Saturday, March 24, 2012

Health Care System in India and US

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Having lived in US for close to 10 years and now back in India for close to 2 years, I feel I have the right credentials to compare the health care system in India and US from the perspective of someone who has been through both systems extensively. I have visited the triage area (emergency room) a couple of times in the US, consulted with doctors numerous times and was with my wife when she had to stay in the hospital for close to 96 hours during our daughters delivery. After coming back I was admitted twice and my wife once to a hospital here due to viral fevers. So having experienced both systems, here is what I think.
Appointment with a Doctor
One day I went to my primary care physician (PCP – equivalent to general physician in India) in US with back pain. He told me that I need to go and see a specialist doctor and he also gave me few names. I came back home and started calling those doctors. The earliest appointment I could get with a specialist, that accepted my insurance, was after six days. I was forced to live with that back pain for those 6 days as I had no other option.
I almost had the same back pain after I came back to India when I was in Trivandrum. It was around 6:00 PM in the evening and I told my father about it. He made some phone calls and asked me to go and meet with a doctor who practiced in his house that was 5 kms (around 3.1 miles) away from my house. I reached there at 7:00 PM and within 30 minutes I could meet him. The doctor I met was one of the best in Trivandrum, a retired professor from Government Medical College. One cannot even imagine such a thing in the US.
I always felt that doctors in US treat you as an object while doctors in India treat you more like a human. I mean ever for very small fever – the doctors in US treat you like a flow diagram we draw in computer classes. He never deviates from that may be due to the fear of suing from the patient if something goes wrong. They do umpteen numbers of tests taken before they start talking to you. A minor incident that comes to my mind – while doing MS a friend of mine had a huge boil in one of his legs. He went to this American doctor who told him that the only solution was a minor operation with local anesthesia. He got the date for the operation after 3 days and for three days he was given pain killers so that he wouldn’t feel the pain. My friend was mentally preparing for the operation when I met him that day. I told him that I had something similar when I was in India and the doctor told me to apply cold water and ice for couple of days as boil comes due of excess heat. He did what I told him and he got his boil healed in 2 days. Rarely will a doctor in US prescribe cold water for boil in your leg. Other than the lack of human touch I always felt that there is not much difference between the Indian and US doctors.
Cleanliness inside hospitals and clinics – no prizes for guessing right - US hospitals and clinics are at least 1000 times better than Indian hospitals in terms of cleanliness. There is a good chance in India that you go to the hospital with one disease and come out infected with another due to unhygienic conditions in and around the hospital. Even the best Indian hospitals have a long way to go.
Guest Care
Most of the time nurses and other hospital staff in India behave very rudely to the patients and other visitors, the reason being that these people are highly understaffed and paid very less. They take out their frustration on patients who visit the hospital. This is not the case in the US. The nurses (you have to be extremely unlucky if you don’t find an Indian as a nurse) and other support staff in hospitals are so good and caring that they do everything to make you feel comfortable during your stay there.
I still remember this one even though it happened 10 years ago. While doing MS, we never had dental insurance. My room mate developed severe tooth pain and went to a dentist. Since he did not have dental insurance, the dentist charged him $300 for that visit and told him that he needed a root canal and will cost close to $1300. My friend who was studying then without a scholarship told the doctor that for that amount he can take a round trip ticket to India, meet his family, undergo root canal and still save $100 or $200. He came to India during summer and got the root canal done. Ten years later I got a root canal for one of my teeth and all I paid was Rs. 3500 ($70). This should sum up the cost of health care in US and India. You are as good as “dead” in US if you don’t have a good insurance. Health care is just not affordable.
My wife had a very bad allergy one night while we were in the US. She knew the medicine she needed to take, confirmed with her brother in India who is a doctor. But that happened to be a prescription drug and no medical store was ready to give it to her over the counter. She had to wait one full day to get an appointment with her PCP and get a similar medicine prescribed by the physician. No such problem in India. Walk into any medical store and you can get any medicine you want. If you are having a mild cold or fever you can even tell the pharmacist the symptoms and majority of the time they give you the correct medicine. Yes it may lead to misusing of drugs but for most of us this is very convenient.
Overall – my observation – health care in India and US are two different systems that cannot be compared. Each has its own unique advantages and disadvantages. It takes sometime to adapt from one system to another.
If you have lived both in India and the US, I would like to know your take on the health care systems.
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Anonymous Rahul Kalbalia said...

Interesting and Informative :)

March 24, 2012 6:18 PM  
Blogger Jennifer Kumar, Cross-Cultural Coach said...

Brijesh, I am an American (as you know!)... I lived in Chennai for two years a decade ago and now been in Kochi a year. I feel I do not have enough information to really compare holistically. But some of the things you said, I also have experienced.

