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Sometimes you need to digress from the mainstream andthen converge. In the process you achieve diversity. Letus take stock of some very well known facts relating to

the two of the worlds largest healthcare markets in making: More than half the world population lives in Asia More than half of that resides in China and India Both practise very diverse forms of health-care and often

lack thereof Larger numbers are outside modern practices than in Millions will move from outside in Millions too will move from alternate practices to western/

allopathic medicine There is a big divide between healthcare and insurance Healthcare insurance is still largely around hospitalisation Insurers are struggling to balance challenges of coping

with volumes and pricing Regulators are dealing with ensuing challenges and trying

to lift the game Rising numbers of ageing population and nuclear families

pose further challenges Raging health ination Not only local population to be addressed, emerging

health tourism too More and more childless seeking surrogate mothers here Growing bio-pharma industry and emergence of local

brands Signicant M&A in the space Increasing clinical trials activity Spurt to medical education. Evils of supply demand mis-

match. Long way to professionalism Consumerism on rise

Social media; nothing to hide Governance; fervent call Litigious societies, in making Urbanisation Quackery aplenty Money-lending menace Life style diseases due to excesses Diseases due to deciency and starvation Wellness emerging

Writing on another wallWith so many threads, not all though, to weave into a mean-ingful form; here is a recipe for a potential chaos if not

disaster. Take for instance the rapid migration ofpopulations from rural to urban areas; demise ofpublic healthcare and joint families into nuclearand rising lifestyle conditions, there will be a huge

mismatch between supply and demand of health care ser-vices. On the supply side, some of the providers may havequestionable standards and experience. There will be lots ofpositive and negative energy ying out of these developments.

At this point, I am tempted to digress from the current ste-reotypic approach and dip into some ongoing debates in theUS. Not that India and China are headed the American way.But the only way wherever these two countries are headedfor, in their unique ways, they can future-proof themselvesis learning from the US today. Thanks to some eye-openingdebates at the American College of Surgeons: New approaches to liability reform:The current medical

liability system in the US is broken. It is costly, draininghealth care system of approximately US$55.6 billion per yearand accounting for 2.4% of annual health care spending.

At the heart of the very costly and inefcient liabilitysystem and the inaccurate process of compensating injuriesrelated to medical errors is tort law. Again, something thatdiffers from state to state.

The American College of Surgeons has a vision to ensurethat the ultimate goal of physicians and hospitals is to deliversafe high quality patient care. That requires a liability systemintegrated with health care infrastructure to promote thoseends. A system that manages risk through the creation ofa just culture of safety and quality improvement. A systemthat provides just compensation when patients are injuredas a result of medical errors, and movement away from thelawsuit lottery. A system that is efcient in whichthe majority of money is spent compensatingthe injured patient, and frivolous claims

are dismissed early to

Mr Praveen Gupta from the Chartered Insurance Institutes (UK) Diversity Action

Group gives an update of the healthcare sector in the US, which serves as a guide for the

healthcare thrusts in Asia, particularly in India and China.

Digressing to diversify:

Consequences of healthcare or

lack thereof!

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avoid wasting resources. Injured patients should not haveto wait an average o fve years to receive compensation.

This would require more than tort reorm. AHRQ programme promotes patient safety and li-

ability reform: The Agency or Healthcare Researchand Quality is a US$25 million initiative which providesgrants to health care organisations that have agreed todevelop systems that promote patient saety and medical

liability reorm. Medical mediation: bringing everyone to the table.

Growing ocus on mediation as a viable orm o alterna-tive disputes resolution (ADR) in medical liability cases.

The University of Michigans Early Disclosure andOffer Program (D&O). Instituted 10 years ago, this hasserved to increase accountability, improve the physicianpatient relationship, reduce cost litigation, and improvepatient saety.

Health courts: With a broken medical liability system,two schools o thought emerge. Whether to have healthcourts or strengthen existing systems?

