Making healthcare service delivery uncomfortable, less conventional

A COLLEAGUE once narrated to me a story of someone going to a local, public hospital and waiting in line for two and a half hours – not because the queue was long but because the attending nurse kept taking his friends in to see the doctor ahead of everyone who had been waiting all the while. When complaints were raised, the nurse coolly told them that they could go elsewhere if they didn’t want to wait. I wasn’t surprised… In fact, I doubt many readers are surprised. We have earned our stripes when it comes to public health indicators and yet there’s a lot to be desired in consumer health service delivery. To be fair, our situation is not unique and judging from news outlets, enormous efforts and resources have been invested in trying to turn public hospitals around. Healthcare delivery is a touchy subject in many countries world over but our context given our history, population growth, you name it, makes everything more perilous. Our doctors are overburdened, which translates into increased human error, thus reducing the quality of care and affecting survival rates; in turn, reduced quality of care means lost economic output because of productivity losses and sunken health care costs – which are a burden to the economy (WHO estimates the total expenditure on health as a percentage of GDP in Rwanda at 10%). So if our hospitals have increased specialist training programmes for doctors, procured innovative health equipment and revamped service delivery, how about revising the business model and financing of these institutions? Think about it…most hospitals have something to gain from the repeated visits by a patient and increased number of patients. In fact, no matter how many trips I make to the hospital, the health provider is assured of compensation. What incentives exist for public health providers to ensure that a patient recovers fully and well, other than good will and reputation? (If you know of any incentives for public providers, please email me). Essentially, it is like a mechanic being assured of pay, regardless of whether the broken-down car is fixed or not. Furthermore with universal health insurance coverage, who is paying for these visits? I will let you answer that. The call for change in the business model of healthcare provision is sweeping up worldwide. The new school of thought advocates for a model whereby the recovery and wellness of a patient is incentivized to the healthcare provider and insurance payer. In this case, the healthcare provider is compensated whenever a patient recovers, and a premium placed on providers who show a track record of few repeat visits for the same condition of any given patient. In this model, the patient doesn’t visit the doctor only when feeling unwell: it is in the interest of both doctor and patient that regular visits are made to the hospital to ensure that the person is healthy. In essence, it is like incentivizing taking your car for regular maintenance and service, as opposed to waiting for a breakdown. Are we ready for this business model? I cannot answer that. I do know that we cannot ignore the urgency for change, even gradual change. With improved standards of living, better sanitation conditions and increased access to medication (and education) for HIV/AIDS, Rwandan life expectancy is increasing; living longer means a surge in the number of elderly people who need medical attention and care. Also, lifestyle changes have increased the burden of Non-Communicable Diseases like cancer and diabetes on our population and health systems. Needless to say, we need more doctors and more nurses, more specialists, and access to the best equipment but we could also take a stab at reinventing how we deliver healthcare to the people – we wouldn’t be the first, as it so happens. For more information on a paradigm shift in healthcare delivery, visit Frost and Sullivan (frost.com) healthcare resources. Next week well address the role technology can play in shaping healthcare. Twitter: @rwandalavender

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Making healthcare service delivery uncomfortable, less conventional