Since this tweet has got interaction beyond my anticipation...will delve into the reasons for it too...its for us to ponder as we try to modernise our healthcare....we are in serious threat of jeopardizing the goodness while we try to ape the west style infrastructure 1/n #thread https://twitter.com/curiosweetie/status/1296875567531175938

As in case of any industry...the more elements / points of contact you add between the supplier of products/ serviced and the end consumer....it will add on to the cost of the product and service. The same principle applies for healthcare too. 2/n

Here the doctor is the 'producer' and patient is the end consumer. When your family doctor or a small doctor in the town runs there own practice - you ste getting goods directly from producers- compare it to the direct farm goods, fresh, clean, unadulterated and best 3/n

Bow there are some limitations to this model yes....in the sense just like a small farmer can supply limited produce, restricted by their own farm capacity, expertise of the kind of cultivation they do (only 1-2 kinds of products to offer), just the raw service and no add on 4/n

Similarly a small set up can only cater to small number of patients, limited kind of ailments (say only eye care or pediatric or gynecological services etc or a combination of 2-3 depending on partner doctors & their expertise) & limited infra 5/n

If we have large population, we need to not just have small farmers but also the bigger ones(industry scale) that help us mass produce to help with our hunger fight, build economies of scale, value add (better breed, pest control, modern equipment for higher yield etc) 6/n

And add as warehouse or supply to large food based industries- which give us value add - pickles, jams, packaged food products etc) we need the bigger hospitals too. They should help us cater to larger numbers, mass and standardized service, 7/n

Capital investment leading to modern equipment and facilities, world class complex procedures, multiple services under one centre etc...they are important too but in the process we neither want small farmers to commit suicide, nor small doctors to close set up 8/n

Each form an essential focal point of the eco-system they operate in. Customized service, personalised care, closer to home delivery (will take cost separately), and indepth expertise rather than generalized approach or health care management 9/n

These smaller set ups take away burden of numbers from larger set up, offer closer to home and personalised care and are more affordable as their supply chain (unlike bigger set up) involves minimal members so individual doctors are able to keep costs low. 10/n

Now if our healthcare has to sustain both the models...we need clear differentiation and also protection of the smaller players from the bigger eagles...much like how Govt would want to protect smaller farmers from big corporate backed agricultural set ups. Sounds logical?? 11/n

But the irony of our country and its government's direction is that it penalizes these smaller set ups (because they are weak and dont have anyone fighting and also junta is against them- avg Indian feels they are leeches who are fleecing us too much & in general apathetic) 12/n

So Govt introduces laws and processes that make them having to register with multiple Govt authorities, licenses for practice, nursing homes, commercial property taxes & norms for smaller clinics/ set ups that are too small to afford...net net making it difficult to sustain 13/n

Leave alone protection (including protection for hooligans who attack doctors, break their properties in case a case goes wrong), they burden them with added paper work & red tapism where every sarkaari babu wants a cut to sanction and approve. 14/n

On top of it rulings like a doctor cannot refuse a patient (even if the small set up is not equipped to handle the emergency or the complexity of the case & hence refers them to a bigger set up) but in Govt eyes it's a crime and negligence for which doctor must be penalised 15/n

Remember so many small set ups were abused and also penalised (both by Govt and patients) first for refusing Corona cases as they weren't equipped to handle and then subsequently for treating them and remaining open & spreading Corona in different part of the countries 16/n

Whereas the bigger chains not just minted money - which didnt go to its doctors btw but only to corporate investors and management while the risk was doctors and front line staff's alone. Now how many of them were questioned about readiness, pulled up for wrong diagnosis, 17/n

negligence or high costs?? None....!!! As always they got a free pass, while the burden, abuses and penalties came to smaller set ups. Compare it to farmers again in your mind. Tell me who would you want to protect and support as Govt (& give tax breaks, free insurance etc) 18/n

vs who would you want to penalize and then compare what is Govt and public doing with smaller independent set ups vs large chains? Who is it penalising and holding to a stricter benchmark vs who is it penalising?? Is it not ironical??? Is it not against logic?? 19/n

Remember the supply chain of bigger hospitals has multiple POCs or stakeholders. From a supplier, to management to investor, to pharma lobby to insurance providers, to TPA, to authorities...everyone's pockets must get filled in the process...hence they will keep costing more 20/n

As we move to more privatization, descent of insurance providers, modern equipment manufacturers, pharma lobby, investors...while we will build infra and economies of scale they will not reduce costs but add on to them much like US healthcare industry. 21/n

With added burden of our population, low penetration and apathy of both end consumers and Govt...it de-incentivizes doctors to start their own private practice/ build their own set ups. Most are closing down, doctors are not sending second or third gen into medicine anymore 22/n

Among all my school mates only 2 put of top 10 became doctors...most were the back benchers who cracked PMT in 4th/5th attempts...leave competence...the 2 I am talking out moved out of country few years back...rest chose service in private chains and not own practice 23/n

If we dont recognize and incentivize our small set ups to continue and respect our medicos...we are heading for US kind commercialisation and then heaven forbid...we wont be able to afford basic 'malham-patti'/ flu treatment forget the complex procedures. 24/n

Think before you harass a doctor next, demand free appointment basic you know their xyz friend/ relative, abuse them, think they overcharge, they need to be available 24X7 on phone and it's their duty, they shouldn't earn as much...It impacts you in the end 25/n #ThreadEnds