Since the outbreak of the second wave of Covid-19, the media has been highlighting the struggle of ailing people in finding a hospital bed. Several celebrities have also conveyed that they had to wait for hours to get a bed during this Covid crisis. Immediate parallels are drawn with the UK and USA. In other words, conclusions are summarily drawn that our systems in India are obtuse and uncaring.
To get to the bottom of the performance of India’s healthcare system during the pandemic, a study was conducted in the National Capital Region (NCR). It focused on the time taken by a typical patient to get a bed when he/she reached the hospital.
A sample of 284 attendants of Covid patients hospitalized reported that it took nearly 2 hours for them to get the person admitted in the hospital. Some did start attending the patient in about 45 minutes but the total time for admission and start of some form of treatment was 2 hours. This data pertains to non-trauma hospital admissions only.
Now, is the average time of 2 hours less or more is something that needs to be examined. Furthermore, can anyone get admitted to super-speciality hospitals such as AIIMS, PGI, etc. and can anyone get admitted to a hospital in the USA and UK directly. 100% of the respondents had come to the hospital without having visited any medical doctors prior to coming to the hospital. 64% had sought telephonic advice and remaining were advised by their attendants, family members, or/and self to go to hospital as they experienced worsening symptoms. Therefore, it would be interesting to see if this is possible in the USA or UK context.
The average wait-time in the A&E (accidents and emergency) area in the UK was well above six hours prior to 1997. It was under Prime Minister Tony Blair, that the National Health Service (NHS) was given a key target to reduce the maximum waiting time at the A&E department to four hours. While this appeared to be an uphill task at that time, it was found that even if this was achieved in majority of the times, it would be an extraordinary success for the National Health Service in the UK. The results were less than encouraging.
In an article written by John Carvel (2003) in The Guardian and later cited in the paper by Kelman and Friedman in 2009, it was reported that two-thirds of NHS A&E departments in England faked the data on improvements in waiting time. In other words, waiting-time remained abysmal. According to an article in Harvard Business Review written by Nicos Savva and Tolga Tezcan in 2019, the average waiting-time for patients entering emergency in the United States is one and a half hours. It was reported in the same article that patients who arrived in the emergency with broken bones had to wait on an average of 54 minutes. Consequently, I am not sure if the wait of two hours for the patients to be admitted is high or low. Every single minute can be excruciatingly painful for a person before receiving care and getting admitted. However, I am not sure if it fares poorly with systems in major countries of the developed world.
Second, can a patient directly walk into a hospital in the UK and USA? The UK and USA both have a referral system. In other words, all those who are eligible will have a primary care physician (general physician). This primary care physician refers the patient for diagnostics and further treatment. In other words, the patients must be referred by their primary care physicians to hospitals. It is only during emergency situations that the patient can come to hospital directly. However, in the Indian context, most of the patients who come in the OPD do not go to primary health care centres, general physicians, Mohalla clinics, etc. before coming to hospitals. The doctors in India continue to provide care to hundreds of OPD patients in government and non-government hospitals every day without turning anyone away. It must be recognized that the Indian healthcare system therefore is least discriminating globally. While patients in Indian OPDs come and wait for hours, they are given care nevertheless by our Indian doctor in the most effective manner under the given circumstances. 100% of the respondents of our study stated that they were able to get medical advice on phone or in person within hours. When asked to estimate the time, 94% of the respondents stated that they could manage to get a doctor on the phone in less than an hour and 88% were able to schedule an appointment with a doctor on the same day. However, it is not easy for patients in some advanced countries to get a doctor’s appointment on the same day or even the next day. Commonwealth Fund International Health Policy Survey of Eleven Countries shows the percentage of adults who were able to get a same-day or next day appointment when they needed care (www.commonwealthfund.org):
It is interesting that most of these countries have a population (other than US and UK) nearly that of Delhi State or even lesser. The UK's population is nearly the same that of Rajasthan state only. The delivery of healthcare remains and will continue to be challenging due to the size of our population and resources available but not because of the people who are delivering services. Consequently, while we must continue to strive to find ways to improve, augment, and innovate, at the same time it may be a bit more useful to be appreciative of the healthcare providers and healthcare system in our country.
(Prof Dheeraj Sharma is Director, IIM Rohtak. The views expressed in the article are personal)
