Nipate
Forum => Kenya Discussion => Topic started by: RV Pundit on August 11, 2015, 03:15:05 PM
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CBA/Mshwari customers to get health service on their phone...
In a country where the doctor-to-patient ratio currently stands at an alarming one doctor to 100,000 patients, the need for innovation in the health sector is critical if hospitals and clinics are to offer quality services,” said promoters of the service in a statement.
The Hello Doctor app works on both smart and selected feature (basic) phones. The service, to be launched Tuesday in Kenya, is already available in South Africa.
http://www.businessdailyafrica.com/Corporate-News/M-Shwari-clients-to-get-mobile-medical-consultation-services-/-/539550/2827254/-/kdoehuz/-/index.html
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In my experience this is a good idea but its not the solution. If its a video conference, then it may help a lot. Whenever there's a doc-patient interaction a lot goes on. The doc watches for a lot of non-verbal interactions and makes a decision based on multiple factors. Misdiagnosis can be deadly. There should be guidelines from professionals on how this is used.
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Compared to overworked and under trained doctors; this is better than nothing. Most folks in these parts of the world consults witch doctors or use herbs or just don't go to hospitals...when they are sick. Those that go...see a community nurse...who misdiagnosis everything probably as malaria or typoid. Let not bring in regulations and standards this early....let this flourish first.
In my experience this is a good idea but its not the solution. If its a video conference, then it may help a lot. Whenever there's a doc-patient interaction a lot goes on. The doc watches for a lot of non-verbal interactions and makes a decision based on multiple factors. Misdiagnosis can be deadly. There should be guidelines from professionals on how this is used.
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The should be guideline , not regulations from industry itself like Kenya Medical Association. Humans are greedy, so guidelines are necessary. These are human lives and some pple tend to e greedy and want to turn it into a "get rich quick scheme" at the expense of patients.
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In my experience this is a good idea but its not the solution. If its a video conference, then it may help a lot. Whenever there's a doc-patient interaction a lot goes on. The doc watches for a lot of non-verbal interactions and makes a decision based on multiple factors. Misdiagnosis can be deadly. There should be guidelines from professionals on how this is used.
It's more like a forum or group on Facebook. Really. I agree on the limitations of diagnosis without physical interaction.
Most people there die of Malaria. It's not clear how such an application can be useful. It seems to me to be a case of a solution looking for a problem to fix rather than the other way round.
If every county can invest in real doctors and medical services the kind the folks at Kapsowar Mission hospital provide. That should be a priority.
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Right now the focus should be encouraging kenyans to start using this like they did with Mpesa and Mshwari.
The should be guideline , not regulations from industry itself like Kenya Medical Association. Humans are greedy, so guidelines are necessary. These are human lives and some pple tend to e greedy and want to turn it into a "get rich quick scheme" at the expense of patients.
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Medicine has not always been like this..and will not always be like this. I think future generation will find the current hospitalization quite primitive. This to me is the future. The time when folks got some physiological treatment after just seeing the doctor is over. Why should I waste time to go and visit the hospital..endure 5hrs on the queue..before going see a doctor for less than 10mins...and then doctors direct you to go XYZ test.
The future for me is something like this..make phone call to the doctor......doctor redirects you to agents of nurses/labs technicians/pharmacist in every village...for more test or for drugs..tests are emailed...you have another talk with doctor..and you head to pharmacist or hospitalizations...end of story...unless you really need to go to theatre....you should never go to an hospital.Such model makes the 1:X doctor:patient very affordable for Africa countries...which are cash -trapped.
And this future like MPESA will be lend by those that don't have nothing close to functioning hospitals.
It's more like a forum or group on Facebook. Really. I agree on the limitations of diagnosis without physical interaction.
Most people there die of Malaria. It's not clear how such an application can be useful. It seems to me to be a case of a solution looking for a problem to fix rather than the other way round.
If every county can invest in real doctors and medical services the kind the folks at Kapsowar Mission hospital provide. That should be a priority.
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One of the assumptions here is that people are taking up doctors' time with "small things". I have no conclusive data, but, from the people I have seen at clinics/hospitals in Kenya, I doubt it; I suspect that the typical Mwafrika goes to the doctor only when he or she feels pretty bad. Typically, a doctor's visit in Africa will end up with some prescription, some injections or other medicine given, admission to hospital, etc. It's hard to see any of that happening on the basis of a short phone conversation.
Another questionable assumption is that if a doctor spends 10 minutes of time talking on the phone, then he or she miraculously gains 10 minutes elsewhere. Not so. In terms of the doctor's time, there is no difference in spending 10 minutes on the phone or 10 minutes in person. In fact, given the shortage of doctors in Kenya, it's not hard to imagine a situation where a doctor could get tied up for the entire day just doing these phone chats. So the idea that this would miraculously free up a doctor's time is questionable. (The matter of a patient having to travel and wait to be attended to is a different one.)
“M-Health will free-up general practitioners, clinics and other healthcare institutions from dealing with non-life-threatening conditions to allow them more time to provide an in-depth examination,”
The majority of people who go to see a doctor are not necessarily suffering from a life-threatening condition. And the implied assumption that non-life-threatening conditions can be dealt with by phone is a questionable one; even such cases require proper diagnosis, with a proper cause of action recommended. What sorts of conditions are amenable to treatment-by-phone?
Why should I waste time to go and visit the hospital..endure 5hrs on the queue..before going see a doctor for less than 10mins...and then doctors direct you to go XYZ test.
