Health Care System and Our Future

By Bachchu Kailash Kaini

"The future" of society and of health care cannot be predicted with certainty. But there are patterns of change that can be anticipated. We know with some certainty, for instance, how many Nepali over age 65 there will be in the second decade of the twenty-first century, even if we are not as certain about their health status. Breakthrough in science and technology can be anticipated in areas such as mapping the human genome and understanding healthy aging. The specific timing of relevant scientific discoveries, their translation into technological applications, and uptake into medical practice are much more difficult to forecast.

Changes in societal values, public policy, and individual behaviour are even more uncertain. Yet these changes are often more important. Will we deal with poverty, the single largest correlate to ill health?  Will trends toward consumer interest in health increase? How will national health care policy and financing evolve? Scenarios - alternative futures for health care in the twenty-first century - allow us to explore varying answers to these questions. Scenarios are designed to provoke the imagination, raise fundamental questions and stretch world views.

While each scenario presents a unique image, one revolutionary change - the "predict and manage" paradigm - is common to them all. Increasing understanding of aging, disease, and genetics will allow us to predict normal declines in health and the course of illness. Better behavioral change techniques and a host of advanced therapeutics and preventive approaches will allow us to "manage" health, leading to lower morbidity. Yet these illuminate major plausible futures for health care, posing key choices for health care leadership. 

Advances in medical knowledge and technology made it possible to predict and increasingly manage an individual's health and illness over his or her life course, profoundly altering health care delivery to be insured. The "predict and manage" paradigm linked the talents of clinicians, behavioral specialists, advanced technology and knowledge.

Nowadays health care delivery became more effective and efficient compared to past. Though we have to cross many stages to reach to the certain standards. Hospital faced challenging times. Expansive technology, inadequate doctors, unavailability of resources and increasing demands are few challenging aspects of modern health care system and hospital set up.

The twentieth-century hospital cured the body; the twenty-first-century hospital cures the body and heals the person. The body repair shop metaphor of the twentieth century has broken down. The hospital no longer just repairs the car; it also works on the driver. Consumers are encouraged to take greater responsibility for their health and to select from a wider range of diagnosis and treatment.

Times are rough for the economy as a whole and for health care too. Political unsuitability and betrayal make more unpredictable future of Nepalese people for their better health. Hard times should be made easier with long-term vision, political commitment and sound infrastructure. An effective coalition of concerned authority, health care policy makers, governmental and non-governmental organizations should make reform a viable issue. Consumers should be empowered by government policies and development of outcome measures and their application to all providers and therapies. Primary health care services should become smarter and quicker to reward cost effective innovation.

Dramatic changes in the paradigms of science, technology, society, and government hasten health care change worldwide. Health care broadens its focus from urban to rural and the secondary level care to primary level care in Nepal. Dissatisfaction does appear in community health care and there should be changes in the health care delivery system especially in rural area.

The second half of the twentieth century has witnessed phenomenal changes in the health care systems of almost all the countries.  During the last three decades medical science has made unprecedented progress and surpassed the achievements of past two centuries. The three movements, each having a pore-eminent concern and currently seeking to change the world of medicine, are - the proponents of evidence based medicine are mainly concerned with ensuring that strategies of proven clinical effectiveness are adopted; the health economists are mainly concerned with establishing that cost effectiveness and not clinical effectiveness is the criterion used in determining option selection; and a variety of patient support and public interest groups are mainly concerned with ensuring that patient and public preferences drive clinical and policy decisions. 

The coverage of health services has fluctuated over the years in Nepal, with improvement in some programmes and failure to meet the targets.  There is a need to make improvement in programmes that failed to meet targets. Also there is a need to strive to improve both the quality and quantity of our work in order to meet the rising expectations of the people. Consolidated effort in institutionalizing the planning, monitoring and evaluation will definitely help to run the health care programme in efficient and effective way to use the limited and scarce resources. The right presentation of problems, constraints, action to be taken and deadlines for those actions on health care issues will give a sense of direction and a common understanding of the objectives and activities to be accomplished in the days to come.