Access to Quality Healthcare: Does the web hold the key?

Dr J Mazumdar, Head of Medical Operations, HealthcareMagic.com
The enthusiasm around online healthcare is palpable. What is fuelling this excitement? Can the internet fill real gaps in healthcare delivery? What solutions are being developed and what can we expect from them?

We can look at these questions in the perspective of a fundamental requirement of an efficient healthcare delivery system -- ease of access. Accessibility of healthcare is often equated with the availability of doctors and hospitals in the immediate neighbourhood. In this context, experts point to the inequitable distribution of healthcare resources in urban and rural areas, which basically leads us to believe that inadequate accessibility is a problem limited to the rural poor.

But hold on, can we safely assume that accessibility is not an issue for those living in the cities or those who can pay their medical bills? Michael L Millman writes that “Access is the TIMELY use of PERSONAL health services to achieve best possible health outcomes”.

If we analyze the health-seeking behaviour of the average urban adult we find that in spite of having an apparently accessible medical centre or physician, he or she avoids or postpones seeing a doctor unless it is perceived as being “really necessary”. The lack of streamlined medical services, long waits, inability to take time off from work, and the pervasive fear of being referred for innumerable medical tests are some of the factors that have built an access barrier that hinders timely doctor-patient contact even in the cities.

In this milieu, it is not surprising that the consumer who has grown accustomed to using the internet to address his fundamental needs -- be it employment, marriage, travel or communication, goes online for his health needs as well and expects the magical World Wide Web to provide solutions.

In what ways can we guide these patients? The initial response to this question was the mushrooming of websites providing medical information. Websites were created for diseases, drugs, treatment options, and also for sharing patient experiences. While this online information has gone a long way in making the user more aware, the plethora of it, along with the contradictory facts from different sources also leaves users perplexed.

Then there is the question of reliability of information. A survey among online health seekers reported that about 44 per cent of them did not consider online health information to be reliable. The predominant factor that influenced the user’s perception about reliability of information was whether it came from a medical professional. Ease of understanding was another important factor that online health seekers looked for.

These findings echo a pressing unfulfilled need among the patients -- the need for reliable, complete, and comprehensible information on one’s health condition. The limited interaction time makes it nearly impossible to get this information in the physician’s office. Can we provide these patients an online consultation chamber where a doctor is willing to discuss their condition at length and at a time convenient to the patient?

There is a growing realization that there is scope to go beyond putting more and more information in the “public domain”. There is a possibility of providing the patient with personalized online medical information, coming from a physician, and answering exactly what the patient needs to know. All those who have experienced the social dynamics of chat rooms know that considerable rapport can be established and information exchanged during a live chat.

If you are having a live chat with a doctor, he can obtain an adequate history, look into your medical reports, give you the required information and guide you with respect to the next appropriate steps if a physical examination is required. This can potentially save the patient hours of browsing and anxiety about the seriousness of his condition. This way your online physician becomes your first point of contact from where you will be referred only if needed and where needed. This concept has led to the advent of new websites that put the patient and the doctor together in a virtual consultation room.

A step further down this lane, second opinions are a niche area for newer online healthcare solutions. The question of accessibility of second opinion involves a complex interplay of increasing cost to the patient, physician attitude towards a peer’s opinion, and of course the geographical distance between multiple facilities. A system that allows secure sharing of patient information and brings together multiple specialists (oncologists, cardiologists, nephrologists, etc.) on a single platform provides the patient an option to consult multiple doctors at a substantially reduced cost and time.

We are going through a period of phenomenal change in the online health-seeker’s needs and expectations as well as the technological solutions available to fulfil them. In the long term, we will be able to see the right mix of online applications and consumer behaviour that utilizes the full potential of the internet in the healthcare domain.