Because the doctor may need to conduct a proper examination in order to know what test to recommend. And here it is important to keep in mind that patients might not understand their symptoms, might not describe them accurately, etc.
The future for me is something like this..make phone call to the doctor......doctor redirects you to agents of nurses/labs technicians/pharmacist in every village.. for more test or for drugs..tests are emailed...you have another talk with doctor..and you head to pharmacist or hospitalizations
Kenya is a long way from having such personnel in every village---right now over 50% of all doctors in Kenya practice in Nairobi---and perhaps that should be the goal before technological gimmicks.
I don't see a situation where doctors will willy-nilly write (non-renewal) prescriptions for drugs or recommend hospitalizations without actually examining the patient. In a place like Kenya, where people are always willing to cut corners, it is certainly possible, but the practice of medicine will---for fairly obvious reasons---always be regulated, and no proper system of regulations or law will allow such a "cowboy" approach.
The time when folks got some physiological treatment after just seeing the doctor is over.
They are far from over. And when they do get "over", it is hard to envisage Africa as the "pioneer" in that regard; MPESA folks should not think that "sending medical advice" is similar to "sending money". Such futuristic outlooks would do well to consider the progress of "telemedicine" in places like the USA, which have the technology, the personnel, etc.
Another thing is that payments have to be made. Leaving aside the "mechanics" of the payment---presumably somebody is going to suggest MPESA for that---how many people will willing to pay for these phone conversations?
A much more serious issue on payments is in regard to insurance companies: it is doubtful that they will be prepared to pay for these phone chats. Setting aside the possibility of scams that would be inevitable in a place like Kenya, there are also legal aspects: what happens in a malpractice suit where the doctor has only given advice over the phone?
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Medicine has not always been like this..and will not always be like this. I think future generation will find the current hospitalization quite primitive. This to me is the future. The time when folks got some physiological treatment after just seeing the doctor is over. Why should I waste time to go and visit the hospital..endure 5hrs on the queue..before going see a doctor for less than 10mins...and then doctors direct you to go XYZ test.
The future for me is something like this..make phone call to the doctor......doctor redirects you to agents of nurses/labs technicians/pharmacist in every village...for more test or for drugs..tests are emailed...you have another talk with doctor..and you head to pharmacist or hospitalizations...end of story...unless you really need to go to theatre....you should never go to an hospital.Such model makes the 1:X doctor:patient very affordable for Africa countries...which are cash -trapped.
And this future like MPESA will be lend by those that don't have nothing close to functioning hospitals.
It's more like a forum or group on Facebook. Really. I agree on the limitations of diagnosis without physical interaction.
Most people there die of Malaria. It's not clear how such an application can be useful. It seems to me to be a case of a solution looking for a problem to fix rather than the other way round.
If every county can invest in real doctors and medical services the kind the folks at Kapsowar Mission hospital provide. That should be a priority.
I agree that adoption of digital technologies can be faster where there was no analogue equivalent or very little to begin with. From an African perspective, most of Africa at least, it can be argued that any interaction with a doctor, even digital is better than nothing. It would be interesting to see how this develops, though my first impression is that this is just a glorified forum.
I think the real problem, is how to motivate these professionals, including nurses, to not only leave their countries in large numbers, but be serious professionals in their work. How does the country ensure that mid-level professionals who are trained at great cost like nurses don't just disappear?
I am not against the digital aspect of the whole thing. But I am skeptical that it is the solution to the scarcity of doctors and nurses.
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This is exactly what folks said about M-pesa. I think we had long winding debate with Terminator about this about 10 yrs ago and in the end M-pesa won. Fact that telemedicine didn't work there is more reason to try it here....where most folks have no options.
What you're describing are just attitude change....from doctors, from patients, from insurances and from everyone..and secondly the availability of trusted brand name to provide lab/nursing changes.
Folks trust hospitals. Folks trust physical doctors. You can make them trust M-health by providing the same reliable service.
I think the first one can be sorted out easily...with heavy advertisement (people need to know this thing is real)..and the second one is even easy...all you need is Aga Khan (or any trusted medical brand) rolling out standardized mini-hospitals linked to the doctors via internet or video-conference.
Or even own branded M-health health centers at market places...as long as they are trained and meet the standards, have internet connection, they can provide services under supervision of a doctor in Nairobi.
You make the phone call..you get a tracking number...talks to a doctor....and if it something that sounds serious..you're advice to go the agha khan lab near you....and you're results are emailed the doctor...the doctors calls you back ...recommend medications..or follow up.
The customers benefits...Lab benefits..doctor saves more lives and get more mullah. There is less hassle for everyone. Opportunity cost savings. Incredible ability to scale it up.
One of the assumptions here is that people are taking up doctors' time with "small things". I have no conclusive data, but, from the people I have seen at clinics/hospitals in Kenya, I doubt it; I suspect that the typical Mwafrika goes to the doctor only when he or she feels pretty bad. Typically, a doctor's visit in Africa will end up with some prescription, some injections or other medicine given, admission to hospital, etc. It's hard to see any of that happening on the basis of a short phone conversation.
Another questionable assumption is that if a doctor spends 10 minutes of time talking on the phone, then he or she miraculously gains 10 minutes elsewhere. Not so. In terms of the doctor's time, there is no difference in spending 10 minutes on the phone or 10 minutes in person. In fact, given the shortage of doctors in Kenya, it's not hard to imagine a situation where a doctor could get tied up for the entire day just doing these phone chats. So the idea that this would miraculously free up a doctor's time is questionable. (The matter of a patient having to travel and wait to be attended to is a different one.)