When the US economy was good (in the 90s) health care and health insurance was better. I have been fortunate, I always found doctors in the US who were thoughtful, considerate and listened to me. I mean PCP or family doctors. Visits to the Emergency Room (ER) on the other hand have generally not been memorable in a good way unless it was a small town. Small town you have to wait, but the doctor will listen and be more personable. Medium size to larger cities I have experienced they do more or less treat patients like numbers, mostly due to this insurance mess.

Yes, I agree medical facilities in India are generally not as clean as in the US. I have had experiences in Chennai, Kanchipuram and Kochi. I always find it amazing (and, sorry to say, gross) when there is no soap or clean towels to wipe your hands on in the bathroom.

I also find in the US there is more emphasis on privacy. In a hospital in Kochi they herded a bunch of people for Xrays. While one person is in there, others can open the door and see what's going on. In another situation an aunty went in for a similar text and had to change in a hospital gown. Her daughter went in to help her. As she was changing back into her sari, the doctor let the next patient into the room to change- a MAN. No consideration or privacy at all. This poor aunty was half undressed when this stranger man was allowed in.

Anyhow, for me the other issue is language barrier. Yes, doctors in India know English and it's not fair because it's better if I could speak the local language. Anyhow, due to the language and cultural barriers I misunderstand a lot here, and that too in the hospital.

One cultural difference in the US people as patients kind of expect the doctor to teach them a lot about the procedure and also allieviate their fears, answer their questions and provide education, not just do a procedure. In India, I found this approach is not existant. If it is, of course it's not in the hospitals I have been to. I don't think people question the experts as much and just trust them to do their job and leave it at that.

One thing I do like in India is the patient is more in charge of their medical records. In India whatever record is made in the visit, I can have it there and then, including any tests that may require films. But, in the US I do not get these unless I fill a 'consent of release of information' and even then it's mostly from doctor to doctor. On the other hand, because this may not be common in all parts of India, when a patient visits a clinic if the patient doesn't come with their records and gets a different doctor in the same clinic, he would have no idea what the previous doctor has recommended. There's a plus and minus to both systems.

March 24, 2012 7:54 PM  
Blogger Brijesh Nair said...

Thanks Jennifer…
Yes medical records – what you said is very true… I don’t think there is a concept of signing any form to release your records…

Indians trust their doctors and believe that they will do a good job unlike in US where doctors are sued for even a small mistake.

All Indian doctors know English – still you faced problem in India?

March 24, 2012 8:18 PM  
Blogger Kristy Bhabi said...

I have lived in both (been in India over a year now and have been sick all but a few weeks out of 14 months). In my experience (limited to Amristar which is nowhere near as nice as the rest of India), doctors here are not friendlier or more personable than in the US. I'm not foolish enough to say that doctors in the US genuinely care about their patients but if you see the same one more than once they take a moment to review your file and at least know what you're there for which makes you feel like less of a number. Here in Amritsar patients are lined up, paid little attention to and really are only a paycheck for most of the doctors I've seen. (I've been to multiple facilities.) I've had doctor make outlandish racist comments right in front of me, one prescribes the exact same medicines to all his patients no matter what they come for, and another with no medical license or degree at all. There simply is no standard of professionalism here in Amritsar. I've blogged about the horrific experiences I've had here, including once where I was taken into surgery without warning and my husband (who is also my only translator) was refused entry into the room and it wasn't necessary surgery. I've also had doctor up the price after services were rendered, overcharge us because I'm white. (I was charged 1.5 lakh for the exact same procedure as an Indian man was charged 80,000 INR for.)

Like you though it's so nice to be able to go to the pharmacy and ask for what I want and get it without the prescription I'm supposed to have (because the medicines even say they're not to be dispensed without prescription) and to be able to see a doctor for any kind of service you want without waiting days.

The dirt is extremely hard to get used to as is the poor condition of facilities here. Actually, as you mentioned, I came home with an infection that took 3 weeks and many horribly painful shots to get rid of after that surgery I wasn't prepared for. Oh,they also gave me too much anesthesia and instead of waking in 2 hours, it took me a full 5 hours to be able to sit up by myself afterwards. It was traumatic to say the least.

I have a 19 year history of hypothyroidism and am no stranger to doctors. Here in India not a single doctor has shown any concern for how tedious this can be. I'm often prescribed medications that I'm not supposed to take because they can cause serious damage because the doctors here just don't listen or care that I have it. Either that or they're not educated about it (and other than the one I mistakenly saw with no degree, all the doctors I go to are western educated).

