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Evidence based medicine is a concept of medical healthcare where evidence in the form of tests and diagnosis is used to make a factual conclusion. Cost for healthcare in India is done on the basis of an individual service/test/diagnosis manner as opposed to a package manner. The recent case pertaining to MAX Hospital charging 13 lakhs for treatment of dengue is an example of individual costing gone wrong.

So with this in mind, we decided to ask the industry experts for their views on whether “evidence based medicine is cost effective?

Dr. Rajendra Patankar, Chief Operating Officer, Nanavati Super Speciality Hospital

Dr. RajendraThese days all standard healthcare practices are evidence-based. It’s an over generalized misconception that doctors or hospitals like to prescribe extra investigations for financial benefits. I believe that with ethical and patient centric health care practice guided by evidence-based medicine, we always ask for what is appropriate and required. The patient is always made aware of the tests and investigations are done only with their consents.

It’s an obvious fact that correct treatment is based on correct diagnosis. The second part of the story is the essentiality of documentation in every clinical practice. Not only the diagnosis but also the follow up (both in case of recovery or deterioration) needs to be scaled and documented both for clinical and medico-legal purposes. Now, let us assume the patient is willing to undergo non-evidence based medical treatment. In this situation, are doctors not indemnified, if the patient worsens.

Technology has given us an extra edge and we should build our skills to utilize the same. Also I would urge the society to restore their faith in the healthcare system and avoid generalization.

Narendra Karkera, Director, HOSMAC

KarkeraThis issue needs to be addressed from 2 points, consumer and availability. There is a shortage in purchasing power of the consumer i.e many patients are unable to keep up with the gradual rising cost of healthcare yet there is no shortage in terms of availability of such services, particularly in urban areas.

The concept of ‘general practitioners’ is virtually non-existent in the modern time. This inflates the cost of healthcare for the patient. GPs and super specialities have very different roles; GPs perform small checkups and prescribe medication whereas super-speciality doctors are highly evidence-based due to company policy, red tape and legislation. The highest individual cost here comes from the investigative side i.e the tests, scans and diagnosis.

Healthcare does not mean medical care. For instance, consuming clean water plays a key role in healthcare. If there is a water-based infection in an area, then no number of hospitals will solve the problem at the source. Similar nuances exist in other of these interconnected disciplines including food consumption, education and academic fees, societal/cultural practices etc. which inflate the cost. In such a system, evidence-based diagnosis further adds to the tremendous fees of medical care.

Arjun Arkal Rao, PhD candidate in computational biology, UC Santa Cruz

ArjunThe Indian system is a little flawed but has potential to be way better than the USA. A lot of the extra tests and choices of extra tests in the USA are guided by the insurance plan held by the patient as well. Insurance is an integral part of healthcare affordability. If you don’t have insurance and have a serious medical problem,you’re going to get bankrupt. If you have insurance and you’re on the network you pay a nominal amount. Out of network, you’re going to have a hard time. When my fiance had an allergic reaction to shrimp, she spent 4 hours in an ER where a nurse gave her 1 bottle of saline, 1 shot of antihistamines, and the bill after insurance was almost $1.3k. This is after paying almost $360/month as an insurance premium. After being here 5 years, I think the Indian way isn’t ideal and can be fixed, yet it is definitely better than here.

Ravindra Karanjekar, CEO and Executive Medical Services and Quality, Jupiter Hospital

RavindraGood clinical examination and seeing what is not obvious was certainly the hallmark of Indian allopathic and other ancient medicine. However in recent years the medico-legal cases have increased and the judiciary is asking for evidence on the procedures and tests. This evidence is given to support your diagnosis in a provable manner in a court of law.

Clinical acumen comes only with experience. However, the cost of this evidence is much higher and to be borne by the patient. And doctors are getting into habit of creating proof for their diagnosis

This is leading to increase health care costs. We need to balance these cost some wherever.

Dr. Joy Chakraborty, Chief Operating Officer, Hinduja Hospital

Dr. JoyWith the advent of consumerism and increasing level of patient expectations, healthcare providers and physicians are questioned regarding treatment protocols, adequacy of treatment coverage and justification for treatment. This is a relatively new phenomenon and indicative of a trust deficit which severely deteriorates the doctor-patient relationship. As a result doctors employ defensive strategies which leads to a further rise in evidence based medicine.

It is needless to say that evidence based medicine, if properly practiced, can bring about an authentic treatment flow for the patient. When the patient has to pay for several investigative procedures out of his/her pocket it leads to unaffordable healthcare. This leads to an ineffective scenario in healthcare delivery.

It is not that evidence based medicine is ineffective, but if it is not backed by suitable affordability then it becomes ineffective for the patient.