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Medical overuse emerges as healthcare issue in India: WB

 

Posted on 03 Aug 2014

Last updated 06 Jul 2016 01:02 IST

  India, Medical overuse, Healthcare
India needs to create a strong primary care system that promotes preventive healthcare and reduces unnecessary referrals to specialists; increase public awareness about the dangers of overuse so that patients understand that ‘more’ treatment is not always ‘better’ treatment; and place greater emphasis on professional ethics during medical education.
HNF Correspondent
 

The growing desire to get admitted in hospitals even in case of feeling a bit uncomfortable than normal and undergoing numbers of medical check-up are part of a global trend of “Medical overuse” that is termed by the World Bank as an “epidemic worldwide” stressing both the economy and healthcare system.

Among the facts placed to support the claim are wide variations in the rates of caesarean sections and treatment for cardiovascular diseases. In the US alone, unnecessary medical care costs $250-300 billion annually by conservative estimates. Another growing danger is the worldwide overuse of antibiotics that is causing a surge in hard-to-treat bugs.

The trend of ‘Medical overuse’ is emerging as a serious issue in India too, especially as more people can afford to pay for medical interventions due to increasing access to insurance cover, says the report based on discussions and suggestions at the special session, devoted to this crucial issue, at its eighth forum for knowledge exchange between India’s major public health insurers for finding ways to ensure the medical necessity of care.

“This is a critical time for India since the country is in the midst of building a healthcare system which will set conditions for decades to follow,” said Somil Nagpal, senior health specialist with the World Bank in India.

 

A concerted effort against medical overuse, involving all stakeholders in the sector, which is already happening elsewhere in the world, is equally relevant in India.

 

“Our goal must be to do much for the patient, and as little as possible to the patient,” said Dr Vikas Saini, a faculty member at the Harvard Medical School and president of the Lown Institute, setting the stage for the discussions with a quote from his mentor, the Nobel laureate Dr. Bernard Lown.

Reasons of overuse

What led to such overuse?

On basis of observation and available data, WB experts reply to this saying, “High levels of unwarranted medical interventions have led to a groundswell of international activity to identify and reduce this hazard. Many factors that drive this trend have been identified globally. These include: the culture of ‘more medical intervention is better’; the slavish use of medical technology even when it is not necessary; defensive medicine  or ‘playing it safe’ by prescribing additional tests or treatment; failure to counsel the patients adequately about the risks and benefits of treatment and the other options available; aggressive marketing of services by hospitals, pharmaceutical firms and the medical device industry; incentives inherent in the way providers are paid for their services; and the growing demand by patients for medical interventions.”

There is also a growing recognition of the unnecessary costs this imposes on the economy. For instance, it often leads to overinvestment in tertiary care and expensive medical technologies, at the expense of investments in the primary healthcare system, a more cost-effective means of care and prevention. In addition, it causes neglect of the social factors contributing to ill health, like access to safe drinking water and sanitation.

Possible solutions

As suggested by experts, India needs to create a strong primary care system that promotes preventive healthcare and reduces unnecessary referrals to specialists; increase public awareness about the dangers of overuse so that patients understand that ‘more’ treatment is not always ‘better’ treatment; and place greater emphasis on professional ethics during medical education.

For insurers, there needs to be greater attention to prior authorization, although it is critical to also ensure that patients are not denied required medical care. A change in payment systems would ensure that providers are not incentivized for more interventions. A review of utilization patterns and public reporting of variations in practice and outcomes will help create transparency.

For regulators, surveillance for insurance fraud, and the systematic assessment of costs and effectiveness before introducing coverage for new drugs or technology, also called Health Technology Assessment (HTA), was suggested.

The policy options suggested included implementation of clinical guidelines to promote consistency, and a change in the way doctors and health care providers are remunerated so that they neither over-prescribe tests and procedures nor under-prescribe them.

Moreover, India needs to leverage available data and invest in HTA to help pre-empt unnecessary care, and optimize the utilization of resources.

A concerted effort against medical overuse, involving all stakeholders in the sector, which is already happening elsewhere in the world, is equally relevant in India. The discussions in the World Bank’s forum were a catalytic effort towards this cause, and the enthusiastic support of the country’s health sector luminaries augurs well for this becoming a sustained movement.

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