of patients. Different types of telemedicine services like store and forward, real-time and remote or self-monitoring provides various educational, healthcare delivery and management, disease screening and disaster management services all over the globe. Even though telemedicine cannot be a solution to all the problems, it can surely help decrease the burden of the healthcare system to a large extent.
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Telemedicine: A New Horizon in Public Health in India
Aparajita Dasgupta, Soumya Deb (2008)
Introduction Telemedicine is the use of electronic information to communicate technologies to provide and support healthcare when distance separates the participants.(1) “Tele” is a Greek word meaning “distance “and “mederi” is a Latin word meaning “to heal”. Time magazine called telemedicine “healing by wire”. Although initially considered “futuristic” and “experimental,” telemedicine is today a reality and has come to stay. Telemedicine has a variety of applications in patient care, education, research, administration and public health.(2) Worldwide, people living in rural and remote areas struggle to access timely, good-quality specialty medical care. Residents of these areas often have substandard access to specialty healthcare, primarily because specialist physicians are more likely to be located in areas of concentrated urban population. Telemedicine has the potential to bridge this distance and facilitate healthcare in these remote areas.(3 4) History of Telemedicine While the explosion of interest in telemedicine over the past four or five years makes it appear as a relatively new use of telecommunications technology, the truth is that telemedicine has been in use in some form or the other for over thirty years. The National Aeronautics and Space Administration (NASA) played an important part in the early development of telemedicine.(5) NASA's efforts in telemedicine began in the early 1960s when humans began flying in space. Physiological parameters were transmitted from both the spacecraft and the space suits during missions.(6) One of the earliest endeavors in telemedicine, Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) delivered medical care to the Papago Indian Reservation in Arizona. It ran from 1972–1975 and was conceived by the NASA. Its goals were to provide healthcare to astronauts in space and to provide general medical care to the Papago Reservation.(1) In 1971, 26 sites in Alaska were chosen by the National Library of Medicine's Lister Hill National Center for Biomedical Communication to see if reliable communication would improve village healthcare. It used ATS-1, the first in NASA's series of Applied Technology Satellites launched in 1966. The primary purpose was to investigate the use of satellite video consultation to improve the quality of rural healthcare in Alaska.(7) Since 1977, the Telemedicine Centre at the Memorial University of Newfoundland has worked toward developing interactive audio networks for educational programs and the transmission of medical data.(1) The North-West Telemedicine Project was set up in 1984 in Australia to pilot-test a government satellite communications network (the Q-Network).(1) The project goals were to provide healthcare to people in five remote towns south of the Gulf of Carpentaria. In 1989, NASA conducted the first international telemedicine program, Space Bridge to Armenia/Ufa. Under the auspices of the US/USSR Joint Working Group on Space Biology, telemedicine consultations were conducted using one-way video, voice and facsimile technologies between a medical center in Yerevan, Armenia and four medical centers in the US.(7) Definitions and Concepts Telemedicine The World Health Organization (WHO) defines Telemedicine as, “The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities.” Telehealth Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education and training, public health and health administration.(8) Telemedicine Consultation Centre (TCC) Telemedicine Consulting Centre is the site where the patient is present. In a Telemedicine Consulting Centre, equipment for scanning / converting, transformation and communicating the patient's medical information can be available.(9) Telemedicine Specialty Centre (TSC) Telemedicine Specialty Centre is a site, where the specialist is present. He can interact with the patient present in the remote site and view his reports and monitor his progress.(9) Telemedicine System The Telemedicine system consists of an interface between hardware, software and a communication channel to eventually bridge two geographical locations to exchange information and enable teleconsultancy between two locations. The hardware consists of a computer, printer, scanner, videoconferencing equipment etc. The software enables the acquisition of patient information (images, reports, films etc.). The communication channel enables the connectivity whereby two locations can connect to each other.