“M-Health will free-up general practitioners, clinics and other healthcare institutions from dealing with non-life-threatening conditions to allow them more time to provide an in-depth examination,”
The majority of people who go to see a doctor are not necessarily suffering from a life-threatening condition. And the implied assumption that non-life-threatening conditions can be dealt with by phone is a questionable one; even such cases require proper diagnosis, with a proper cause of action recommended. What sorts of conditions are amenable to treatment-by-phone?
Why should I waste time to go and visit the hospital..endure 5hrs on the queue..before going see a doctor for less than 10mins...and then doctors direct you to go XYZ test.
Because the doctor may need to conduct a proper examination in order to know what test to recommend. And here it is important to keep in mind that patients might not understand their symptoms, might not describe them accurately, etc.
The future for me is something like this..make phone call to the doctor......doctor redirects you to agents of nurses/labs technicians/pharmacist in every village.. for more test or for drugs..tests are emailed...you have another talk with doctor..and you head to pharmacist or hospitalizations
Kenya is a long way from having such personnel in every village---right now over 50% of all doctors in Kenya practice in Nairobi---and perhaps that should be the goal before technological gimmicks.
I don't see a situation where doctors will willy-nilly write (non-renewal) prescriptions for drugs or recommend hospitalizations without actually examining the patient. In a place like Kenya, where people are always willing to cut corners, it is certainly possible, but the practice of medicine will---for fairly obvious reasons---always be regulated, and no proper system of regulations or law will allow such a "cowboy" approach.
The time when folks got some physiological treatment after just seeing the doctor is over.
They are far from over. And when they do get "over", it is hard to envisage Africa as the "pioneer" in that regard; MPESA folks should not think that "sending medical advice" is similar to "sending money". Such futuristic outlooks would do well to consider the progress of "telemedicine" in places like the USA, which have the technology, the personnel, etc.
Another thing is that payments have to be made. Leaving aside the "mechanics" of the payment---presumably somebody is going to suggest MPESA for that---how many people will willing to pay for these phone conversations?
A much more serious issue on payments is in regard to insurance companies: it is doubtful that they will be prepared to pay for these phone chats. Setting aside the possibility of scams that would be inevitable in a place like Kenya, there are also legal aspects: what happens in a malpractice suit where the doctor has only given advice over the phone?
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I think the real problem, is how to motivate these professionals, including nurses, to not only leave their countries in large numbers, but be serious professionals in their work.
Take a look at this:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283025/
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This is exactly what folks said about M-pesa.
I anticipated such a response. That is why I wrote a remark on the difference between medical consultations and sending money. Apart form many obvious differences that you claim require no more than an "attitude change", the practice of medicine will always be, and should always be regulated in a manner that is very different from the practice of finance.
Fact that telemedicine didn't work there is more reason to try it here....where most folks have no options.
Tremendous steps have in fact been made in telemedicine. Places worth looking at include Montana (and other backward parts of the USA), where many rural folks are not within easy reach of a doctor.
Like "Windy City Assassin", I don't see this doing much for the fundamental healthcare problems in Kenya. But if it is just an online forum, then why not?
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Medicine and finance have been evolving..and will evolve. What you call modern finance is maybe 150 yrs old...and that is getting pretty much destroyed. The same with medicine. The idea of a doctor in hospitals with nurses is very very new. Spend time reading history of things.
The future is tele-medicine/e-medicine..whatever you want to call you it..it may take time...it may faces challenges..but future generation will not waste time and money on an inefficient systems...like visiting an hospital bed and probably end up contracting more diseases...when all you need is to email a report of your blood and fluid samples...right in your houses.
Future generation will find the current practice completely dumb and primitive in very many levels....and Kenya should be in the fore-front creating that future.
the practice of medicine will always be, and should always be regulated in a manner that is very different from the practice of finance.
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I actually chose to ignore the regulation part because it dumb. Everything is regulated. Including tele-medicine or e-banking. Who says you cannot regulate a doctor offering his service via internet or phone? The difference is the mechanics....not the regulation...which gov does and will adapt it's laws with the changing reality.
The future for finance, medicine, education ,name it is E- or M- or something.
These are ideas that out of research labs and now even Kenya company like CBA think it can fly.
If there are missing pieces in the puzzles...trust they will slowly and surely fall in places...and viola...the current primitive medicine will be confined to history.
Yes, I could spend more time reading up on the history of things. In what specific ways would that enlighten me on the need to regulate medicine and finance in different ways?
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I actually chose to ignore the regulation part because it dumb. Everything is regulated. Including tele-medicine or e-banking. Who says you cannot regulate a doctor offering his service via internet?
You are certainly free to consider it dumb, but you might want to take a look at countries that been at this telemedicine thing for a while.
They certainly can be regulated. In fact, the "problem" in many places is that they are regulated in an extremely tough way.
The difference is the mechanics....not the regulation...
I'm afraid not. There will be no mechanics if the regulations forbid it or has serious consequences.
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That is dumb regulation. M-pesa thrived because CBK refused to regulate it. You need to let the idea flourish before you regulate it. So the over-regulation is regulating who? Nobody. Let people die from tele-medicine first..before you jump in to regulate. Otherwise many are dying from simple ailments coz they can't get to hospital fast enough...or they never can afford it.
In fact, the "problem" in many places is that they are regulated in an extremely tough way.
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You need to let the idea flourish before you regulate it. So the over-regulation is regulating who? Nobody. Let people die from tele-medicine first..before you jump in to regulate.
