Healthcare is on a transformational journey propelled by the explosion of digital technology that has emerged stronger after the pandemic. Social media posts are inundated with techno-solutions ranging from devices, apps and quick-fix remedies that promise to convert existing medical care into a more accessible, equitable and affordable system.
The emergence of artificial intelligence has given it a fillip, promising to leapfrog healthcare into a new orbit of excellence. As the canvas of healthcare gets repainted, it is also being marketed in the public domain with captivating graphics and lofty promises rather than by the direct offerings of caregivers. The last bastion of healthcare has finally been captured it would seem.
However, these predictions come not from medical experts but from a new ring of stakeholders hitherto peripheral to the medical world – software giants, venture capitalists and digital evangelists for whom health is more of a lucrative industry rather than a domain of service. It is business and investment journals that carry articles on health more than health journals. Conventional medicine has been second-placed as a sub-optimal system that needs to be re-injected with the steroid of transformative technology.
The public has bought into this hype and remains smug in the prospect of a new dawn in healthcare that will be efficacious, faster and cost-effective. But amid this digital health revolution lies a growing neglect of the foundational pillars of healthcare — health education, public health concerns and clinical practice. The perception gaining ground is that the existing deficits in health infrastructure and manpower can be easily overcome by technology.
For example, telemedicine, which salvaged medical care during the lockdown, is marketed as a permanent alternative to direct doctor-patient interface, reducing the dependence on doctors. It may be premature to establish this, considering the accruing evidence of limitations of digital delivery. Healthcare in the United States, the epicenter of techno-innovation, is already facing setbacks. It’s showing in the low shelf-life of digital innovations and the collapse of many start-ups in the medical sphere. As per a 2022 survey, the number of Indians using wellness apps increased during the Covid-19 pandemic.About 21% of the respondents started using health apps; 40% reported to using more during the pandemic. With an investment winter in the offing and the large attrition of medical workforce from hospitals, digital systems may not replace clinical healthcare so easily. Caution needs to be exercised against blindly copying the trends of the western world without contextualising technology to the harsh realities of our public health.
Our population, epidemiology, affordability, digital literacy and social dynamics form a difficult matrix must first be teased out before applying costly technology as the prime solution. There is a growing vacuum of medical skill, insurance cover and trust deficit that impacts effective care delivery. While welcoming and working on digital capacity-building to its maximum potential, it is prudent not to overlook conventional healthcare in the Indian context.
A ‘non-digital transformation of healthcare’ must run parallel to digital transformation initiatives for the latter to come to fruition. Conventional healthcare, developed over centuries, is too well validated to be replaced by untested technologies, however magical they may appear to be. The human element integral to conventional caregiving and seeking may not be measurable, but it remains a non-negotiable pre-requisite to holistic care. Non-digital healthcare transformation involves focus on several aspects. The first is medical education. A systematic review of the medical curriculum is long overdue.
Developed in colonial India, it is information-heavy, theoretical and too extensive. The current meritocratic, examoriented, decade-long course must make way for a more compact, skillbased one which addresses public health. Graduates of the current system are not sensitised to national priorities as their bookish training does not expose them to social realities. Instead, their merit-based entitlements push them to private practice or careers abroad. Motivational thrust is low, which is why even at an average output of 50,000 graduates a year for at least 25 years, India is still short by two million doctors.
The periodic announcements of new restrictive regulations on medical colleges and clinical practice do not auger well to incentivise the medical fraternity to raise the bar of medical excellence. A renewed and redirected thrust on family and community health practice is also fundamental to healthcare transformation. India needs more generalists than specialists to bolster the sagging status of our health. Health work in rural and tribal areas must be incentivised substantially to increase physician residency in needy areas.
An NHS-like pyramidal system of care is worth exploring for better care delivery on this vast Indian landscape. Healthcare must become a prioritised corporate social responsibility for corporates. The doubleedged statistic of a young India under 30 years and a burgeoning elder population above 60 years calls for strategic health planning at the grass-root level.
Cost control must become a priority in the private sector. The cost of healthcare cannot be obligatory in the pursuit of excellence. With 65% of our population spending out of pocket, and insurance cover only partial, the forthcoming health transformations will push many more below poverty line. Low-cost care must become a national priority for sustainable change.
The urgency to alter social determinants of ill health lies within the scope of non-digital interventions and political resolve. Tackling the triple-disease burden (the addition of viral epidemics of the scale of Covid, Nipaah and Ebola which have become a public health burden in addition to the existing double-disease burden of communicable and noncommunicable diseases in India), environmental pollution and unhealthy food consumption calls for medically oriented policy changes. We are miles away from ‘health for all’. But it can be fast-tracked by marrying exciting digital innovations underway with prudent nondigital transformation that remains the essential backbone of sustainable healthcare