(10) Utility of Telemedicine [Figure 1](1 9 11–13) Figure 1 A modern telemedicine system Easy access to remote areas Using telemedicine in peripheral health set-ups can significantly reduce the time and costs of patient transportation Monitoring home care and ambulatory monitoring Improves communications between health providers separated by distance Critical care monitoring where it is not possible to transfer the patient Continuing medical education and clinical research A tool for public awareness A tool for disaster management Second opinion and complex interpretations The greatest hope for use of telemedicine technology is that it can bring the expertise to medical practices once telecommunication has been established. Telementored procedures-surgery using hand robots Disease surveillance and program tracking It provides an opportunity for standardization and equity in provision of healthcare, both within individual countries and across regions and continents. The Centre for International Rehabilitation recognizes that telecommunication and telemedicine are important technologies to improve and provide rehabilitation services in remote areas. Telemedicine cannot be substitutes for physicians in rural areas especially in developing countries where resources are scarce and public health problems are in plenty. So it is unrealistic to think at this stage of substituting unwilling doctors with this technology. However, it can supplement the current health scenario in a huge way in most countries. Types of Technology Two different kinds of technology make up most of the telemedicine applications in use today. The first, called store and forward, is used to transfer digital images from one location to another. A digital image is taken using a digital camera, ‘stored’ and then sent (‘forwarded’) by a computer to another location. This is typically used for nonemergent situations, when a diagnosis or consultation may be made in the next 24-48 hours and sent back. Teleradiology, telepathology and teledermatology are a few examples.(14) The other widely used technology, the two-way interactive television (IATV), is used when a ‘face-to-face’ consultation is necessary. The patient and sometimes their provider or more commonly a nurse practitioner or telemedicine coordinator (or any combination of the three), are at the originating site. The specialist is at the referral site, most often at an urban medical center. Videoconferencing equipment at both locations allow a ‘real-time’ consultation to take place.(15) Almost all specialties of medicine have been found to be conducive to this kind of consultation including psychiatry, internal medicine, rehabilitation, cardiology, pediatrics, obstetrics and gynecology and neurology.(15) Infrastructure The telemedicine centers could be broadly classified into the following classes: Primary Telemedicine Center (PTC) Secondary Telemedicine Center (STC) Tertiary Telemedicine Center (TTC)(9) PTCs would be based in Primary Health Centers, STCs in Secondary Medical Centers and TTCs in Tertiary Medical Centers. The Hardware requirements / standards will be referred in the context of the Telemedicine Consulting and Specialist Centres (TCC) and (TSC).(9) Telecommunication Technologies The first among the challenging questions arising when planning a telemedicine network is ‘What is bandwidth?’ Bandwidth is the capacity that determines how quickly bits may be sent down the channels in a telecommunication medium. Bandwidth is proportional to the complexity of the data for a given level of system performance.(16) The following technologies are currently in use: Integrated Services Digital Network (ISDN) ISDN is a dial-up (not dedicated but used on a call-by-call basis) digital connection to the telecommunication carrier. An ISDN line can carry information at nearly five times the fastest rate achievable using analog modems over POTS (plain old telephone service).(16) T-1 This is the backbone of digital service provided to the end user (typically business) in USA today which transmits voice and data digitally at 1.554 megabits per second (Mbps). It can be used to carry analog and digital voice, data and video signals and can even be configured for ISDN service.(16) Plain Old Telephone Service (POTS) POTS transmits data at a rate of up to 56 kilobits per second (kbps) (Bezar 1995) and is the most widely available telecommunication technology in the world. POTS can be suitable for audio conferencing, store-and-forward communication, Internet and low bandwidth videophone conferencing.(16) Internet The Internet has a strong impact in delivering certain kinds of care to patients. In a survey of 1,000 Chief Intelligence Officers (CIOs) conducted by Internet Health Care Magazine, 65% said their organization had a Web presence and another 24% had one in development. With the increasing proliferation of e-health sites on the Web today, many consumers are finding access to online patient scheduling, health education, review of lab work and even e-mail consultations.