"Let people die first" does not appear to be the standard attitude in such things---at least in sensible places. The general expectation---codified in all sorts of rules, regulations, and laws---is that one must show that people are unlikely to die.
Whether that's dumb or not may be debated, but there it is. What's more, it seems unlikely to change---at least in sensible places.
Otherwise many are dying from simple ailments coz they can't get to hospital fast enough..
It's hard to see how "MPESA Telemedicine" will get them to hospital any quicker.
Also, many "simple ailments" that kill people in places like Africa---and I am here thinking of something like diarrhea---can be dealt with quite easily (e.g. good basic hygiene) and without the involvement of any fancy ideas.
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I'm assuming this is referring to general doctors and not specialists or surgeons. Majority if not all non-student doctors are chock-a-block busy with conducting theatre (surgical procedures). Everywhere else outside hospitals- its the pharmacist who are regarded as doctors because they have access to medicines. Very basic medicines like cough syrups. Experience tells me that malaria and HIV are the accepted western medical diagnosis. Reason for seeing a pharmacist might be to purchase malaria tabs, cough syrups, pain killers, birth control pills and not much else.
I'm not seeing what benefit a virtual doctor would be over Googling your symptoms or seeing a pharmacist, nurse or lab technician who can order tests as well. If it's more serious they make referrals to hospitals but in that case the patient has a serious disorder like HIV, obstructive deformity etc. a virtual doctor can't do much about that. I think we've forgotten hospitals in Kenya are like war zones. You win some and lose some to senseless botched operations and other mysterious occurrences. Doctors get too much leverage in East Africa. I don't blame them because they don't get the luxury of dealing with first world problems. The ones I've spoken to went into medicine to get the hell out of Kenya before they contract something deadly and die in their 30s. Let's not forget the life expectancy of doctors in Kenya are in their 30s.
However, the culture of healthcare may benefit using mobile technology. In the sense the doctor connects with villages. It might be confusing though because withcraft is still rampant and it'll undermine pharmacists, nurses and lab technicians who in my opinion are better people than the average doctor trained in Kenya. Kenyan doctors are unskilled and are too snobby to interact with village folks. There's a stiff hierarchy in Kenya's healthcare system. I see more likely MSF designing an APP of somesort but on the same token demanding money from the govt perhaps money better spent in equipping pharmacists, nurses, lab technicians with prescription privileges or running anti witch doctor public health campaigns.
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Why is it so hard to standardize test and common treatment for common diseases? Lab test should pretty much tell you what to look for and that should pretty much be the first line of treatment which can be done via tele-medicine. Only emergency cases get admitted. Otherwise first port of call...is your medical 911...and if you don't get well say after 3days-1 week...then you go see a doctor.
This certainly would lessen the burden of any health care systems.
Kenya last year had 40M hospital/dispensary visits..40% of basic diarrhea cases..another 40% on basic respiratory problems....all these overburdened the few doctors unnecessarily.
I'm assuming this is referring to general doctors and not specialists or surgeons. Majority if not all non-student doctors are chock-a-block busy with conducting theatre (surgical procedures). Everywhere else outside hospitals- its the pharmacist who are regarded as doctors because they have access to medicines. Very basic medicines like cough syrups. Experience tells me that malaria and HIV are the accepted western medical diagnosis. Reason for seeing a pharmacist might be to purchase malaria tabs, cough syrups, pain killers, birth control pills and not much else.
I'm not seeing what benefit a virtual doctor would be over Googling your symptoms or seeing a pharmacist, nurse or lab technician who can order tests as well. If it's more serious they make referrals to hospitals but in that case the patient has a serious disorder like HIV, obstructive deformity etc. a virtual doctor can't do much about that. I think we've forgotten hospitals in Kenya are like war zones. You win some and lose some to senseless botched operations and other mysterious occurrences. Doctors get too much leverage in East Africa. I don't blame them because they don't get the luxury of dealing with first world problems. The ones I've spoken to went into medicine to get the hell out of Kenya before they contract something deadly and die in their 30s. Let's not forget the life expectancy of doctors in Kenya are in their 30s.
However, the culture of healthcare may benefit using mobile technology. In the sense the doctor connects with villages. It might be confusing though because withcraft is still rampant and it'll undermine pharmacists, nurses and lab technicians who in my opinion are better people than the average doctor trained in Kenya. Kenyan doctors are unskilled and are too snobby to interact with village folks. There's a stiff hierarchy in Kenya's healthcare system. I see more likely MSF designing an APP of somesort but on the same token demanding money from the govt perhaps money better spent in equipping pharmacists, nurses, lab technicians with prescription privileges or running anti witch doctor public health campaigns.
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However, the culture of healthcare may benefit using mobile technology. In the sense the doctor connects with villages.
Not really. The village folks are ones who are most likely to want a "doctor in flesh" when they are really ill. And when they go to see one, they have expectations: a white lab-coat, a big injection (preferably of antibiotics, no matter what the ailment is), etc.
It might be confusing though because withcraft is still rampant and it'll undermine pharmacists, nurses and lab technicians who in my opinion are better people than the average doctor trained in Kenya.
Witchcraft doesn't undermine that. "Modern" or "religious" Africans will profess not to have much use for it, but they will have it as a Plan-B, in case Western gods or medicine don't come through. The rest will have it as Plan A or Plan B according to what alternative is available and what needs to be done.
