Kriti (name changed), my co-resident in an apartment I am renting out during the internship is a typical young professional working in the booming software industry in India. The neighborhood we live in is serviced by the best amenities possible including services for health care that range from clinics, secondary hospitals and super-specialty centers. Two weeks into my stay here, Kriti developed a recurring back pain that almost affected her mobility. She knew she had to see a doctor but needed answers to many questions before she chose one – which doctor/ specialist will be right for the problem, how expensive will the services be, will the doctor have time to hear about her entire medical history before he/ she prescribes her a treatment.
Incidentally my study during the internship was looking at this very issue – the rising cost of healthcare resulting from a lack of preventive care as well as lack of information. For example, a lot of Kriti’s problems could be sorted if she could see a family physician. The family physician would perform a preliminary investigation helping Kriti diagnose the problem and also prescribe the preliminary treatment. While the specialists look only at the specific cause of concern, the physicians would view Kriti’s health concerns from a holistic point of view and provide a more comprehensive line of treatment. If need be, he would direct Kriti to the right specialist. On top of all this, seeing a family physician would be much less expensive than seeing a specialist in the first place.
The problem is that the presence of family physicians has significantly dropped in India. Fewer medical graduates want to follow the stream of family medicine as against super-specializations like cardiology, neurology and urology etc. More and more people are changing cities frequently for their jobs making it difficult to have a dedicated family doctor. Further, with a rise in income levels and easier access to specialists, there has been a surge in demand for their services. With a diminishing supply of providers, and an inconsistent demand for general practice, the breed of family physicians is nearing extinction in the country.
At the same time, lifestyle related and non-communicable diseases are rising in India. According to a 2010 World Bank report, the percent of out of pocket expenses incurred by households in the country on non-communicable diseases rose from 31.6 percent in 1995-96 to 47.3 percent in 2004. Family physicians who take on the role of health managers and promote preventive health can significantly improve health stats of the population.
A handful of providers are doing just that. Nationwide Healthcare in Bangalore, Ross clinics in Gurgaon and Healthspring in Mumbai are amongst some of the providers trying to revive the family physician model. They are all multi-clinic chains servicing communities in urban and peri-urban areas and working to reestablish the trust for a family physician as the first point of contact for any health concern. More importantly, they are reinforcing the importance of preventive rather than curative care. They are all in the first few years of their operation, and while it may be hard to assess their success at this stage, they offer an interesting study as innovative health care models that are striving to improve the population’s health indices.
ACCESS Health International (AHI), the agency I am interning at is taking an active interest in these models and others similar to them. While here, I am conducting a study of these models to understand their delivery model, document their success stories, and identify challenges they face including support for replicating and scaling up. Going forward, AHI will be working to build a community of practice that will facilitate a collaborative environment amidst the different players interested in the field.