(16) Application of Telemedicine in Public Health An epidemiological Surveillance:(17) Telemedicine applications for epidemiological surveillance are gradually reaching new heights with the development of technology such as geographic information systems (GISs). It can give new insight into geographical distribution and gradients in disease prevalence and incidence and valuable insight into population health assessment. It also provides valuable information of differential populations at risk based on risk factor profiles. It helps in differentiating and delineating the risk factors in the population. It also helps in interventional planning, assessment of various interventional strategies and their effectiveness. It can play a pivotal role in anticipating epidemics. It is an essential tool in real-time monitoring of diseases, locally and globally. GIS provides the basic architecture and analytical tools to perform spatial-temporal modeling of climate, environment and disease transmission helpful in understanding the spread of vector-borne diseases. Remote sensing techniques have been recently been used in this regard. A GIS-based method for acquiring, retrieving, analyzing and managing data differs from traditional modes of disease surveillance and reporting. It facilitates aggregation and integration of disparate data from diverse sources so it can guide the formulation of public health programs and policy decisions. Interactive health communication and disease prevention(17) Information technology and telemedicine can be used to inform, influence and motivate individuals and population organizations on health, health-related issues and adoption of healthy lifestyles. The various approaches and applications can advance and support primary, secondary and tertiary health promotion and disease prevention agendas. It can relay information to individuals as well as to the population as a whole. It can provide an easy access to those living in remote areas. It enables informed decision-making. It also simplifies the health decision-making process / or communication between healthcare providers and individuals regarding prevention, diagnosis or management of a health condition. As a result, the users are exposed to a broader choice base. It can go a long way to promote and maintain healthy behaviors in the community. It can also help in peer information exchange and emotional support. Examples include online Internet applications that enable individuals with specific health conditions, needs or issues to communicate with each other, share information and provide / receive emotional support. It promotes self-care and domiciliary care practices. Many living in the remote areas can be benefited by self-management of health problems which will supplement existing health care services. It can be a very important tool for the evaluation and monitoring of healthcare services. Telemedicine in India In Utopia, every citizen may have immediate access to the appropriate specialist for medical consultation. In the real world however, this cannot even be a dream. It is a fact of life that “All Men are equal, but some are more equal than others.” We in India are at present, unable to provide even total primary medical care in the rural areas. Secondary and tertiary medical care is not uniformly available even in suburban and urban areas. Incentives to entice specialists to practise even in suburban areas have failed.(18) In contrast to the bleak scenario in healthcare, computer literacy is developing quickly in India. Healthcare providers are now looking at Telemedicine as their newly found Avatar. Theoretically, it is far easier to set up an excellent telecommunication infrastructure in suburban and rural India than to place hundreds of medical specialists in these places. We have realized that the future of telecommunications lies in satellite-based technology and fiber optic cables.(18) The Beginning The Apollo group of hospitals was a pioneer in starting a pilot project at a secondary level hospital in a village called Aragonda 16 km from Chitoor (population 5000, Aragonda project) in Andhra Pradesh. Starting from simple web cameras and ISDN telephone lines today, the village hospital has a state-of-the-art videoconferencing system and a VSAT (Very Small Aperture Terminal) satellite installed by ISRO (Indian Space Research Organisation). Coupled with this was the Sriharikota Space Center project (130 km from Chennai) which formed an important launch pad of the Indian Space Research Organisation in this field.(2) Current Efforts In India, telemedicine programs are actively supported by: Department of Information Technology (DIT) Indian Space Research Organization NEC Telemedicine program for North-Eastern states Apollo Hospitals Asia Heart Foundation State governments Telemedicine technology also supported by some other private organizations(13) DIT as a facilitator with the long-term objective of effective utilization / incorporation of Information Technology (IT) in all major sectors, has taken the following leads in Telemedicine: Development of Technology Initiation of pilot schemes-Selected Specialty, e.g., Oncology, Tropical Diseases and General telemedicine system covering all specialties Standardization Framework for building IT Infrastructure in health(13) The telemedicine software system has also been developed by the Centre for Development of Advanced Computing, C-DAC which supports Tele-Cardiology, Tele-Radiology and Tele-Pathology etc. It uses ISDN, VSAT, POTS and is used to connect the three premier Medical Institutes of the country (viz. All India Institute of Medical Sciences (AIIMS), New Delhi, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow and Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh). Now it is being connected to include Medical centres in Rohtak, Shimla and Cuttack.