India’s problem of overtreatment, overmedication, Pg6

Key Highlights:

• Modern medicine in India is increasingly prone to overtreatment and overmedication, despite advancements in diagnostic and therapeutic capabilities.
• This issue coexists with undertreatment, where many still lack essential primary care and affordable medicines.
• Key drivers include excessive and unnecessary testing, fragmentation of healthcare leading to over-specialization, and the transformation of healthcare into a marketplace.
• Studies indicate high rates of polypharmacy among older adults in India, with approximately 49% experiencing it and about one-third taking five or more prescribed medicines.
• Patient expectations, a desire for certainty, and defensive medicine practices by clinicians also contribute to overtreatment.

Detailed Insights:

• Unwarranted health-check packages often lead to false-positive results, anxiety, and a cascade of further investigations and treatments.
• The focus on specialist care means patients are often treated in parts, neglecting holistic health, especially in older adults.
• The fee-for-service model in Indian healthcare incentivizes volume of services over restraint, blurring the lines between necessary and unnecessary interventions.
• Health insurance, while providing financial protection, can create moral hazard by encouraging costlier interventions and discouraging preventive care.
• Doctors may respond to patient expectations for tangible interventions, leading to unnecessary tests or prescriptions, particularly in crowded clinics.
• Defensive medicine, driven by fear of missing rare diagnoses, prompts clinicians to order more tests, each carrying potential risks.
• India is not alone; the global Choosing Wisely movement encourages questioning the necessity of certain tests and treatments.
• Solutions include rebuilding stronger primary care with family physicians as the first point of contact to manage referrals and reconcile prescriptions.
• Every medical prescription should have a review date, and older adults or those on multiple medicines should undergo structured medication reviews.
• Professional bodies like the Indian Council of Medical Research should develop India-specific lists of low-value tests and treatments, integrating these into medical training.
• Patients should actively question the necessity, benefits, risks, and alternatives of any proposed test or treatment.
• Payment systems and health insurance models need to reward outcomes and clinical reasoning rather than just the volume of services provided.

Key Concepts Involved:

• Polypharmacy: The regular use of at least five or more medications by a patient, often seen in older adults.
• Fee-for-service model: A payment model where healthcare providers are paid for each service they provide, potentially incentivizing more services.
• Moral Hazard: A situation where one party takes on more risk because another party bears the cost of that risk, often seen in insurance contexts.
• Choosing Wisely movement: A global initiative encouraging conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.