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MK, you misunderstand me. First of all I support mobile health technology like RVP's brilliant idea but within a framework that works. In my opinion there should be a new certification - health technicians? So training nurses, pharmacists and lab technicians in mobile health interfaces (so they speak to doctors via free SIP technology - another reason to endorse data cabling :wink: so prescribing medicines for HIV and specialist disorders with doctor permissions- sort of like nurse practitioners in first world countries who do the same general doctor duties working for NGOs or underprivileged regions but charge dirt cheaper than doctors and are hell of a lot better at diagnosing than doctors. American doctors are awful. Kenyan doctors are near just as blind and completely out of touch with village culture.
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Kenya last year had 40M hospital/dispensary visits..40% of basic diarrhea cases..another 40% on basic respiratory problems....all these overburdened the few doctors unnecessarily.
As I see it, we should be trying to deal with such cases much earlier, rather than trying to reduce burden on doctors and hospitals. Clean water and basic hygiene will take care of a great deal of what would otherwise be diarrhea cases.
In relation to the topic at hand: by the time a person decides that his or her diarrhea is so bad that a doctor is needed, it's hard to see how there will be much use in "MPESA Telemedicine". So I don't see how the "overburdened ... few doctors" will be helped by this system.
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MK, you misunderstand me.
And you misunderstand me. I understand that you support the general idea ... "telemedicine for Africa" and all that. What I was getting at is that you misunderstand the general situation/context: diarrhea, witchcraft, etc. are as African as apple-pie is American. Telemedicine won't change any of that, although, with respect to the first, something as simple as clean drinking water could save lives, reduce burdens on doctors and hospitals, etc.
I hope that clarification helps you understand the misunderstandings here.
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Diarrhea and respiratory infections could be rooted in any underlying health disorder. With proper training, a health technician can perhaps be equipped with tools to make a more fine tuned diagnosis. That means providing village labs with more specialised equipment for detecting cholera from salmonella poisoning. If this isn't feasible. Have a system which would allow biological samples picked up by lab vehicles and transported to district labs. The problem I see here is lack of infrastructure and working with what we have. Why not employ specialist matatus to transport biological specimens? Why not train village clinics in health informatics and login systems usually privy in hospitals? Why not break the social class barriers between doctors and nurses so nurses aren't intimidated to consult a doctor for advise or vice a versa a doctor not be too snobby to give honest advice to a pharmacist. These are inherent cultural problems and I do believe mobile technology when cleverly implemented can break down those barriers.
If I had to understand the misunderstandings here between you and I... I see technology as a means of social empowerment whereas you seem to see it like a logic board with no vision other than selected facts. Are you a visionary ? I'm not seeing it.
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Diarrhea and respiratory infections could be rooted in any underlying health disorder.
I can't comment on the latter. On diarrhea in places like Kenya, the roots are well known and have been for ages. The solutions do not require "more fine tuned diagnosis ... village labs with more specialised equipment" etc.
Why not employ specialist matatus to transport biological specimens?
Can they be relied on to transport a dead chicken?
Why not break the social class barriers between doctors and nurses so nurses aren't intimidated to consult a doctor for advise or vice a versa a doctor not be too snobby to give honest advice to a pharmacist.
These exist all over the world, and the doctors will ensure that things stay that way. But, more importantly, I don't see that as being a key issue in healthcare in places like Kenya: we have more basic problems.
If I had to understand the misunderstandings here between you and I... I see technology as a means of social empowerment whereas you seem to see it like a logic board with no vision other than selected facts. Are you a visionary ? I'm not seeing it.
I don't know what to make of the big words, like "social empowerment". My view is this: technology can never be better than the people who use it, in the sense that it cannot fundamentally change who they are. The failure or refusal to understand this produces the Kenyas of the world.
Consider, for example, the notion that the moral deficit in Kenyans (w.r.t corruption) can be fixed with technology. And then you have a whole cabinet secretary say that close to Sh. 1 billion is getting stolen because someone got her password. Some obvious questions: why does the CS have total and free access to the financial side of the ministry? What checks are there to ensure that a single password cannot allow one to do as one pleases? The issue here is not whether or not there is the "right" technology; it is whether Kenyans will stop thieving.
On health: What are the real serious problems with the healthcare system in Kenya? Is it merely a matter of having the "right" technology? Not really.
For Kenya to really move forward, Kenyans will have to give up on ideas such as "our people above all", "eat before the other person eats it", etc. At the root of such attitudes are "problems" that cannot be solved with the mere application of technology; there is certainly little evidence to suggest that the most "technologically advanced" Kenyans are any more advanced onthose issues than the manamba villagers.
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Why is it so hard to standardize test and common treatment for common diseases? Lab test should pretty much tell you what to look for and that should pretty much be the first line of treatment which can be done via tele-medicine. Only emergency cases get admitted. Otherwise first port of call...is your medical 911...and if you don't get well say after 3days-1 week...then you go see a doctor.
This certainly would lessen the burden of any health care systems.
Kenya last year had 40M hospital/dispensary visits..40% of basic diarrhea cases..another 40% on basic respiratory problems....all these overburdened the few doctors unnecessarily.
40% of medical diagnoses are misdiagnosed in places like America due to doctors who just don't bother investigating further or because of poor lab results e.g. false positives, true negatives. Also lab specimens are dependent on the lab technician's skill. Add to that mix- unreliable results published in medical journals and Big Pharma incentives to entice doctors to prescribe their drugs. It's really the patient in majority of cases who know their body best. Second, third, fifth doctor opinions on complex disorders are a must in today's healthcare. To avoid Kenya falling into such a first world healthcare crisis- health technicians should be empowered so institutional forces like Big Pharma and medical journals bear little influence in manipulating the healthcare system.