(13) The telemedicine system has been installed in the School of Tropical Medicine (STM), Kolkata and two District Hospitals. In West Bengal, two hospitals where telemedicine centres have been established are the First Coronary Care Unit inaugurated in Siliguri District Hospital, Siliguri, West Bengal on 24 June, 2001 and Bankura Sammilani Hospital, Bankura, West Bengal inaugurated on 21 July, 2001. Apart from the project at STM, the Second Telemedicine Project has been implemented by Webel ECS at two Referral Centres (Nil Ratan Sircar Medical College and Hospital (NRS MC and H), Kolkata and Burdwan MC and H, Burdwan) and four Nodal Centres (Midnapore (W) District Hospital, Behrampur District Hospital, Suri District Hospital and Purulia District Hospital). The Project uses a 512 kbps leased line and West Bengal State Wide Area Network (WBSWAN) (2 Mbps fiber optic link) as the backbone.(19) In the past three years, ISRO's telemedicine network has expanded to connect 45 remote and rural hospitals and 15 superspecialty hospitals. The remote / rural nodes include the offshore islands of Andaman and Nicobar and Lakshadweep, the mountainous and hilly regions of Jammu and Kashmir including Kargil and Leh, Medical College hospitals in Orissa and some of the rural / district hospitals in the mainland states.(19) The Telemedicine project is a “NonProfitable” project sponsored by Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS) Calcutta, Narayana Hrudayalaya (NH) Bangalore, Hewlett Packard, Indian Space Research Organisation (ISRO) and the state governments of the seven North Eastern states of India. The Rabindranath Institute at Kolkata and Narayana Hrudayalaya at Bangalore will be the main Telemedicine linking hub for the seven states. The specialists at both the institutions will offer their services for this project entirely free of charge. A 100 bedded hospital will be identified in each of these seven states and the hospitals will be selected based on distance from the state capital and the lack of a coronary care unit. In the past two years, the pilot project on Telemedicine in Karnataka has already provided more than 10,000 teleconsultations. In the operational phase, the Karnataka Telemedicine Project is expected to bring multi-specialty healthcare to a significant section of the rural population of Karnataka. This network would serve as a model for the utilization of ‘HEALTHSAT,’ which is proposed for launch in the future. Challenges(9 15 19) Perspective of medical practitioners: Doctors are not fully convinced and familiar with e-medicine. Patients' fear and unfamiliarity: There is a lack of confidence in patients about the outcome of e-Medicine. Financial unavailability: The technology and communication costs being too high, sometimes make Telemedicine financially unfeasible. Lack of basic amenities: In India, nearly 40% of population lives below the poverty level. Basic amenities like transportation, electricity, telecommunication, safe drinking water, primary health services, etc. are missing. No technological advancement can change anything when a person has nothing to change. Literacy rate and diversity in languages: Only 65.38% of India's population is literate with only 2% being well-versed in English. Technical constraints: e-medicine supported by various types of software and hardware still needs to mature. For correct diagnosis and pacing of data, we require advanced biological sensors and more bandwidth support. Quality aspect: “Quality is the essence” and every one wants it but this can sometimes create problems. In case of healthcare, there is no proper governing body to form guidelines in this respect and motivate the organizations to follow-it is solely left to organizations on how they take it. Government Support: The government has limitations and so do private enterprises. Any technology in its primary stage needs care and support. Only the government has the resources and the power to help it survive and grow. There is no such initiative taken by the government to develop it. Conclusion It does not require too much of a stretch of imagination to realize that telemedicine will soon be just another way to see a health professional. Remote monitoring has the potential to make every minute count by gathering clinical data from many patients simultaneously. However, information may be lost due to a software glitch or hardware meltdown. Therefore, relying too heavily on a computer system to prevent errors in healthcare data may be problematic. There has to be a smart balance between total dependence on computer solutions and the use of human intelligence. Striking that balance may make all the difference in saving someone's life. In 2008, the potential of telemedicine, tele-health and e-health is still left to our imaginations.(20) Time alone will tell that Telemedicine is a “forward step in a backward direction” or to paraphrase Neil Armstrong “one small step for IT but one giant leap for Healthcare”.
