Entry #15
May 15, 2014
I would like to discuss some of the differences between the Indian and American healthcare systems. They are worlds apart, but I will point out the starkest contrasts I encounter.
Health insurance in India is not ever mentioned and does not seem to be necessary. Treatment and visits or tests are quite cheap for citizens who often struggle financially. An MRI could cost around 17 USD. In the US, this cheap price is not possible because citizens are overrun by competitive, corruptive third party payers. There may not be one insurance company that monopolizes the market, but the market certainly monopolizes society's pockets. While America has higher quality facilities and equipment, I believe it is vital to establish a middle ground between zero insurance companies and a barely-regulated competitive market.
Secondly, healthcare professionals in India do not maintain standard hygienic standards. I have yet to see one box of gloves and there is never soap in the bathrooms. Hygiene in all of India is underwhelming. especially in important healthcare settings. Greg asked me today if undergoing surgery in India would be safe due to the lack of hygiene, and I haughtily replied that surgeries in India obviously require sterilization and such. Truthfully, I'm not so sure. I am curious to observe surgery here to understand the health and hygiene practices that surround it.
Another stark contrast is the lack of patient records in India compared to the strict upholding of such records in the US. Everything is done on paper in India and there is no requirement to obtain and store patient records. Everything in the US was transferred to EMRs, which is impractical for a country with inconsistent electricity. Every day, multiple times a day, there are bouts of overloaded power lines and blackouts. There frequent occurrences do not last more than a half hour normally, but it would make EMRs difficult and undesirable. These overloads are so natural to daily life here that Dr. Joshi asked how I keep from freezing in the winter when my power goes out. I explained that our power almost never goes out. He didn't seem to completely understand the concept.
As I have mentioned before, there is no patient confidentiality or privacy in India. There are no laws here that parallel HIPPA and the country is so overpopulated that there are often 30 patients crowded in one room while the physician treats them in the same room right on the spot. If personal information needs to be discussed, it is in front of strangers. Greg and I are able to take pictures of test results and patients. This lack of confidentiality serves students well and is unfortunately more practical due to overpopulation.
Another large difference often not considered is the nonexistence of patent laws in India. This means that any person can start a pharmaceutical company and sell whatever products to providers or directly to patients. There is nothing similar to the FDA. There are at least 90 companies in just the city of Dehradun! We learned this early on this week when Dr. Gandhi sat through at least 20 sales pitches for different drugs. Every day he lies victim to an onslaught of 30-40 sales pitches and politely rejects each one. They know exactly when his rotations end and show up 10 minutes early to begin lining up. They have access to information about every drug he prescribes and he is considered an A grade doctor due to the amount of patients he sees each day. The poor man is forced to listen to these pitches and accept flyers because he must memorize what drugs belong to which companies and what their indications are in case his patients use any of these drugs.
There are far more differences between the two healthcare systems but these key points are pronounced and influential to the experiences I have had.
