And so, I recently stumbled at a random article written by a guy called Baltej Maini. He was writing about how to fix the health care system in India, but his points are still worth an examining look. I will list his points and state how I think they relate to Libya.
1. Develop and implement national standards for examination by which doctors, nurses and pharmacists are able to practice and get employment.
As far as I know, the only standards needed to practice medicine, nursing or pharma is to pass your respective university's examinations, the written, oral and clinical exams. Which is all good. But, where is the "continuing education" part? how do we know that the doctors, nurses, pharmacists who graduated 20 years ago have the necessary knowledge and skills to be able to keep up with the advancements in medicine? who is keeping watch over the performance of all these health care personnel? who is setting the standards of care? who is setting the ethics of care? A doctor cant show up for work 5 hours late and leave 2 hours early while he's got lots of patients waiting, that is just unacceptable.
2. Rapidly develop and implement national accreditation of hospitals; those that do not comply would not get paid by insurance companies. However, a performance incentive plan that targets specific treatment parameters would be a useful adjunct.There are very few hospitals in Libya to start with, very few, mind national accreditation! We can ignore the insurance bit for now because that does not exist in Libya yet and is not what we are focusing on at the moment. What matters here is regular review of hospitals, seeing that they are up to date and are running smoothly and meeting national standards of care. What matters more is ofc, building MORE hospitals!
3. Obtain proposals from private insurance companies and the government on ways to provide medical insurance coverage to the population at large and execute the strategy. It is healthy to have competition in healthcare, and provide health insurance to the millions who cannot afford it.
Health insurance is almost non-existent in Libya, so a major step will be to introduce that to the system; provide thousands if not millions of people with at least the minimum health care that they deserve. Set up a system of insurance that ENSURES patients get at least the minimum care that they need, instead of none at all due to their inability to pickup the bill!
4. Utilise and apply medical information systems that encourage the use of evidence-based medicine, guidelines and protocols as well as electronic prescribing in inpatient and outpatient settings. This is possible though the implementation of the EHR; this will, in time, encourage healthcare data collection, transparency, quality management, patient safety, efficiency, efficacy and appropriateness of care.
The keywords here are " health care data collection, transparency, quality management, patient safety, efficiency, efficacy and appropriateness of care". Almost all of these do not exist in the health care system in Libya. I think the most important of which is patient safety and quality management. How do we ensure that our patients are receiving the appropriate care and that the quality of our health care system is constantly developing? We also need to collect health care data, data that is either too old or unreliable won't work, we need reliable updated health care data to know exactly what we're facing in our health care system.
6. Develop multi-specialty group practices that have their incentives aligned with those of hospitals and payers. It is much easier to teach the techniques of sophisticated medical care to a group of employed physicians than it is to physicians as a whole. It is also important that doctors are paid adequately for what they do.
I remember a famous story of a man who's young son or daughter got extremely ill and needed the care of a specialized Neurologist. However after much search it came to notice that were was only ONE neurologist assigned to the ENTIRE CITY OF TRIPOLI that night, and when he was contacted it turned out he was int he other half of the country! The health care system needs more specialized physicians. In addition, health care employees, especially physicians, need to be paid more adequately, otherwise we are going to remain with the 3 hour a day work schedule that a lot of them have!
7. Encourage business schools to develop executive training programs in health care, which will effectively reduce the talent gap for leadership in this area.
BINGO! health care management is an area extremely under-developed in Libya and many other Arab countries. Business schools offering training in public health business management will drastically improve the health care system in Libya. If there is one point to take out of all that I just wrote, it's this!
8. Revise the curriculum in medical, nursing, pharmacy and other schools that train health care professionals, so that they too are trained in the new paradigm.
self explanatory. yet very very very important!
9. Develop partnerships between the public and private sectors that design newer ways to deliver healthcare. An example of this would include outpatient radiology and diagnostic testing centres.
This is very possible once the private sector exists on a large scale.
10. The government should appoint a commission which makes recommendations for the healthcare system and monitors its performance.
Unfortunately, the main job of any such commission (if it did exist) was to protect the population from dying from infectious diseases they acquired at hospitals. Monitoring the system and its performance have already been discussed, yet it never harms to stress the point once more! this ties back to point 1, 2, 7 and 4.
I hope this will be read by anyone who can make a difference right now. As always, I seek to do my part, unfortunately, I am still a pre-med student and this is all I am capable of at the moment in the current circumstances, to think.
And again, I am just a pre-med student, if anyone has any comments or would like to discuss any of the above please do in the comments!!!!!!!!!!
و الله المستعان
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