Heart disease was once considered as rich man’s disease . . . It’s no longer true . We in India , are witnessing an epidemic of CAD . The reasons are varied . Apart from conventional factors , social factors like changing demographic pattern , life style , ethnic risk like south Asian metabolic profile are responsible .
While Rheumatic heart disease (RHD ) continues to be a huge burden , CAD is the number one cause for cardiovascular morbidity and mortality .
CAD affect the poor and rich with equal vengeance . The later is better equipped financially to tackle it . Of course , it has resulted in maximum inappropriate interventions. The poor (or borderline poor ) have no other option but to knock the doors of Government hospitals. It is heartening to note, various state Governments are gradually involving insurance schemes.
Still , many struggle to find the required finance for a major cardiac intervention. It roughly costs 100,000 rupees for PTCA .While PCI is required in all symptomatic , critical coronary occlusions , still . . . majority of the CAD in general population do not require it . There are 675 cath labs in India performing 180000 angioplasties every year on an average of 15000 PCI per month ( 500 /day ) This is grossly inadequate . We have huge potential
What is the hurdle ?
- Expertise ?
- Hard ware ?
- Awareness ?
No . . . it is all about financial resources
Recently I stumbled upon an advertisement on Times of India
Hospitals want to market the procedure . Convert angiograms to angioplasties . That’s corporate boardroom mantra . And one fine day , bankers and medical doctor sat together and brought a brilliant idea.
Why not do the procedure on credit and push the patient life long into a financial debt !
Wonderful idea . . . many thought .Thus came the financing scheme for cardiac procedures.
Financing a poor patient with good intention is welcome. But, there is big caveat .In a vast country with high illiteracy , inappropriate procedures may be thrusted upon on the poor souls.
Now , our patients have one more risk parameter to assess ” Number of remaining EMI( Equal monthly instalment ) and incidence of stent thrombosis” “Accumulated interest and angina” What a wonderful way to provide cardiac care !
I can recall a patient who sold his livestock (his sole income source ) for undergoing a open heart surgery and lost his life as well in the process leaving the family stranded !
The only solution is to provide a strictly regulated Govt sponsored insurance scheme. High tech procedures should be continuously and meticulously audited for cost effectiveness .