Healthcare is a service provided by multiple stakeholders. These are hospitals and clinics and their owners, physicians and allied staff , the Government, the population being served and the regulatory authorities. Gradually, the initiative is slipping into the hands of entrepreneurs with government and physicians playing a lesser and lesser role. Interlocutors have appeared who broker ( digitally) the cost , timing and availability between patients and healthcare providers. This is the most rapidly growing field. Regulatory bodies have enhanced their domain by controlling the quality of medical education and training, the eligibility and quality of care , the ethics of practice, the scope of drugs and devices and many unchartered areas. Corporate world and venture capitalists have now a big stake in healthcare and are rapidly consolidating their hold.. A healthcare provider is a person directly involved with patients. That includes physicians, nurses, technicians, physician assistants and other paramedical staff. Then there are healthcare managerswho organize and run the healthcare facilities and are a link between patients and healthcare providers and oversee regulatory issues as well. Healthcare regulators are both government and the autonomous institutions created for this purpose which also include representation from the healthcare providers either by nomination or election.All in all, there is some semblance of order with some obvious flaws. Healthcare is always in flux because it involves life of citizens, needs mega-bucks and there is constant innovation which to be put in practice will require approval, finances and acceptance.
However, let us confine our selves to quality and equity in healthcare. Quality is difficult to define. Some body said quality is doing your best when nobody is watching. Quality also has important ingredients like training and experience of healthcare personnel, their motivation and mission , managing time and resources, inter-disciplinary interaction and cost-sensitiveness. Money alone can not buy quality and good intentions alone can not provide quality. Motivation ( financial or otherwise ) can not be undermined. In the United Kingdom , number of patients seen by a family physician per day is about ten, in USA it is about 20 and in India it is about 50. With the same level of training and experience, quality of care will obviously differ. With 50 patients to examine in a typical 6-8 hour schedule , I may not measure blood pressure or temperature or weight or cut corners some other way. This will affect quality. Spacing by specialists is even more important. I once went for an outpatient appointment from a neurosurgeon for my wife in the USA. I looked at his schedule. Each appointment was 90 minutes apart. That is the way. Can we do so in India, Virtually impossible. Then the talk of quality is humbug. Training, qualification and experience of physicians is also an important factor in delivering quality . Can we uniformaliseit ?.If I work in a fee-for-service mixed outpatient environment and look after patients from scheme-card holding public or non-public sector along with cash-paying private patients as is the routine in most corporate hospitals, you would be naïve if you think quality of care will not differ when remuneration differs by a factor of ten. Equity is intertwined with quality as well as affordability. In an ideal world, quality and equity should have no denominators. Sadly , it is not so. Welcome to the real-world and smell the cow-dung rather than coffee.