India outsources medical care… to its cities

PLoS Medicine

How do you provide healthcare to citizens in a country where nearly 75 percent of the population lives in the country, and more than 75 percent of the country’s doctors live in cities? India’s answer: telemedicine.

The Indian government has been investing in the technology to make healthcare accessible and affordable for the country’s rural population, according to The Lancet. Telemedicine works like a regular medical consultation—except the doctor is on a computer screen peering through a webcam, and the patient’s vitals are monitored by traditional equipment such as stethoscopes hooked up to computers (a more precise explanation can be found here and here). Sometimes a general physician is present, but the specialist reading and interpreting the information is located remotely.

The country’s first telemedicine center was established in the state of Andhra Pradesh in 2000, and since then many analysts have come to believe that telemedicine “could be the future for health care in India.” Today, there are about 500 telemedicine centers across the country, linked to about 50 specialist hospitals. So far the centers have provided “teleconsultations” to an estimated 150,000 patients—a drop in the ocean in a country of more than 1 billion. According to anecdotal accounts, however, initial skepticism about “impersonal” health consultations is waning and patients who have been treated through telemedicine appear satisfied with the care. Meanwhile, public-private partnerships are continuing to expand the size and the scope of telemedicine facilities.

Telemedicine, like the use of cellphones for health, could be a revolutionary step in medical provision for the poor. Rural residents won’t need to travel as great a distance in order to access sophisticated medical treatment, and doctors won’t need to move to rural areas. As of now, telemedicine consultations cost around $22—still beyond the reach of most Indians. But the government is promising to provide the consultations free of charge for the poor, though it’s not clear if this is entirely feasible since many clinics are operated privately.

But as revolutionary as it might be, the growth of long-distance medicine raises some questions about accountability. What happens if a patient is misdiagnosed, or sent away with a clean bill of health when there is actually an underlying problem? Can anyone fairly be held responsible? Nonetheless, it does seem like the benefits at the moment outweigh the risks. As one surgeon and hospital director argues:

In terms of disease management, there is [a] 99% possibility that the person who is unwell does not require [an] operation. If you don’t operate you don’t need to touch the patient. And if you don’t need to touch the patient, you don’t need to be there.

Come to think of it, there’s no reason to think Indian specialists and doctors couldn’t start treating patients in this manner who hail from anywhere in the world, including the United States. Indeed, Indian doctors are already providing diagnostic interpretation of radiological images, including X-rays, CTs and MRIs, for American patients from hospitals in places as far away as Bangalore.