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MK, I don't wish to get into the politics of healthcare in Kenya. We could be here for years.
Kenya is one of few countries in the world to successfully implement mobile technology at unprecedented levels- socially and economically. Mobile technology is a link to the global world. Mobile culture is already flourishing in Kenya. Mzungu medicine may not be accepted but mobile technology has become a social mandate. Such things should be maximised as much as possible.
Talking with a health practitioner over the phone is much more practical than catching a dozen matatus to get to a provincial hospital and then wait half a day to meet the doctor who then tells you there's a waiting list for surgical procedures. I think however doctors call nurses more these days to book procedures beforehand. Such infrastructure could be maximized.
Matatus can be refurbished with fridges and buffered adequately to transport biological specimens. It can be contracted out so they don't have to speed for money. A van is useful for many things. Instead of transporting people it could be used for trade like telecommunication services. With enough investment, these vans have immense potential.
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My two cent opinion is that we should adopt this, but it should be by video conference with a patient. Provider can decide whether to have a face to face meeting. Ive seen surgeries performed in India while the practisioner in in Oregon via video conference.
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Talking with a health practitioner over the phone is much more practical than catching a dozen matatus to get to a provincial hospital and then wait half a day to meet the doctor who then tells you there's a waiting list for surgical procedures.
It certainly is easier, but what do you mean by "more practical"?
If you look at the small things that are finishing Kenyans, how would a phone chat help? And the fact that Kenya has supposedly been able to "successfully implement mobile technology at unprecedented levels- socially and economically" doesn't answer that question. Dealing with diarrhea, cholera, etc. does not require high-tech mobile anything.
If the patient is sufficiently ill to require a surgical procedure---and that can be determined only by a real consultation by a doctor---then he or she will simply have to swallow the inconvenience that you refer to. MPESA Telemedicine can neither shorten such waiting lists nor do away with the need for a proper examination.
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My two cent opinion is that we should adopt this, but it should be by video conference with a patient. Provider can decide whether to have a face to face meeting. Ive seen surgeries performed in India while the practisioner in in Oregon via video conference.
I too am all for such things; I think telemedicine can make a huge difference in some ways, and the only way is onward and upward, as one might say. But it has its place, and that does not include the basic health problems that many Africans face.
MPESA Telemedicine purely as a "forum", why not? Those already exist all over the place:
You can post "I ate a goat-head and drank 3 beers last night, and now my poop is green and I feel woozy? Am I dying? Should I call 911?".
And somebody, medical or medically inclined will write back with "No, you aren't dying. Just drink some strong black tea. If the symptoms persist, then take two aspirins. And next time don't mix goat-heads with beer".
I imagine that a real doctor on such a "forums" would also probably say: "I'm not going to make any money here, but bait was made for fish. Oh, that sounds very serious. We need to get you into this here clinic right away. We have seen a lot of this, and we are experts at it
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I think cyber docs are ok as long as there's secondary follow up. Someone Whois 40 miles from the closest medical facility will appreciate a cyber doc who makes an initial diagnosis of appendicitis than wait 12hrs later.
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My two cent opinion is that we should adopt this, but it should be by video conference with a patient. Provider can decide whether to have a face to face meeting. Ive seen surgeries performed in India while the practisioner in in Oregon via video conference.
I too am all for such things; I think telemedicine can make a huge difference in some ways, and the only way is onward and upward, as one might say. But it has its place, and that does not include the basic health problems that many Africans face.
MPESA Telemedicine purely as a "forum", why not? Those already exist all over the place:
You can post "I ate a goat-head and drank 3 beers last night, and now my poop is green and I feel woozy? Am I dying? Should I call 911?".
And somebody, medical or medically inclined will write back with "No, you aren't dying. Just drink some strong black tea. If the symptoms persist, then take two aspirins. And next time don't mix goat-heads with beer".
I imagine that a real doctor on such a "forums" would also probably say: "I'm not going to make any money here, but bait was made for fish. Oh, that sounds very serious. We need to get you into this here clinic right away. We have seen a lot of this, and we are experts at it
Hehehe...
The idea by itself is okay. Commendable actually. But the marketing is misplaced when they suggest it is the solution to the fundamental problem of healthcare delivery. But maybe that is the only way they can sell it.
While technology is an excellent multiplier when applied in the appropriate context and problem, it's not the solution to everything. You mention elsewhere about the diseases of poverty like diarrhea. These were largely eliminated in the west just by a rise in the standards of living. No new super drug, or mobile app. But widespread access to clean water.
@veritas, I know you have recently shown some heightened interest in technology. You might want to look at water purification technologies. Those ought to be something very appropriate in many places in Kenya and Africa.
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Talking with a health practitioner over the phone is much more practical than catching a dozen matatus to get to a provincial hospital and then wait half a day to meet the doctor who then tells you there's a waiting list for surgical procedures.
It certainly is easier, but what do you mean by "more practical"?
If you look at the small things that are finishing Kenyans, how would a phone chat help? And the fact that Kenya has supposedly been able to "successfully implement mobile technology at unprecedented levels- socially and economically" doesn't answer that question. Dealing with diarrhea, cholera, etc. does not require high-tech mobile anything.
If the patient is sufficiently ill to require a surgical procedure---and that can be determined only by a real consultation by a doctor---then he or she will simply have to swallow the inconvenience that you refer to. MPESA Telemedicine can neither shorten such waiting lists nor do away with the need for a proper examination.
Better in practice.
