Shahid Akhter, editor, ETHealthworld, spoke to Dr Ayush Sharma, Co-founder, Aartas CliniShare, New Delhi to understand a model of care that Aartas follows by creating a space that is more collaborative and tends to be equally transparent for both, patients and doctors.
The rising cost of healthcare: R & D
If you try to understand the primary reason why the cost of healthcare is going up, you will see that nowadays there is a lot of advancement that is happening in the field of medicine with a lot of technology coming into the picture, and how we are developing technology comes at a cost.
When I was training at the Mayo Clinic, we would spend a lot of time researching, coming up with new things, and then working on them. So all that investment that was going into the research eventually came at a cost. When we come up with a successful product and launch it into the market, it comes at a cost. Yes, we agree that that cost is for the benefit of the patient, but at the same time, it needs to be recovered. Let’s take an example, like an MRI. When MRI was introduced, it was meant to provide good, high resolution images of our human body so we could make better diagnosis. With time, we started increasing the resolution, and after doing a lot of research, we realised that we could do better and better. And you see, today we are adding artificial intelligence to the MRI for better diagnosis. At the end of the day, all this work that is being done at the back end does increase the cost, and there is an investment that goes into it. So this is the fundamental reason why the cost of healthcare, especially diagnosis, has gone up in recent times.
The rising cost of healthcare: Hospital infrastructure & Super Speciality hospitals
Another reason why the cost is going up is because our focus from primary and preventive care has shifted to super specialty care, and this also comes because there is a demand from the population. And we see that the hospitals are trying to get the latest infrastructure and are investing in it, which all comes at a cost, and then they have to recover it as well.
The rising cost of healthcare: Practicing defensive medicine
The third reason for the cost going up is that doctors are now practising defensive medicine. What does that mean? There is an inherent fear that if I do something and now miss something, tomorrow the patient can come and sue me, and my effort could go down the drain. I will give you an example. Usually, when a patient comes in, walks into the OPD, and says, “I have a headache,” you try to find out the reason for the headache and give some medicines. But nowadays, you are afraid that this could be an underlying tumour. Eventually, that extra investigation will add to the cost.
The rising cost of healthcare: Emerging technologies
Now we see robotics coming into the picture in the field of surgery. Initially, it started with simple robotics as an assistant to the surgeon, but nowadays they are able to do complicated surgeries as well. And all this advancement is coming at a cost because robots are very expensive. With increasing technology, we are also adding artificial intelligence to these robots, which is improving patient outcomes. So all this advancement that we are making in medicine is coming at a cost to the patient.The rising cost of healthcare: Insurance
I think insurance plays a very critical role in this. Like today you walk into a hospital, the first thing they are going to ask you is your mode of payment. They are not worried about what disease you have. Seeing whether you are going to pay by insurance or it is going to be out of pocket, yes, they are trying to secure themselves and that does help in giving unbiased care, but definitely it comes at a cost and overall it could increase the expenditure of health care.
Making healthcare affordable: Ayushman Bharat
I think our government has done a fantastic job with Ayushman Bharat, which is insurance for all. What that does actually is it decreases the threshold of a patient to go and visit their doctor to get care. This eventually helps in preventing complicated diseases and in patients and decreasing the overall cost of healthcare.
Making healthcare affordable: strengthening preventive healthcare
I think what we need to have is more preventive healthcare and primary health care combined with specialty healthcare, but in a leaner model where the infrastructure burden is not there on the doctors and so that they can give unbiased opinions. And I think the government is already doing a fantastic job with this, having more centers where you can get access to better care at a lower cost.
Hospital care: Challenges
If you see a hospital today, they are actually overburdened with so much crowding, which is adding to the dissatisfaction of the patients and, at the same time, causing burnout and fatigue among the doctors who are treating them. Hospitals are meant for advanced treatment, but today they are walk-ins for all regular visits. So we need to think of more linear models where the outpatient setting is taken out of the hospital, where they can focus more on inpatient services and high-quality care while doctors in a more relaxed environment can deliver outpatient care to the patients.
Aartas CliniShare
While I was studying and practising in the US, I saw very different healthcare compared to India, especially when I was at the Mayo Clinic. What we saw was integrative collaborative care, where multiple doctors from different specialties are working together for the best patient outcome. And I always felt that this was something that we lacked in India. While most of these places were driven by Indian doctors, they were doing excellent over there.
There was a lack of environment in our country, because of which the doctors are not able to deliver that kind of care. We started working on an idea: what if you made the doctor independent, took out all the burdens so that they could focus on the quality of care, and provided an environment where it was more collaborative and they worked together for the best patient outcome? And I think that is where the idea of Clinishare was born in 2019.
On day one, they can actually, without any investment, start their own independent brand and focus on the care because that is what the doctor’s job is: to focus on the care. At the same time, for the patients, we are trying to provide the most seamless experience and have the most advanced technology so they can get their OPD care in a much cleaner and nicer environment. We opened the first Aartas Clinishare on Ring Road, South Delhi, and within a year, we had a tremendous response from the community, both doctors and patients. Currently, we have over 35 super specialists at this location, and we are just opening another one in Golf Course Road, Gurugram. The idea is that by the end of this year we will cover Delhi NCR and then move to Mumbai. In the next 3 years, our vision is to open 100 such centres across India and build the largest private practise network for doctors.
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