Thursday, September 30, 2010

Health care, a la carte

Editor's Note: Like last year, I came back home from India being totally behind with blog posting. So I'll be posting a few retroactively, with the following being the first in the series. Anjoy!

Getting health care in India is very different than in America. Because of the health insurance system, in the U.S. I always feel like my health care is not in my hands. It's controlled by entities in the foggy distance; there are these big institutions that know all about my medical history, control how I interact with my doctor, give their permission and approval to do anything, and require me to update them when I have availed any service.

Not the case in India. If you want to see a doctor, you just call one up and make an appointment, or better, just show up to his office. And he's not going to ask you what coverage you have and to fill out this or that form. He just sees you like you would go to a barber for a haircut. No strings.

It's all very raw, very street. That's exactly how I described my experience last year when I had to get my elbow stitched after falling off of a bus, walked into a local doctor's office, laid down, stuck out my arm, and got sewn up with no anesthesia and no doctor's gloves, and walked out an hour later for Rs.150 (post mortem: The doctor had told me that my stitches didn't need to be removed because they would dissolve on their own. After weeks they were still there and so I had them removed. Now that patch of skin on my elbow is all gnarly coagulated looking and I feel a pain every time the skin gets stretched. So yeah, I paid Rs.150 for stitches, and I got what I paid for).

Recently I was sick and had to get some blood tests done. I used a service called Green Cross, which is basically a consumer pathology lab. They send over a dude with a bag full of needles and vials to your house. He takes your blood, sends it to the lab to have whatever tests you want on it done, comes back later that day with a full printed report with a doctor's number for referral, and takes your money. And all actually on time, and all at affordable cost (basic CBC blood test costs Rs.170 all in)! It is such a delightful service.

And it's unlike anything in the US because it is health care a la carte. There was no doctor or institution telling me how I should interpret my blood test, or even that I should have gotten a blood test in the first place. Self-diagnosis. I look at the report which shows my health reduced down to numeric scores, and see if things fall within the given arbitrary ranges. Then I can go online and find out what it all means, and even walk down the street and buy my own medicine. No doctor necessary. It's like going to the barber shop, sitting in the chair, grabbing the scissors and cutting your own hair as the barber just stands idly by. There are no people or institutions that are gatekeepers to your health care needs. It's all up to you.

It's both empowering and scary. What the hell do I really know about my hemoglobin count? It all seems a bit dodgy because you're dealing with something (health) that I've come to believe an expert should be consulted for. After all, in the U.S. kids spend thousands and give a decade of their lives to be able to put on a white coat and be an authority. Can it all really be bypassed? On the other hand my experience with doctors in India is that they don't really tell you much you don't know, like they work from common sense more than any specialized education. And usually the conversations are you speculating about what's wrong with you and what you should do about it, and the doctor just agreeing with anything you say. Madhu was on the phone with his doctor and even prescribed himself medicine. The doctor just said, "Yeah that's cool".

On one hand it's the way it should be. Our health is our own responsibility, and doctors are not magicians. On the other hand, one's health is a pretty risky thing to be mucking around with, and there is a need for specialized expertise. My feeling: bring on the a la carte health paradigm, as long as I have access to insights about my urine like this:


  1. I'd like to see the other options

  2. Did you know that as much as 90% of the data doctors rely on is flawed or wrong?

    Turns out that the aromatic qualities of your urine, or Madhu's self-prescribed medication is as good as the next observation or pill. I too have a stash of desi meds that I use for many of the basics.

    Ala carte is the way to go. But I think you'll find that insights and observations from the cushion turn out to be powerfully self-diagnostic for many of the simple, common, and less-serious afflictions.