A New Approach to Quality Health Care

The quality and model of health care must be reengineered and benchmarked on best practices prevailing in the world so as to provide quality health care services to the people and to play a premier role in helping Mauritius become a competitive centre of excellence of high tech medicine

By Mrinal Roy

A sum of Rs 12.2 billion was earmarked in the Budget 2018-2019 for the Ministry of Health and Quality of life in order to ‘enhance the health care system and make of Mauritius a medical centre of excellence.’ What is the real situation in the health sector?

Mauritius benefits from a large health care infrastructure comprising general and specialized hospitals and health centres spread across the country manned by some 5,000 medical and paramedical personnel, which offer a broad spectrum of free health services to the people. Costly medical treatment such as cardiac surgery, dialysis, angioplasty and stent placement, neurosurgery, etc., or investigations such as MRI or CT scans,  etc., which all cost enormously in private clinics as well as the diverse consumables required for treatment are borne by public funds.

Yet, criticisms are intermittently levelled against the quality of public health care. Despite the wide range of facilities, the public health care service is perceived as being subpar to the costly medical services provided by private clinics despite the fact that very often the specialists in various fields practise in both the public and private health care sectors. Isn’t it time to reappraise the whole system of public health care to ensure that it is aligned on the highest benchmarks prevailing in the world?

It must also be underlined that apart from the quality of medical care provided, medical insurance cover is the key factor which determines the choice of treatment of patients in private clinics. The insurance cover is benchmarked on the costs of appropriate treatment available worldwide. It has had a potent cost-push effect on the cost of medical treatment locally. The upshot is that the medical insurance cover schemes guarantee to a large extent the revenues of private clinics.

Unequal choice

The choice of people for competent treatment and cure cannot depend on whether they benefit from private medical insurance cover or have the means to pay for the costly bills of treatment in private clinics. With such a substantial budget outlay invested in health care facilities, the public health service must be able to offer an equally competent treatment, health care and cure especially for the multitude who neither have medical insurance cover or the means for treatment in private clinics. The people cannot be short changed.

The medical landscape in the country is grim and the challenges daunting. The population is ageing. Health can be very fragile. In a country where some 200,000 persons are aged above 60 years old, it is vital that the health services of the country provide a quality health care to them and to people generally. They need to be treated with dignity and their ailment cured competently. For those suffering from life-limiting illnesses, every effort must be made to allay their suffering through palliative care and to comfort them. It is disconcerting that the vital project of a geriatric hospital has disappeared from the government screen. The quality of the medical and paramedical personnel must also be continuously upgraded so as to enable them to provide a constantly improved health care to patients.

All things being equal, more people will seek, owing to the ageing population, health treatment for a variety of ailments associated with old age. Furthermore, senior citizens cannot, owing to their age, obtain health insurance cover. They are compelled to be their own health insurers and whenever necessary foot the bill of the excessively high cost of health care and surgery if necessary, in private clinics. However, it is only a minority of elderly patients who can afford these costly treatments. Most of them depend on the public health service for treatment.

The public health services must therefore be fully prepared to treat a larger number of elderly patients who would require treatment for diverse ailments and more importantly would need a much higher quality of health care from the medical and paramedical personnel.

Life threatening

Medical statistics also show that diabetes, heart diseases, cancer & tumors, chronic respiratory diseases and cerebrovascular diseases are in that order the principal causes of death in the country. Are the national health services geared and equipped to competently deal with such a daunting list of life threatening diseases? Would it not therefore be more judicious and sensible to build the important state of the art cancer hospital from scratch on state lands in a location which is easily accessible by public transport instead of transforming the derelict MedPoint premises?

It should be noted in this context that the 2018 Nobel Prize winners in Medicine was awarded jointly to James P. Allison and Tasuku Honjo “for their discovery of cancer therapy by inhibition of negative immune regulation.” Thus, immunotherapy brings hope as it is now successfully used abroad to boost the body’s defense against cancer cells in the case of skin, bladder or lung cancer.

Is it not equally high time to start as is the case for the National Health Service in the United Kingdom a preventive medicine campaign based on an early tracking of diseases likely to affect people after a certain age, through appropriate tests carried out on all persons at risk? This should inter alia include mammography and pap smear test for women and psa to detect prostate cancer. Colonoscopy as from a certain age to detect colorectal cancer and chest X-Ray to detect lung cancer should also be included in the tracking procedures in place, for both men and women.

Proper communication with the patient and the next of kin is also a key element of treatment and cure. Whenever you come across somebody you know whose family member has been admitted to hospital, you seldom have precise information on the exact ailment the patient is suffering from, the treatment he is receiving, the name of the doctor who is treating the patient or on the prognosis, etc. In line with the best practices prevailing in the world, hand in hand with providing quality treatment to patients, it is equally important that the patient and his next of kin are regularly apprised of his/her state of health and the timeline and outcome of his/her treatment through regular communication. Is there not a well codified protocol to deal with hospital patients? Do the doctors in charge of their treatment regularly inform the patient and their next of kin on his/her state of health and the treatment envisaged?

Oath of duty

It does not cost anything for the medical and paramedical personnel to communicate regularly with patients and their next of kin to explain, reassure and comfort in line with the oath of duty of doctors towards their patients. The quality of health care would have been so much better. It would also lead to confidence building in public health services and establish a trustworthy connect between doctors and nurses and their patients.

High tech medicine has been earmarked to be another robust pillar of the economy. It should however be underlined that the well known foreign partners of private clinics who helped (with their pool of highly qualified specialists skilled in diverse cutting edge treatments)  build the reputation of Mauritius as a reputable centre for high tech medicine have left the country. Mauritius can only build this sector into a major pillar of the economy if the sector is geared to provide high tech medical services and offer the most pointed and state of the art medical procedures and treatment to foreign patients in a wide range of medical fields including cardiology, ophthalmology, nephrology, dentistry, cosmetic & plastic surgery, etc., at competitive prices.

Premier role

Should we not envisage as is the case in government hospitals in the United Kingdom and France specially designed private wings in state hospitals offering diverse medical treatments to foreign patients at competitive rates? These could be tied up with renowned specialists in different fields from across the world to offer more pointed and high tech medical treatment to both local and foreign patients. Such a development would not only help train local specialists, doctors and nurses into more pointed medical procedures but also be a significant source of financing to invest in better medical facilities and equipment. It would also bring healthy competition and benchmark medical costs in the country.

The status quo is therefore untenable. The quality and model of health care must therefore be reengineered and benchmarked on best practices prevailing in the world so as to provide quality health care services to the people and to play a premier role in helping Mauritius become a competitive centre of excellence of high tech medicine for the benefit of the country.

* Published in print edition on 16 November 2018

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