Are you talking about cholera from poor sanitation? That's a public health issue. I'm not talking about pts who see a health practitioner because of diarrhoea due to poor sanitation in refugee camps. That rarely happens because you need pesa to even see a nurse and refugee camps rely on WHO handouts. If a pt has ongoing or painful diarrhoea it could be bowel obstruction to HIV. You don't need a doctor to make diagnoses in Kenya but you do need referrals to district hospitals to gain access to certain medicines not in pharmacy kiosks or for booking surgical procedures requiring hospital equipment. The medical system is completely different to first world countries. Last time I checked, only one hospital in Western province had an incubator for premature born babies. These hospitals function like the Florence Nightingale era with the wide white nurse hats. The likely instance is when calls are made by a rural nurse to a doctor living in first world countries through an NGO about a complicated condition.
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Are you talking about cholera from poor sanitation? That's a public health issue. I'm not talking about pts who see a health practitioner because of diarrhoea due to poor sanitation in refugee camps.
OK. Now I know what you are not talking about. What I don't know is what you are talking about.
You don't need a doctor to make diagnoses in Kenya but you do need referrals to district hospitals to gain access to certain medicines not in pharmacy kiosks or for booking surgical procedures requiring hospital equipment.
I doubt that most sick people in Kenya wait for referrals to hospitals. As far as I can tell, when they feel sufficiently ill, they simply pop up at the hospital.
Last time I checked, only one hospital in Western province had an incubator for premature born babies.
And MPESA Telemedicine will help how?
The likely instance is when calls are made by a rural nurse to a doctor living in first world countries through an NGO about a complicated condition.
I don't think that's what they have in mind here.
I note that this service was launched in South Africa about 4 years ago, and on their website they are now proudly advertising the "Kenyan Launch":
http://www.hellodoctor.co.za/
So how effective has it been? I'll await answers. But I note that their claims and goals are decidedly more modest than what is being peddled right now in Kenya:
We could never replace face-to-face consultations with your GP.
and
"We enable consumers to make informed decisions about their health; no diagnosis or treatment decisions are made,"
They do, however, cast aside their modestly when it comes to specifying how many versions of the app you can buy (online, with debit or credit card).
It also appears that the most frequent recommendation from these chats is "go see a doctor in person". I would not be surprised if that recommended in-person also turned out to be the person making the recommendation.
The general news from South Africa suggests that they haven't exactly had a happy time of it down there:
Diagnosis bad for ‘Hello Doctor’: The Health Professions Council of South Africa has warned doctors, other healthcare practitioners and the public not to participate in, or make use of, the advertised Hello Doctor or any other act of “unethical telemedicine”, that may be in breach of the Council’s ethical rules and regulations.
The HPSCA said that despite submissions by Sanlam Health and MTN as well as Hello Doctor, a subsidiary of Metropolitan Health, being rejected by the council in 2012, the regulator has noticed, with concern, recent initiatives by the MTN Hello Doctor partnership offering “text conversations” with doctors as well as telephonic “House call” access to doctors’ services.
Practices such as these are in breach of patients’ rights such as practitioner-patient relationship, patient confidentiality and informed consent, it said.
http://www.news24.com/Archives/Witness/Diagnosis-bad-for-Hello-Doctor-20150430
and
SAMA supports HPCSA's denunciation of Hello Doctor: The South African Medical Association [SAMA] has noted with concern certain advertisements publicising the fact that Hello Doctor, a subsidiary of Metropolitan Health, has partnered with the MTN Group to "provide mobile health services" across its markets.
SAMA supports the initiative the HPCSA has taken to warn doctors against using the Hello Doctor platform to offer their services, because the telemedicine practices so offered will constitute a breach of the ethical rules that govern¬ HPCSA members. These services are in breach of the doctor-patient relationship, patient confidentiality and the principle of informed consent.
SAMA would also like to reiterate that it does not support any initiative that discourages face-to-face consultation between patient and doctor. A doctor should put him/herself in a position to make a sound clinical judgment before offering advice by means of a face-to-face examination.
The anonymity of the consulting doctor ('how does a patient verify that they are who they say they are?') continues to pose a major ethical dilemma.
https://www.facebook.com/SAHIVSoc/posts/626807940712455
It is also interesting to note that what Hello Doctor claimed it would offer in South Africa in 2011 is very similar to what is supposedly going to be on offer in Kenya. But there has since been a significant retreat from in South Africa---to the extent that exists if hardly recognizable relative to the initial high-flying talk.
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Someone does something finally about something and all you hear are the usual 1) it not a priority 2) there are better ideas 3) this won't work. Now what stopping you from doing it.
This idea is laudable...at least for for the single fact...they are trying something. It may not work. It may work. CBA has trail blazed with Mshwari..and has within 2yrs overtaken all banks to have more than 10M bank accounts...and have loaned out billions..and recieved nearly 100B deposits from the poorest.
We had the same same arguments with M-pesa...how it was not a real bank...cookie called it Morse code technology...I think City called it smoke tech....but right now folks are using it to wire trillions of kshs..it morphed into many many things.
Poor folks in kenya are not stupid...they are very literate...and such ideas may stutter but they will work..because there is NO ALTERNATIVE.
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Someone does something finally about something and all you hear are the usual 1) it not a priority 2) there are better ideas 3) this won't work. Now what stopping you from doing it.
This idea is laudable...at least for for the single fact...they are trying something. It may not work. It may work. CBA has trail blazed with Mshwari..and has within 2yrs overtaken all banks to have more than 10M bank accounts...and have loaned out billions..and recieved nearly 100B deposits from the poorest.