I've pretty much quit going to doctors here in India and have started self diagnosing because their medicines always made me sicker. I'm safer not using the Amritsar health care system. If you're interested, here's a post I put up about how they dispose of needles here as well - it's definitely not up to par with Indian standards. ( Please keep in mind this is an upscale clinic with international clientele in the best area of Amritsar. The doctor was educated in Denmark and is a member of several worldwide organizations. It was not a government hospital.

I don't doubt your experiences are much better if you're anywhere but here. I agree with you about the nurses here, I even got in a major argument and took on 6 of them in one office one day because their behavior was so bad. The doctor sided with me and ended up firing one of them. I've had nothing but nightmares here and would give anything to be back in the US with a 15 minute standard appointment with some jackass that is only interested in my money but pays attention to the clinical standards and goes through the motions to keep from getting sued lol.

March 24, 2012 9:13 PM  
Blogger Jennifer Kumar, Cross-Cultural Coach said...

As a devil's advocate, Brijesh.....

Do people not question because they trust or because there is no culture of questioning?

Does questioning mean one does not trust? (As Americans question everyone and everything?)

Now, I feel this boils down to a cultural mindset difference, which is a BIG cultural difference. I wouldn't say Americans trust their doctors LESS because they question. I would say it's part of the culture to question. As an American myself, my mindset is this- questioning opens a dialogue. I can see the experience of the doctor and also how he handles himself by asking questions and getting answers from him. I guess maybe from the Indian mindset, this is considered mistrust, but not in the American sense. Now, yes, Americans are more apt to sue, there are legalities for the legalities, but I am not convinced questioning comes from mistrust due to suing others. We'd have to go into history to see if people questioned long before this sueing business came into be. In my mind as a patient in the US I would not question because I fear I would have to sue the guy later! (Or woman, too!)

Once I had to go for a root canal. In this case the doctor was forthcoming with all the procedures from A to Z... this alleviated my fear. She was so thorough I had to ask no questions. This practice is rare in the US, but I am sure rarer in India.

Doctors are NOT always perfect. They are human like the rest of us. Just because someone has a title doesn't mean they are the know-it-all in that field. I respect the doctors, the job is not an easy one, that's why I never went to be one (though initially I did want to be a doctor, but after starting college and realizing the path to take, I bowed out gracefully!) I am glad in the US we have the option to hold doctors accountable for their mistakes (ie. SUE) only because they do make mistakes. Unfortunately these legalities and the lawyers and fine print doctors NEED to be in business increase their fees along with the medical insurance. Most of what we pay for doctors fees in the US doesn't go into the doctor's pocket.

And, though it's true doctors in India know English, many are more comfortable in their mother tongue. This makes sense. I am sure there are doctors in India for which English is more fluent for them than even me, but I have met few doctors like this. Also, whenever I have gone to the doctor with someone who knows the local language (90% of my visits are like this) the doctor talks to my husband, friend, friend's mom etc in the local language and things are translated to me.

A funny thing happened in a doctor's office in Kochi. I went in with my father in law. WHen I went in with him, I was to support him and ask questions about his treatment plan. But when I went in with him, they talked only to him and talked to him only in Malayalam. I tried to enter the conversation but was ignored. (The doctor was a woman, too!) Then my husband entered and at that moment the doctor directed all the communication to my husband and that too in English! It was like I did not even exist in that room!

March 24, 2012 9:39 PM  
Blogger Vaishnavam said...

Obviously, being local makes a big difference, we never go to a doctor for any serious issue without getting a reference from someone who had a good experience from that person. Same with hospitals. Usually, someone in our family, close friends or colleagues are living in that place for decades and is able to point us to a good place to get cured.

One other thing I like in India is that there are options of Ayurveda and Homeopathy for not so complicated problems.

March 25, 2012 9:18 AM  
Anonymous Anonymous said...

I agree that the two systems are so fundamentally different -- founded on different principles, practiced very differently and influenced a lot by the native culture. Something like comparing two religions.

While the comparison of differences might be difficult, we can try to understand the basic driving forces behind such deviation. We can quickly compare a doctors/hospitals typical monthly income/expenses in the US.

(1) Malpractice and personal insurance

(2) Maintaining office and front desk staff

(3) Maintaining records and patient privacy (social security #, medical history, contact info)

(4) Maintain collection agencies for delinquent payments.

(5) Account for salary for staff and doctors.

Now, if the doctor is associated with a hospital the patient will get two sets of bills - from the hospital and the doctor’s office. Each of them operates like individual entities with exactly similar expense, savings structure and philosophy which makes healthcare costs go through the roof without an insurance..

You mentioned about the waiting time for doc appointments. I think that’s mainly due to difficulties and overheads associated with maintaining and handling medical records and patient satisfaction. Even if improvements are made to improve the record handling steps but fall short on the "customer satisfaction" side or something was overlooked because they couldn't dedicate as much time to each of the cases they handled they might end up with huge lawsuit or few "angry patients" who can significantly impact the doctor/hospitals reputation.

