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A Fresh approach is needed for the Community investments in the Health Delivery System

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Post-Covid: With a Disrupted Primary health care system, poor Muslims are the worst sufferer

• Extensive randomized studies find that people given free Healthcare consume a lot more medicine yet don’t end up noticeably healthier.

• Meanwhile, non-medical interventions—such as efforts to alleviate stress or improve diet, exercise, sleep, or air quality have a much more significant apparent effect on health. Yet, patients, social entrepreneurs, and community philanthropists are far less eager to pursue them.

Some studies have pointed that Poor Indians are now experiencing disruptions in health care delivery services. Such as health checkups, vaccinations, prenatal and post-natal care, postponement of surgeries, routine medical treatment, resource constraints, and a general uneasiness with using health services due to a fear of getting COVID-19.

When Poor children are denied access to health services because the system is overrun, and when women are afraid to give birth at the hospital for fear of infection, they, too, may become casualties of COVID-19. Without urgent investments to re-start disrupted health systems and services, millions of children under five, especially newborns, mothers of just born babies, elders who have comorbidities, could die.

Community is spending exorbitantly on heroic end-of-life care, tertiary and emergency medicines. Even though cheap, palliative care is usually just as effective at prolonging life and even better preserving the quality of life. There are many misconceptions, such as that medicine is always beneficial and improves health. To probe these and other Misconceptions prevalent, this writer and his Agency, ‘Trend Research & Analysis Centre’ (TRAC), surveyed search answers to the two common healthcare-related issues faced by the Muslim community in the covid post period.

• What are the Gaps in the health care delivery system, which requires community investments to save precious lives by timely intervention?
• What are the priority areas in health care which can benefit the maximum number of Poorest amongst Muslims?

The primary objective of the research is to find out the most effective ways for the utilization of the scarce community resources and to provide data to the social entrepreneurs and community philanthropists in the delivery of health care amongst the poorest amongst Muslims.

Unfortunately, due to lock down, the funds available for primary Healthcare such as post and pre natal care, Dental care, basic hygiene, and sanitations have dried up, and the poorest of the poor have to go without Primary health care. The need is to utilize the community resources and investments by identifying the priority that could benefit the poorest section of the community.

Muslim Community, in a way, is better-off in comparison to other communities as they have a socio-religious system of Zakat and community philanthropy. Though Funds have drastically reduced due to lockdown, the community continues its investments in providing Healthcare to the downtrodden.

Now the question of priority arises. Pre-covid period, substantial Community funds were earmarked for establishing tertiary healthcare setups such as heart and other complicated surgeries, Dialysis centers, Cancer hospitals, and high-end medical investigations centers.

In health care, there are no basic Gap studies conducted. The community’s investments are disbursed based on the projects submitted by the social Entrepreneurs or socio-religious groups. Thus many a time, non-priority health care gets the funds at the cost of priority health care.

We hypothesize that a significant issue in health care is the wastage in the health delivery system funded by the community. Contemporary human society seeks and gives Healthcare even when it isn’t medically beneficial. Cesarean delivery, Invasive and Non-invasive diagnostic testing, surgeries etc., and similar healthcare transactions lurk within our modern medical system. Except we don’t notice it because it’s masked by all the genuine healing that takes place and plays upon the most powerful human need to preserve life at any cost.

In other words, expensive medical care does heal us, but it’s simultaneously an elaborate and costly tool for earning profits by those parts of the health care system. In this transaction, the patient is assured of social support, while those who provide such help hope to buy a little slice of loyalty from the patient and thus earn profits. And it’s not just doctors who are on the supportive side of the transaction, but everyone who helps the patient along the way: the spouse, parents, or children who insist on the doctor’s visit, the relatives who watch the kids, the boss who’s lenient about work deadlines, and even the institutions, like employers and community organizations, that sponsored the patient’s health care in the first place.

Emergency medicine and tertiary health care routinely save people from situations that would have killed them in the past. But the fact that medicine is often effective doesn’t prevent us from using it to show that we care (and are cared for). That leads to overmedication and wastage.

All these transactions are done to satisfy the most basic need of the human being to receive care. But in the entire process, the mechanical part and its process dominate, and ‘care,’ the basic need goes out of the window. As a result, though, each of these parties is hoping to save life at any cost, but the net result is that patients end up getting more medicine than they need strictly for their health, spending more than what is necessary, which in turn deteriorates their health.

Another practice that needs rethinking and re-strategizing is the free distribution of medicine to the poor. A large community fund is utilized for distributing free medicine to needy patients. Ironically, studies have confirmed that free distribution of medicines has resulted in over medication, which is harmful to patients and loss of precious resources.

Extensive randomized studies, for example, find that people given free Healthcare consume a lot more medicine yet don’t end up noticeably healthier. Between 1974 and 1982, the RAND Corporation, a nonprofit policy think tank, spent $50 million to study the causal effect of the medicine on health. It was, and remains, “one of the largest and most comprehensive social science experiments ever performed in the United States. As expected, patients whose medicine was fully subsidized (i.e., free) consumed a lot more of it than other patients. As measured by total spending, patients with full subsidies consumed 45 percent more than patients in the unsubsidized group. However, despite the significant differences in medical consumption, the RAND experiment found almost no detectable health differences across these groups.

The only other large, randomized study like the RAND experiment is the Oregon Health Insurance Experiment. In 2008, the state of Oregon held a lottery to decide who was eligible to enroll in Medicaid. Like in the RAND study, lottery winners ended up consuming more medicine than lottery losers. However, unlike the RAND study, the Oregon study found two areas where lottery winners fared significantly better than lottery losers. One of these areas was mental health: lottery winners had a lower incidence of depression. The other area was subjective: winners reported that they felt healthier. Surprisingly, however, two-thirds of this emotional benefit appeared immediately following the lottery, before the winning patients had any chance to avail themselves of their newly subsidized Healthcare. In other words, lottery winners experienced something akin to the placebo effect.

Thus, Orgon’s study confirms that more than medicine, most patients require the feeling that there is someone who cares for them. Therefore non-medical interventions such as efforts to alleviate stress or improve diet, exercise, sleep, or air quality have a much more significant apparent effect on health. Yet, patients, community philanthropists, and social Entrepreneurs are far less eager to invest in these life support systems.

(To be continued… Survey findings and analysis in the October edition of Islamic Voice)

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