Health care without paper

The Duterte administration wants to provide health care for all—universal health care. It’s a fine aim, and most governments want it, though few ever achieve it. The key reasons: money, organizational capability, personnel, infrastructure.

As I’ve explained in earlier columns, we’re moving into a world you’ll not recognize. A world where “Big Brother” will know everything about you; Big Brother being any organization. Haven’t you received a text suggesting a movie you should watch or a book you should read? They know what you like. Soon they’ll know more about you than you know yourself.

Well, the same intrusion is needed for health. The medical system needs to know details of your body and your brain. When you walk into a hospital or clinic, the caregiver should know with just a tap on a screen what condition you’re in and most likely what is needed to be done. We need to rapidly improve our health IT pathway to accelerate doing it all efficiently and cost-effectively.

In an emergency, it can be a lifesaver. The doctor will instantly know your health record, allergies, susceptibilities, the lot. Treatment can be done immediately. I had my blood type tattooed on my wrist so in an emergency, a caregiver would know what type of blood I need. In a computerized health care system, it wouldn’t be needed; it would be onscreen. Let’s fill in a medical form once in our lifetime — online; updates should be automatic with each visit.

That data, though, must be protected; it’s as private as your bank account, and even more so. The modern word is cybersecurity. All medical data need to be accessible by only you and approved caregivers. (Unless you’re the President, whose health condition is of national concern; he looks fine to me).

Introducing an integrated, fully online, paperless system will need assistance. The Department of Health (DOH) has the willingness to do it, but not the sufficient expertise. Private sector support will be needed. Given the huge disparities extant in the Philippines, it’s going to be a complex system and it will cost a lot of money, money that the DOH would be better off spending on curing patients.

Contracting it out to be designed and developed in consultation with the DOH, and then managing it, can best be done by the private sector where the expertise and experience exists. The DOH can ensure that it is responsibly undertaken.

But this is only the underpinning of what must be a much larger system. A system that can cover you from a headache to fourth-stage cancer, and be able to recognize where you best need to go to get the appropriate treatment.

That means enough hospitals, enough clinics, enough doctors and nurses, enough medicines, enough money to pay for it all. Mind you, doctors will become less and less needed as artificial intelligence and integrated medical equipment and systems take over more and more. An MRI is only an early example; it can detect internal problems better than a doctor can. Soon, you’ll be able to stand in a box and the box will read all about you. Until then, we’ll need doctors. (That’s good, I like mine.)

One of the biggest expenses is running hospitals and equipping them, even building them. This is another area where the private sector can help and take over. Make money from those who can afford it, but be mandated to provide equally for the poor for free — funded by the rich and subsidized by the government, too, if necessary. Government can legitimately subsidize, since it’s cheaper than doing it fully itself. The private sector is generally more efficient, too, albeit not always; the top government hospitals have a very fine record of management.

Local governments, too, play a part, as they’re responsible for maintaining clinics for primary health care, relieving hospitals from being overburdened with minor illnesses a clinic can handle. Too many clinics aren’t doing that job well enough.

Medicines are another big expense. Here, savings can be achieved by going big. Buy within a centralized system that allows for large volume purchases under a multiyear contract. That way, low prices can be negotiated. This is a more effective and acceptable way of getting the best deal than trying to artificially control prices, which can have serious negative repercussions.

In all of these, the doctors, nurses and other health caregivers, including the pharmaceutical industry, need to be included in the development of the best systems. It wouldn’t hurt to talk to a few patients, too.

Farewell to a great man, Nesting Espenilla.

E-mail: wallace_likeitis@wbf.ph