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Issues of Unequal Access to Public Health in India
Debasis Barik, Amit Thorat (2015)
Introduction Health in India is a state subject. Although the central government shares a significant part in establishing health care infrastructure, each of the Indian states determines their priorities for health care financing, and provides services to the population. India’s 12th plan document 1 promises to build upon the initiatives that were taken in the 11th plan and expand the reach and coverage of health care to achieve the long-term objective of “universal health care.” Irrespective of the ability to pay, people in India increasingly seek private health care even for minor illnesses like cold, fever, and diarrhea. Private health care in India, however, is not only expensive but also suffers severely from a lack of trained and skilled manpower as compared to the public sector (2). Access to health care facilities is significantly urban biased. So, people living in the rural areas face the additional handicap of such a situation and they form a disproportionately larger share of the unhealthy population. With respect to access to health care, the 12th plan document states that “Barriers to access would be recognized and overcome especially for the disadvantaged and those living far from facilities.” The document goes on to mention that “… the SC and ST, 2 the particularly vulnerable tribal groups, the de-notified 3 and nomadic tribes, the Musahars 4 and the internally displaced must be given special attention while making provisions for, setting up and renovating sub-centers and anganwadis 5 .” These groups need special attention as they not only suffer from unequal and lower access but also produce the worst health outcomes in the country. This is primarily because these groups have been traditionally excluded and discriminated, and therefore suffer from high incidences of poverty and low levels of education (health care awareness), among other disadvantages, which have made their access to public health care tougher. While the public health care system required to have ensured better care and treatment for these marginalized communities, evidence shows that access remains the lowest among these population group. In this paper, we focus on the issues of unequal access to health care in India by rural–urban residence, economic status, and caste/religion identity. Access to Health Care Poor housing condition, unsafe drinking water, lack of sanitation, use of biomass fuels, exposure to environmental odds as a part of the livelihood among the marginal population group often increase the risk of numerous health problems. Desai et al. (3) noted a very high prevalence of minor ailments like cough, fever, diarrhea. (124 per 1,000 individuals) among Indian population. The minor illnesses despite being short term in nature cause substantial time loss from usual activities. The prevalence of these minor ailments is seen to vary substantially by socio-economic conditions of households. These are more prevalent among the poor and the uneducated population and those who belong to the scheduled tribe community. The prevalence seems to reduce with the improvement in living conditions. However, everybody benefits from living in a metro city, regardless of their social position. Treatment rates across groups do not show much variation for minor illnesses. Minor illnesses do not require much laboratory test and people in rural areas prefer to go to a private provider for such types of illnesses due to easy availability and greater convenience. The major share of the cost of minor illnesses is the doctors’ fees and medicine. But, disparity in health care seeking between various socio-economic groups becomes prominent in case of major illnesses like hypertension, heart diseases, diabetes etc. Major illnesses are long term in nature and subject to a number of diagnostic tests. A sizeable proportion of major illnesses in rural areas remain untreated mainly due to unavailability of diagnostic facilities in the local vicinity. Desai et al. (3) have shown that only 3% of the major illnesses in metro areas remain untreated, whereas 12% of the same remain untreated in the less developed villages. Again, one-fifth of the diagnosed major illness among the scheduled tribes remain untreated. The tribal households are usually located in places, which have fewer health facilities and still rely on the traditional healers. A majority of these long-term major illnesses also remain undiagnosed amongst them. They need to go out of the villages, which are often isolated to avail treatment. Access to health care is very much asymmetric between rural and urban India. While urban residents have a choice between public or private providers, the rural residents face far fewer choices. India has a very vast public health network with sub-centers working at the community level. The health sub-centers are manned mainly by bare foot health workers and work as a bridge between community and the primary health centers (PHC). PHC is the first contact point between village community and medical officer; meant to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. Community health centers (CHC) are more equipped and acts mainly as a first referral unit with diagnostic facilities and a bunch of specialists. Since the recommendations of the Bhore Committee in 1946, a lot of emphasis has been put on the door step delivery of the health services. But, availability of any health facilities does not seem enough to attract people to the government facilities. Desai et al. (3) further noted that the possibility of visiting a government facility for minor illnesses reduce in the presence of any private facilities in the locality, but the reduction is much lesser for larger health care units like the CHC than the sub-centers. Cost of Treatment for Major and Minor Illnesses The envisioned universal access to health care is far from achieving its goals. Over time, a lot of emphasis has been placed on the doorstep delivery of health services. However, the scheme-wise expenditure on India’s National Rural Health Mission (NRHM) during 11th Plan (2007–2012) on public health