Saturday January 19, 2019

Obamacare: Lessons Indian healthcare can imbibe

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health-621353_640By Dr. J.K. Bhutani

The healthcare system of any country, be it US or India essentially has three key players, viz. Providers, Payers and the Public Health. The successive governments have had many successes inter playing these keys and such actions have led to many improvements in the US healthcare delivery systems. But much work still remains to be done. The private and public insurance reforms and other interventions apart, one in six Americans still does not have insurance cover and thus, cannot access the best health care.

The infant mortality, the life expectancy, other health parameters and quality of healthcare have improved over the years but the cost escalation has increased to disturbing levels too. The US health care costs are disturbingly high, so much so that the providers are sometimes labeled as ‘Working just for commerce and profits unlike the forefathers who worked for serving the humanity’.

From Harry Truman shortly after World War II, to Barack Obama now, many presidents have tried to reform the US healthcare system. The most laudable and controversial has been ‘The Patient Protection and Affordable Care Act of 2010’ or ACA, which has attempted to recognize and support the key role of Public Health in the healthcare system. The US Supreme Court recently upheld the nationwide availability of tax subsidies for the implementation of President Barack Obama’s signature healthcare law… Obamacare (Affordable Care Act – 2010).

Of the four components of any health delivery system (Patients, providers, payers, and public health), The Affordable Care Act attempts for more funding and key role of Public Health. The ACA shall reduce ‘out of pocket’ expenses and bring all preventative care under insurance… subsides by the Federal Government. All developing economies including India, need to learn and strengthen the Public Health institutions from the greedy corporates and their ‘Target-business’ models of health delivery for hospitals and service providers.

Other issues which need attention in US and India are –

1. The American health system with a provision of ‘cutting edge technology’, ‘micro-specialization’ and the ‘best evidence-based practice state of the art medicine’, is the role model for the whole world. The costs are more essentially because of the excessive reliance on the investigative ‘work up’ for fear of litigation. The bulk of the common diseases which have self-limiting course are also worked up unnecessarily.

The primary care strengthening should address this and some strategy can be evolved and legislated to keep common day-to-diseases out of the ambit of litigation. This single step can reduce the cost of nearly 80 percent of the diseases which have an insignificant or self-limiting course.

2. The onus of responsibility exclusively on the Federal Government though sounds responsible but is more of a populist measure for winning the elections in democratic set ups. The onus of the physical and mental health of the family and children should be the responsibility of the parents and the role of the governments should be to improve the social component of health like providing good civil conditions and good environment including water, housing etc.

3. The Insurance concept makes us all reckless with our health and should not be owned completely by the governments and should be shared by the people especially for the Metabolic disorders and Lifestyle diseases like Obesity, Hypertension, Diabetes, Trauma, Alcoholism, Drug Abuse, etc. for which the person himself should pay and Federal Government should only have affirmative role in such diseases. These should be out of ambit of Medicare or Medicaid and insurance subsidies….!

JK1

Dr J.K.Bhutani MD is a protagonist of preventive and promotive health care based on austere biology and facilitating self-healing powers of human organism.
You can follow him at https://twitter.com/drjkbhutani

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Keep A Sleep Track During Pregnancy

Understanding the role of maternal sleep may help us identify interventions that would put us in a better position to advise women

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Pregnancy, Breast Cancer
Keep a check pregnancy check.

Sleeping more than nine hours per night during pregnancy may be associated with late stillbirth, suggests a new study.

This is because blood pressure reaches its lowest point during sleep which has been linked with foetal growth problems, preterm birth, and stillbirth.

The study, led by a team from the University of Michigan, explored how maternal sleep habits, including lengthy periods of sleep without waking more than once in the night, may be associated with foetal health independent of other risk factors.

Moreover, pregnant women often report waking up and getting up in the middle of the night.Very disruptive sleep has also been associated with poor pregnancy outcomes, including growth restriction and preterm growth.

The safety of domestic violence victims can also be potentially threatened by the discovery of a disposed of the test. Wikimedia Commons
Balanced sleep is important in pregnancy for a healthy baby.

“Our findings add to research indicating that maternal sleep plays a role in foetal well being. Studies aiming to reduce stillbirths should consider maternal sleep as this is a potentially modifiable risk factor,” said lead author Louise O’Brien, researcher at the varsity.

“Understanding the role of maternal sleep may help us identify interventions that would put us in a better position to advise women,” O’Brien added.

Also Read: Understanding the role of maternal sleep may help us identify interventions that would put us in a better position to advise women

For the study, reported in the journal Birth, the team involved 153 women who had experienced a late stillbirth (on or after 28 weeks of pregnancy) within the previous month and 480 women with an ongoing third-trimester pregnancy or who had recently delivered a live born baby during the same period.

Progress in reducing stillbirth deaths has been slow but stillbirth is an urgent global health issue that should be at the centre of more research programmes, the researchers noted. (IANS)