Dr Ketan Parikh, Founder, PyraMed Telemedicine explains the timely intervention of the diseases
Ill-Health episodes if not attended to in good time can become a permanent liability on an individuals’ health. Delay in accessing appropriate health-care may lead to significant morbidity and at times also mortality. A chronic ill-health is not only a nuisance for the individual but can also become a significant burden on the society due to the loss of productivity and social contribution by the individual. Thus timely, appropriate and adequate healthcare is not only a humanity issue but also a major socio-political necessity. In Europe losses linked to health inequities have been estimated to cost around 1.4% of gross domestic product (GDP) within the European Union1 but the Indian figures are likely to be much higher.
Every individual has a responsibility to safe-guard his/her own health and also their dependents’ health. Lack of awareness and commitment by the individual could be a reason to not take timely treatment. However it is equally necessary for the society to ensure the availability of the requisite need-specific health-care facilities to the individual. Lack of access to proper treatment facilities can also be a major deterrent to avail appropriate health-care.. This inequity in health facilities is known to affect almost 70% of the country’s population. The rural social structure tends to affect women and children even more with this inequity.
Why people in rural areas fail to get timely treatment?
70% of the Indian population resides in rural areas but almost 70% – 90% of the medical specialists are located in the major cities. Nearly 75% of dispensaries, 60% of hospitals, and 80% of doctors are located in urban areas, where only 23% of the population resides. Rural, peri-urban areas and urban slums lack adequate access to quality healthcare. Much of the care delivered in underserved areas is either through private licensed/ unlicensed providers or through the public sector community health centres. Residents of these areas often have substandard access to specialty healthcare. These people may suffer due to the limitations of inaccess to specialists’ opinion who are mostly city-based. Whereas, the division of tier 1 and tier 2 cities may be justified on social basis but it is very unfortunate to similarly classify and trivialise access to healthcare.
Health inequity strongly mirrors the development of a society as it hurts both individuals and communities. Those with the greatest need for health care have the greatest difficulty in accessing health services. Prohibitive costs of visiting cities leads to either delay or refusal in seeking specialised healthcare which worsens the health condition and further increases costs for these patients.
Telehealth though a potential saviour, has experienced certain limitations:
- Digital alienation affects a large section of this population and especially women.
- The specialist misses the vital information which could have been obtained from physical examination of the patient;
- Similarly, patients feel the dissatisfaction due to the absence of physical connection with the doctor. There is no substitute for the human touch.
Digitising healthcare services without a strong digital inclusion strategy will further deepen the inequities within the Indian healthcare system. However, if appropriately channelised, telemedicine can be a boon for patients.
Telehealth facilities can be significantly augmented if a health-care intermediary is used by these patients. A primary doctor/health care worker will
- identify the need for a timely specialist consultation,
- identify the nature of the specialist best suited for the problem from the myriad of specialties and super-specialties available.
- Whereas telemedicine portals have the potential of bridging the gaps in distance, patients often need hand-holding to navigate them for effective health care on these portals. The patients need to be guided through the information and counselled appropriately. Lack of guidance or support can also lead to exploitation of patients on such platforms.
- The primary doctor can effectively link this consultation episode with the existing and future medical history of the patient, thus ensuring the ‘continuity of care’.
How to encourage timely opinions?
The ease of accessing specialty opinion through this digital channel would encourage more timely opinions and that would again contribute to improved health at a lesser cost. Analytics on aggregated and anonymized data will allow population-wide correlation between clinician advice and health outcomes. Over time, the aggregated data will also help in standardising clinical protocols and improving care quality. Digitisation of health records will also help better data availability, track disease epidemiology, and rationalize treatment strategies.