New directions in liability reform: It calls or reormsthat can transorm the current medical liability systeminto a system that is patient ocused. In which saety, qual-ity, accountability, and equity are paramount. It recognisesthis will require a sustained commitment and iterativeeorts rom the health care community. The frst step issetting up experiments with innovative reorms that areocused on the appropriate goals. The regulatory systemmust begin to support notions o just culture as well asmechanisms or early dispute resolution.

Furthermore, providers and insurers must publiclydemonstrate a commitment to vigorous sel-regulation; i

liability is no longer the main mechanism o enorcingquality standards, the medical community must assurethe public that it can assume greater responsibility or thattask. Encouraging this paradigm shit and looking towardreorms that solve shortcomings in the liability systembeyond cost containment are paramount to developing asystem that truly drives quality and saety improvements.

Safe harbours: These are designed to protect physiciansrom liability risk i they provide care that ollows ap-proved clinical practice standards. The creation o saeharbours may improve both patient saety and medicalliability system perormance. Sae harbours have many

potential benefts, which include discouraging non-mer-itorious liability claims, mitigating the unpredictabilityo settlements and verdicts, reducing deensive practicesand bolstering the integration o evidence based careinto clinical practice to improve patient saety.

CRICO way: The largest medical liability insurer inMassachusetts and an internationally known leader inevidence-based risk management. CRICOs mission is toprovide superior medical liability insurance to its mem-bers and to assist them in delivering the saest healthcare

in the world. To achieve this CRICO is committed todeending good medical practice, oering compensa-tion or substandard medical care, and contesting attrial non-meritorious cases in which no medical aultis apparent.

Connecticut Center for Patient Safety (CTCPS): TheUS health care system boasts some o the worlds mostsophisticated medical treatment, superior medicaleducation and training, and hundreds o thousands oconscientious and committed health care proession-als. Nonetheless, patient saety in the US has been thesource o concern or many years now. Patient injuryis widespread, and there is little evidence o consistent

improvement. The Centres or Disease Control and Pre-vention (CDC) estimates that up to 10% o hospitalisedpatients develop a hospital-acquired inection (HAI),and that 1.6 to 3.8 million inections occur annually inlong-term care acilities. The annual direct costs o theseinections may be as great as US$45 billion.

The CTCPS looks orward to working with and notagainst the health care sector. By collaborating to improvepatient saety, patient advocates and providers can honourthe needs and rights o patients, acknowledge the harm thathas been previously done, and help ensure that such harmdoes not occur in uture.

In conclusion

Leafng through a recent issue o the Bulletin o AmericanCollege o Surgeons, I thought the writing on the wall couldnot be clearer. It is a special issue on new approaches toliability reorm. Very inspiring to see a section o the medi-cal proession determined to address consequences o theirown malpractice. Still early days o tort action in India andChina, it will neither be orever quiet on the liability rontnor will liability related issues be the only ones heatingup the health space.

Harmonisation o the various under-currents unleashedby the orces o rapid change and coping with consequences

o ast growth is what this eature is about. Neither is this anattempt at pushing the realm o insurance beyond knownboundaries nor transgressing into others. This is an attemptto take a holistic view and address a not too distant uture,ar more complex than the current paradigm allows us tobelieve, that stares us in our ace.

The big question, thereore, is how must we re-visit thearchitecture or everything to do with health? Should notanything and everything to do with it all be under one rooto ensure a seamlessly coordinated approach?

Mr Praveen Gupta is MD & CEO at Raheja QBE General InsuranceCo Ltd. The article represents his personal views. He champions thecause of diversity as the Deputy Chairman of Chartered Insurance

Institutes (UK) Diversity Action Group. He also writes a blog www.thediversityblog.wordpress.com. The author is grateful to the AmericanCollege of Surgeons March 2013 Bulletin; a special issue on Newapproaches to liabili ty reform. He has generously quoted from thoughtprovoking works appearing in this i ssue.

Thoughts on Diversity