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31st December – Editorials/Opinions Analyses




Timeline of development of healthcare in the United States since the early 20th century.

  • Mayo brothers’ initially modest set­up (Mayo Clinic) prolifically expanded into the prototypical ‘multispecialty group practice’ in the U.S.
  • Concerns that such arrangements would be bereft of the personal touch in patient care were raised.
  • The concern continued with the evolution of more and more organized structures like Health Maintenance Organisations (HMOs)
  • Criticised for turning healthcare into a marketable commodity sold by unfeeling healthcare providers in supermarket ­like institutions, destitute of traits like empathy, regard and loyalty.
  •  U.S. healthcare has ended up as one of the most impersonal healthcare systems.

Problematic proposition

  • The NITI Aayog’s proposed 15­year plan for Indian healthcare entitled “Health Systems for a New India: Building Blocks — Potential Pathways  to Reform”
    • Outlines prospects of such an infelicitous turn in Indian healthcare.
    • Some commendable proposals for health system strengthening
    • Elimination of informality,
    • Merging of fragmented risk pools,
    • Reduction of out­ of­ pocket health spending
  • However the proposal to consolidate small practices into larger business­like Organisations appears problematic on multiple fronts.
  • Nearly 98% of healthcare providers have less than 10 employees is identified as a negative trait
  • Apart from cost and competition related concerns, an enthusiastic pursuit of it could portend an exacerbated commodification of healthcare from the bottom ­up.
  • The report’s bent towards the U.S. HMO model further adds to such a foreboding.
  • Loyalty and longitudinality form vital pillars of the patient ­physician relationship. The edifice of these is built upon a substratum of mutual trust, warmth, and understanding that accrues over time between a patient and their personal physician.
  • Momentary and haphazardly physician ­patient interactions in a system that limits access to one’s ‘physician of choice’ are incapable of fostering such enduring relationships.

Role of personal Physician

  • A family physician’s longitudinal relationship with their patient helps in a better understanding of the patient’s needs and expectations and in avoiding unnecessary clinical hassles and encounters
  • This in turn reflects in better outcomes and increased patient satisfaction.

Widespread commercialisation of care over the past few decades has entailed that the family physician is a dying breed in India today.

  • This has a sizeable role in impairing the doctor ­patient relationship Increases violence against healthcare providers.
  • Mistrust in the healthcare provider and its gruesome implications

Advantage of small clinics

  • Healthcare received in small clinics scores higher in terms of patient satisfaction than that received in larger institutions.
  • This increased satisfaction manifests as better compliance with the treatment regimen and regular follow­ ups, culminating in improved clinical outcomes.
  • Patient­ clinician relationship has a statistically significant effect on healthcare outcomes. Indeed, disregard for this aspect in health services design is bound to entail a sizeable cost to the health system.
  • However, the subtle, fuzzy, and perceived non­urgent nature of this problem keeps it from assuming significance to policy­ makers — as a result of which doctor­ patient relationship considerations are largely invisibles in the policy discourse in favor of more pressing concerns like lack of funds and manpower.
  • Time and again, however, this omission has surfaced in the performance of health systems worldwide. As India looks forward to a long­ term healthcare plan, neglecting this consideration could be of sizeable consequence.

The need for empathy

  • A popular myth often floated is that considerations regarding emotive aspects of healthcare such as empathy and trust are disparate from, and thus cannot be realistically factored into, hard­headed health policy and system design considerations.
  • In reality, these are entirely amenable to cultivation through careful, evidence­ based manipulation of the health system design and its components.
  • It would necessitate, among other measures, installing an inbuilt family physician ‘gatekeeper’ in the health services system who acts as the first port of call for every registered patient.
  • The NITI Aayog’s long term plan provides a good opportunity to envisage such long ­called ­for reforms, but that would require not the U.S. model but the U.K. model to be kept at the forefront for emulation.
  • Already taken a minor, yet encouraging, step of sorts by introducing Attitude, Ethics, and Communication (AETCOM) in the revised undergraduate medical curriculum.
  • One hopes that the pronouncement of this long ­term healthcare plan doesn’t indicate adoption of U.S. ­like healthcare policies. The plan needs to be revisited to ensure that healthcare clinics delivering patient care don’t transform into veritable supermarket stores marketing medical services any further



  • The upswing highlighted by the signing of the civilian nuclear deal in 2008
  • Started abating when Donald Trump became president of the US in 2017.
  • Economic progress was the outstanding reason why India went up in America’s estimation after 1991.
  • Its high growth rates over a 15-year period persuaded Washington to believe that it could become a counterpoise to rising authoritarian China.
  • Additionally, India’s stability as a multicultural democracy also impressed the US, especially after the collapse of the authoritarian Soviet Union and Yugoslavia in 1991.
  • By 2019, however, it was obvious to the world that India’s economy had fallen into decline over the last six years.
  • Political and social polarisation, symbolised by increasing communal violence since 2014 and the large-scale protests over the Citizenship Amendment Act (CAA) have raised questions about the quality of its democracy.
  • The economic downturn and New Delhi’s ruling out of a quick recovery brings into question India’s ability to counter China in Mr Trump’s “Indo-Pacific”.
  • Over the last decade, India and the US have signed More than $15 billion worth of arms deals — and Washington recently offered India another $1 billion worth of naval guns.
  • But to New Delhi’s chagrin, the US still refuses to transfer sensitive military technology because India is not a formal ally.
  • Sovereignty decrees that India has a right to buy Russia’s S-400 missile, this air defense system blocks closer military ties with the US, which sees Russia as a security threat.
  • Absence of an alliance reflects India’s determination to uphold its strategic autonomy, it simultaneously makes Washington doubtful about the viability of the Indo-US tie.
  • Trade issues are another sticking point in their tie. India’s cat’s cradle of red tape and protectionist tariffs irk Washington.
  • A mere 2.1 per cent of US exports come to India; and 2.2 per cent of imports come from India.
  • Fifteen per cent of India’s imports come from the US, 16 per cent of its exports go to the US.
  • As India’s economy has taken a nosedive, China has shown off its economic progress by expanding its Belt and Road Initiative (BRI) worldwide. Several member-states of the European Union and all of India’s neighbors have joined the BRI.
  • China’s financial clout has established it as the largest investor in their economies.
  • It is also the largest arms seller to Myanmar and Bangladesh. Its growing presence in the Indian Ocean poses tough queries about India’s standing as the dominant South Asian power.
  • The other domestic development — the passing of the CAA and the large-scale protests that it provoked have led many in the US to question India’s secular democratic credentials.
  • Even before that, the State Department in June reported that religious intolerance in India had grown under Prime Minister Narendra Modi’s government. India predictably riposted that a foreign government had “no right” to comment on the country’s internal affairs.
March 2024