US also has the most elaborate, complicated and profit driven insurance schemes in the world which by itself adds multiple levels of cost overhead. A scheme operated mainly by private companies answerable only to their shareholders. The treatment one gets from a hospital or doctor is only as good as the insurance one carries. People are not too happy when Obama took the few steps to introduce the universal healthcare which has obvious benefits to making healthcare more accessible and inclusive..

Always under constant stress of practicing medicine the doctor and hospital are forced to run all the different tests so that they can justify their decisions in court (if required), to the insurance company and their patients.. This is also the reason why the doctors in the US only "recommends" a course of treatment, explains the pros and cons of the treatment and the patient "decides" if they agree to go with the doctor’s recommendation. While this gives the patient more power to make choices, it could be very stressful for the patients who are forced to make real hard choices regarding his health and life and also for the doctor when he sees his patient take a choice which is very different from a treatment regime that he would have otherwise prescribed.

Now, think about medical practice in India. They can knock down costs significantly because they don't have to worry so much about the items 1-4 above. The doctors in India are also able to provide faster/sooner service because they can focus on the treatment plan and in the practice of medicine rather than be concerned with legal/administrative issues associated with running the practice. They can spend time to diagnose (possibly with fewer tests). The patient trusts the doctor and takes the consequences as "one of these things in life or fate or god's will".

To be continued…

March 25, 2012 10:45 AM  
Anonymous Anonymous said...

We also hear about a lot of new "multi-drug-resistant" bacterial strains found in India. These I assume are mainly consequences of abuse of drugs-- under-prescription by doctors or self-medication by individuals and definitely not maintaining a clean environment in doctor’s office and hospitals - doctors washing hands between examinations, using gloves, sterilizing the medical equipment’s as per standard guidelines. Not following these basic hospital hygiene standards could result in spreading these strains between patients and each person making them stronger before spreading it to someone else. These are things we hear rarely in US.

If India had some better accountability for doctors and hospitals (even if those are not as stringent as in in the US) we will definitely see huge improvements in the overall doctors visit experience, but that will come at the expense of accessibility, cost of medical care and access to medications.


March 25, 2012 10:47 AM  
Blogger Brijesh Nair said...

Kristy Bhabi,
I never thought Amristar had such a bad medical system.

Yes Homeopathy and Ayurveda - I never heard of them when in US...

That was a great explanation as usual.. Will help every one to understand both systems well...

March 26, 2012 4:21 AM  
Blogger Jennifer Kumar, Cross-Cultural Coach said...


Ayurveda and Homeopathy, along with other alternative treatments like Chinese Medicine, Native American "medicine", herbal medicine, Reiki, Shiatsu, and other alternative forms are definitely alive and well in the US. I know about these as I have personally received treatments in all these areas.

The main problem is since they are not generally covered by medical insurance and they are kind of considered 'hokey' by most people, they are on the fringes. But going to any city one can search for these practitioners in their city or general area of the state/country. One way to find out is to visit a YOGA center. Generally, yoga teachers come to know about these things through their networks.

The other problem with 'natural cures' is the herbs used are not standardized. What I mean is that the FDA can not test and confirm safety or same potency of herbs because unlike man-made medicines herbs, grown from plants need sun and water and many other factors that are not always as easy to control while growing. This means herbs in some medicines can be more or less potent than others in other bottles. (I have done some reading into this!)

You were in Arizona. Interestingly there is a town in Arizona called SEDONA. This place is kind of known for all these alternative treatments. I am sure ayurveda is alive and THRIVIING there.

March 26, 2012 5:05 AM  
Blogger Anand said...

Agree with all comments you made Brijesh, however I feel the doctors in the US are more receptive to questions, where as in India, there is the "I am God" mentality and they dont encourage questions from the patient/patient's family or well wishers (it is different if you knew the doctor personally or mutually acquainted). I experienced this personally during our daughter's delivery here in comparison to my nephew's birth in India.

April 04, 2012 12:47 AM  
Blogger Anand said...

Agree with all comments you made Brijesh, however I feel the doctors in the US are more receptive to questions, where as in India, there is the "I am God" mentality and they dont encourage questions from the patient/patient's family or well wishers (it is different if you knew the doctor personally or mutually acquainted). I experienced this personally during our daughter's delivery here in comparison to my nephew's birth in India.

April 04, 2012 12:49 AM  
Blogger Akshaya Borkar said...

Hello Brijesh,Very informative post. I realised that Australian Medical System is much better than US but the costing is similar for temporary residents.
I also liked the comments and discussions happening on this post.

April 12, 2012 4:15 AM  

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