This rapidly expanding population of physicians is already increasing the competitive pressure on practitioners to generate more income by using marginal or new unproven procedures, tests, and technology. As the number of physicians continues to increase, and as competition from outside the profession from nurse practitioners, chiropractors, and other kinds of health practitioners also expands, the pressure is bound to grow.
MEDICINES YESTERDAY DISPENSING THE MIXTURES, POWDERS & COMPOUNDS
January 26, 2001 was a significant day for India in more ways than one. Apart from being the country’s Republic Day, the day was also marked by the devastating earthquake in Gujarat. Some 40,000 lives were lost, and over one lakh people were badly injured. The need at that point in time was to immediately treat the injured and provide healthcare facilities to prevent further deaths. But given the magnitude of the calamity, the number of available medical personnel proved inadequate. To make matters worse, many hospitals and other medical facilities were destroyed by the earthquake.
In this gloomy scenario one promising technology made its impact: Telemedicine. The day after the earthquake, the Ahmedabad-based Online Telemedicine Research Institute (OTRI) came to the rescue and established the first communication link from Bhuj, which was close to the epicentre of the quake. Within the next four days, OTRI established a disaster management system with online transmission from places like Rapar, Bhachau, Gandhidham, Anjar and Ahmedabad, with the control room based at Gandhinagar .
Specialists were able to provide consultations from far-off places, thanks to the established telemedicine links. For example, after the telemedicine centre was set up at Bhuj hospital, an X-ray facility was provided to the people whereby a specialist provided online consultation from Ahmedabad. During the subsequent days, quake victims could get medical advice from other doctors based at Ahmedabad and Bangalore. Over 750 sessions were established in a period of 30 days, thus saving many lives.
Telemedicine :-A method by which patients can be examined, monitored and treated, while the patient and doctor are located in different places. The patient’s reports can be sent via text, voice, images or even video, and medical advice offered from a remote location.
of patients. They became claimants for medical care to which they felt entitled because the insurance premiums had been paid, and they had no personal interest in what things cost, since there were no out-of-pocket expenses.
NEWER INVESTIGATIONS A nationwide network of over 45 medical equipment distributors can place and service the system you purchase with other doctors in hospitals that actually use the equipment. The doctor or hospital using your equipment then pays you for each ECG they run, with a minimal monthly guarantee.” The ad goes on to explain how the purchase and subsequent lease of this equipment provides a physician with depreciation,
SPONSOR FACTOR …. “ Dear Dr.: You probably recognize the value treadmill exercise testing and Holter monitoring/ INSULINS have in helping you deal more effectively with the epidemic incidence of coronary heart/ DIABETES & disease . . . but may have questions about the procedures and how they will fit into your setting. What better way to evaluate the role of either or both of these valuable procedures than to take advantage of this Special Offer. . . . ”
The ad then explains that the company will pay the doctor’s travel and lodging expenses to attend a two-day professional educational seminar on exercise testing and Holter monitoring, which is to be held in Taj Goa/ XYZ.
For those who purchase equipment, the company offers to pay all expenses for two, for a week in a luxury hotel in Goa/
They further offer to train the doctor’s office staff and provide a sixty-day period to evaluate the procedure on a lease or rental basis. They also offer to reimburse the doctor the difference between billings, and the rental during those sixty days. This kind of appeal evidently does not fall on deaf ears because the ad concludes this way: “We have assisted literally thousands of Physicians to evaluate the role of these procedures in their setting. Let us send you referrals in your area .
In the long run, physicians must be in charge of medical care, but they must live within budgets and be accountable to payers and to their patients. The only solution that makes sense to me is one based on multiple local physician networks, organized on a not-for-profit basis. In short, I predict that staff and group model HMOs, with salaried physicians, will be the mainstay of the medical care delivery system within a few decades .