It is time for a healthcare rating movement to take shape. But along with it, accreditation, self-regulation and improved doctor-patient communication is a must
Every crisis is an opportunity. Healthcare and more particularly hospitals, stand at an inflection point today. 2017 was a watershed year for the sector. A price capping regime, increased mistrust between patients and providers, questions on ethics, conduct of doctors and incidents at leading hospitals — all have led to much soul searching within the sector and amongst the commentariat. The scrutiny, though excessive, both in the offence and in the defending, has not lead to any clear actionables. Healthcare needs systemic reforms — both from the policy standpoint and through self-regulation from providers. Both need to be synchronous and cadenced to help regain public trust and reinstate the hallowed status that doctors and hospitals hitherto enjoyed.
One starting point to what will need to be a whole host of steps is the need to have an unbiased assessment of how hospitals are performing. Accreditation, often publicised as a measure of quality and outcomes, is at best a ‘point-of-time’ validation rather than a continuous assessment over distinct periods of time. Similarly, governmental assessment, at the time of tendering of projects and schemes, lays emphasis on hard infrastructure and output-based metrics. A blend of quantitative and quantitative assessment, that helps patients, make informed choices clearly emerge as the need of the hour.
The banking and financial sectors faced similar dilemmas at various points of time over the past 200 years. Boom-bust cycles, economic meltdowns and depressions led to public outrage, Governmental action and intra-sectoral finger pointing. Much of this is echoed in the current environment that healthcare finds itself in. Of the many solutions — both through policy directives and through self regulation — to emerge was the creation of credible credit ratings agencies that benchmarked businesses, industries and even sovereign economies. Today, Moody’s, Standard & Poor and Fitch ratings are not for sole consumption of the financial districts, but central to performance assessments from Parliaments to prime time. Maybe it is time for this movement to take shape in healthcare.
The obvious structural questions around such a solution would be: Who will operate these; what will they assess; and how do they remain credible and unbiasedIJ At a time when any and every institution’s credibility is being questioned, adding another one seems paradoxical. Then again, a standalone institution, that remains unaligned to the Government or the provider ecosystem, will be one that enjoys the maximum possible acceptance. The largest credit ratings agencies in the world are private companies or limited liability entities that have worked for decades, building the trust of investors, the media and Governments. Though not without their own criticisms, they have been able to establish a firm footing in terms of unbiased and credible assessments. A similar body that works to rate hospitals on their performance, outcomes and impact to society would be welcome.
What to assess, will be a vexing issue, were such an agency to appear on the horizon. Measuring performance and publishing ratings for healthcare have been notoriously hard. A judicious mix of clinical, non-clinical, service, outcome based and cost linked metrics would need to be defined for rating any hospital. These ratings would need the acceptability of the provider network and those of Governments. linking payments for Government health schemes — where the private sector is a provider of services like the Central Government Health Scheme (CGHS) or Rashtriya Swasthya Bima Yojana (RSBY) — could be linked to ratings, rather than only accreditation, for any hospital. Similarly, hospital ratings could become the benchmark for Government contracting and tendering, which remain mired in metrics borrowed from the construction and hard infrastructure industry. Credit ratings linked bank borrowings and funding streams could prove to be attractive for hospitals.
For patients and families, such publicly available ratings could help make informed choices for their care. Choosing a hospital for a condition is often a complicated decision given the information asymmetry inherent in healthcare. Ratings could help resolve this issue to some extent. Fear of poor ratings could push doctors and administrators to improve performance, both operational and financial. Ratings on their own will by no means be a single solution for all that ails healthcare currently. But along with accreditation, self regulation and improved doctor-patient communication, can help improve standards and perceptions of care.
(The writer is general manager, Operation and Public Affairs, Indraprastha Apollo Hospitals. He can be reached at dr.karanthakur@gmail.com)
