14 September 2010
Mumbai, India
The proposed National Standard Treatment Policy (NSTP), which will create a common framework for medical diagnosis and treatment, is a positive move by the Union health ministry. For a start, it seeks to level the field between laymen and experts; faced with a doctor’s opinion, few can afford to question the diagnosis or the tests prescribed, whatever the cost. Second, NSTP will help reduce disputes between hospitals and medical insurance companies over what is, or is not, a legitimate expense. Recently the two have been at loggerheads, and insurers have struck off several hospitals from their active list of cashless hospitalisation. Net result: patients have been left high and dry.
The main problem is that doctors don’t always agree on the line of treatment or the number of tests needed to aid diagnosis. Many patients suspect that doctors and hospitals prescribe tests based on a patient’s ability to pay rather than real need. While it would be foolish to tar the entire medical profession with pecuniary motives, there’s little doubt that clinics and diagnostic centres that invest in expensive equipment have to ensure a certain throughput to recover costs — and friendly doctors can be allies in this.
That said, one has to recognise that there are limits to standardisation. Given the huge outlays required for drug development, there is some correlation between higher costs and better healthcare. Without these incentives, pharmaceutical companies have little reason to develop new drugs and push the frontiers of research.
The other point is that governments should not seek to play doctor. While it is good to have a chart of standardised tests so that all patients know what is to be generally expected, doctors have to do what is best for their patients. This means whether we have a standard treatment policy or not, the doctor has to have the final word. When doctors have the responsibility to help a patient get better, the government cannot afford to second-guess their expertise. If not, patients can take the NSTP chart and treat themselves.
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