care expenditure reveals that a major share of the allocated resource on health was spent on family welfare program (90%), leaving a small segment (7.7%) for disease control (4). Though investment in family welfare program is necessary, investment in disease control program cannot be ignored. Limited public health spending and higher emphasis on family planning services over time has resulted into a huge scarcity of resources to be spent on general health. A lot of public health facilities have been initiated in the outreach areas in the last decade, but due to unavailability of quality doctors and diagnostic facilities, people rush to the equally poor private facilities and end up spending more, almost all of which is out-of-pocket (OOP) expense. Impact of Medical Expenditure on Household Well-Being Does the health expenditure cost the same to each household? This remains a major policy concern in many of the developing countries including India, where household OOP payment for health care is a significant part of the total health expenditure. The high OOP spending on health often leads to catastrophic level of spending for healthcare to many households and push them into poverty (5–7). The proportion of households facing catastrophic OOP health payments during 2004–2005, as measured by Ghosh (7) was 15.4% and the range varies as less as 3.5% in Assam to 32.4% in Kerala. Barik and Desai (8) measured the expenditure ratio (health expenditure as a percentage of income) on health care in India as 6% of the monthly average income, which is higher than the common benchmark of affordability (5%) in developing countries (9, 10). Moreover, this health burden is disproportionately distributed among various socio-economic groups. Poor households spent nearly 15% of their monthly income on healthcare compared to the richest households, who spend <1% of their income (Table 1). Table 1 Share of total household income spend on health care in India, 2004–2005. Health care spending (%) on monthly household income Any morbidity Short term Long term All India 6.02 4.43 1.59 Place of residence Metro 1.13 0.67 0.46 Other urban 3.57 2.42 1.15 More developed village 7.73 5.72 2.01 Less developed village 6.87 5.18 1.69 Income Lowest quintile 14.53 11.15 3.38 Second quintile 4.53 3.27 1.26 Thirrd quintile 2.44 1.74 0.7 Fourth quintile 1.44 1.02 0.42 Top quintile 0.65 0.37 0.28 Social groups High caste Hindu 5.13 3.65 1.48 OBC 7.59 5.66 1.93 Dalit 5.32 4.06 1.26 Adivasi 3.88 2.78 1.1 Muslim 4.84 3.88 0.96 Other religion 9.19 4.36 4.83 Barik and Desai (8), p. 57. As discussed above, the income share of the cost of treatment appears much higher on the socially and economically disadvantageous households. These higher health care cost often discourages them to avail treatment as reflected in case of major illnesses. More than two-thirds of the total health expenditure in India is met through household OOP. The coverage of health insurance is also very low among the Indians. Social insurance schemes contribute only 1.13% of the total health expenditure (11). Besides availability and affordability, as discussed above, acceptability and adequacy are the two other important aspects of access to health care (12). A persistent negative attitude toward public health facilities in India has been recorded in a number of studies (13, 14). Das and Hammer (13) evaluated the quality of medical practices as a function of doctor’s competence in terms of knowledge of diseases and the practice of existing knowledge. They found that doctors in the public facilities are more qualified than the private doctors, but they use their knowledge less than what they should do in practice. Again, few studies have pointed out doctor’s absenteeism as the leading cause of people’s avoidance to government health facilities (15, 16). Complaints regarding long waiting hours, lack of privacy in the consultation room etc. are some common supply side constraints of public health system in developing countries including India (17, 18). Discussion Even after more than 50 years of independence, health in India remains a luxury and only the rich can afford it. People visit equally poor private practitioners, ignoring the available public health units, and pay beyond their capacity. Quality health services, either public or private, with some government regulation, can help to improve the present scenario. The adivasi and the dalits are still away from the health equity and face more challenges than the others. Well-equipped health facilities in the vicinity and knowledge of disease conditions can improve the access of public health services. Rather than focusing on the doorstep services, well-equipped PHCs even can do better. A recent study by Goel and Khera (16) noted that provision of free medicine and diagnostic facilities have impacted positively on the patient utilization rate in the state of Rajasthan. Increased coverage of health insurance can add an extra protection from the health risks and early detection of disease conditions may help in achieving good health and lower treatment cost. On the eve of the epidemiological transition, rising share of non-communicable diseases will demand for facilities with diagnostic services (19, 20). So, time has come to change a move from quantity to quality. Author Contributions Dr. DB is the main author responsible for the facts and figures. Dr. AT has assisted on shaping the ideas. Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Journal ID (publisher-id): TMT
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Telehealth and Medicine Today
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Open Academia
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April
2021
Publication date Collection: 2021
Volume: 6
Electronic Location Identifier: 10.30953/tmt.v6.259
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ScienceOpen disciplines: Social & Information networks,General medicine,General life sciences,Health & Social care,Public health,Hardware architecture
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ScienceOpen disciplines: Social & Information networks, General medicine, General life sciences, Health & Social care, Public health, Hardware architecture