Having been associated with the development of this healthcare delivery model from its inceptions, I feel there is still a great distance we all have to travel to achieve the ideals we all aspire for. We have seen value of insurance coverage in many instances as life saving for poorer patients but I agree that there are inherent risks in models like Arogyashree as they incentivise intervention while distracting the focus from primary care.
There is little doubt that treating disease (which we call “demand based service” – where the sick person demands from healthcare providers) becomes more and more expensive at each rung of primary, secondary and tertiary setting. Even more importantly prevention or early intervention (which we call “protocol based service” – where the provider has to follow an agreed protocol) reduces cost at each step. The assumption with managed care models is they would promote the latter approach. There is much to be argued, both, for and against managed care models (as practices in developed countries) because virtually nothing can compensate distorted human values. Does choosing one model over the other compensate for tilted power scales, biased prescriptions and misaligned incentives? We still have the opportunity of learn from the west (of good that is achieved) and not repeat the mistakes they have made before engineering our interventions.Whether demand based or protocol based, delivering care at grassroots level, in a timely, appropriate and guideline driven manner is not an easy task. Planting a "biologically engineered exotic tree” of western medicine in wild rural Indian climate requires a lot of tendering care. Coping with skill gaps, evidence gaps and resource gaps requires constant innovation and acclimatization to local environment, just like a “wild bush” does. I continue to wonder, how the hybrids will evolve, and how "cross pollination" (of ideas) would influence their future appearance.
Being a great advocate of keeping people healthy within their communities, I continue to be inspired by the value of traditional wisdom hidden within the powerful Sanskrit word "swa-stha" which means 'established within oneself' (swa = self, stha = established - across homeostatic, psychological, financial and spiritual dimensions). It defines for us the concepts of positive health, self sufficiency and local empowerment that could become the underpinning philosophy and possibly contribute towards greater global understanding. Healthcare delivery, health financing and even public health measures could benefit by keeping common values in the centre and attempt to bridge gaps between modern medical interventions and traditional wisdom.