We had the same same arguments with M-pesa...how it was not a real bank...cookie called it Morse code technology...I think City called it smoke tech....but right now folks are using it to wire trillions of kshs..it morphed into many many things.
Poor folks in kenya are not stupid...they are very literate...and such ideas may stutter but they will work..because there is NO ALTERNATIVE.
Just a correction. I recall having an argument with you about who developed M-Pesa. Not its utility.
I also remember thinking, mistakenly that it will be adopted by a major US cell phone company. Arguing against cookie in that respect.
While you might be right about cookie, you seem to want to lump every objection one makes into one box. Let's try and stick to the facts. I have zero to gain from arguing against facts.
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No problem. Apologies If I mixed it up. The m-pesa debate went on for ages. My point though remain the same. These guys (private sector) are trying out an idea that could revolutionize health care in kenya and maybe globally like Mpesa did. Others need to do their job...gov being one...but certainly these guys deserve all the kudos for trying.
Just a correction. I recall having an argument with you about who developed M-Pesa. Not its utility.
I also remember thinking, mistakenly that it will be adopted by a major US cell phone company. Arguing against cookie in that respect.
While you might be right about cookie, you seem to want to lump every objection one makes into one box. Let's try and stick to the facts. I have zero to gain from arguing against facts.
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No problem. Apologies If I mixed it up. The m-pesa debate went on for ages. My point though remain the same. These guys (private sector) are trying out an idea that could revolutionize health care in kenya and maybe globally like Mpesa did. Others need to do their job...gov being one...but certainly these guys deserve all the kudos for trying.
Just a correction. I recall having an argument with you about who developed M-Pesa. Not its utility.
I also remember thinking, mistakenly that it will be adopted by a major US cell phone company. Arguing against cookie in that respect.
While you might be right about cookie, you seem to want to lump every objection one makes into one box. Let's try and stick to the facts. I have zero to gain from arguing against facts.
No issue there. The real beef I have had with M-PESA has always been about publishing the API. I have always thought that was a win-win situation for safcom, but obviously they think otherwise. They prefer to limit access and exploit their monopoly on it, in the process slowing down innovation, much like Microsoft did with its products until it was overtaken by events.
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I also remember thinking, mistakenly that it will be adopted by a major US cell phone company. Arguing against cookie in that respect.
It's hard to imagine what use something like MPESA would be in a place with a decent banking system:
* Most people, except possibly some criminals, who prefer "cash money", will have bank accounts. And in many places it is easy enough to "send money" from a computer or a mobile phone.
* Folks who don't have bank accounts or the right sorts of plastic cards have other options, such as pre-paid credit cards, and it is possible to put money into those, either by computer/phone or by going to the right place (the equivalent of a MPESA agent).
* Cash (more than trivial amounts) is both "suspicious" and unnecessary. (I am right now reflecting that I hardly ever have cash at hand or the need for it; and that seems to be the case with most folks I see wandering around.)
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Someone does something finally about something and all you hear are the usual 1) it not a priority 2) there are better ideas 3) this won't work. Now what stopping you from doing it.
This idea is laudable...at least for for the single fact...they are trying something. I
It is certainly laudable, in so far as "something is better than nothing"; but that seems to be about it.
It may work. CBA has trail blazed with Mshwari..and has within 2yrs overtaken all banks to have more than 10M bank accounts...and have loaned out billions..and recieved nearly 100B deposits from the poorest.
We had the same same arguments with M-pesa...
Nevertheless matters of health are different. There are serious ethical and legal issues in health that are both different and not easy to get around; in that regard, a reference to "same arguments" is entirely misplaced. (Moreover, the mere fact that something that was scoffed at, by some, ended up working does not necessarily imply that everything that is scoffed at will work; "proof by exception" generally does not work. Each "innovation" must be judged on its own merits.)
And there's another thing to keep in mind here: Whereas more technologically advanced places might not have tried something like MPESA---because there is little use for it---they certainly have been hard at work on telemedicine. So the notion of Kenya/South Africa blazing trails with this "forum" is simply off. What's more, there are important lessons to be learned from the others.
Poor folks in kenya are not stupid...they are very literate...and such ideas may stutter but they will work..because there is NO ALTERNATIVE.
The basic issues have little to do with "stupidity" or "literacy", and there is no need to inject irrelevant "emotion" into this. And it depends on what you mean "will work". Will it work as a "forum"? I don't see why it can't; it might even be useful in that way. Beyond that? One only has to look at the initial ideas in South Africa---diagnosis by phone, prescriptions by phone, etc.---and what Hello Doctor in South Africa currently is.
To my mind, the matter here is quite straightforward, and I will put in thus:
(a) What are the basic health problems that most Kenyans (Africans) face?
(b) What are the prospects that this Hello (Sema) Doctor will be able to address those?
In (a), we have, for example, diarrhea, which you mentioned. Another is malaria. Cholera is never too far away. And so on, and so forth. We know that there would be tremendous improvements in the health of Kenyans (Africans) just by having toilets and latrines, people pooping right and washing hands, having clean drinking water, etc. No type of fancy mobile-phone "app" will change that.
So, unless people will be using mobile phones to plug their butts when they have diarrhea, or using them to whack mosquitos, it's hard to see where this particular "high tech" thing is going in that regard. The basic problems of health in Africa will not be solved with such gimmicks. What is required is real hard and serious work, with attention paid to the fundamentals---and that there is the ALTERNATIVE. To the extent that anyone claims otherwise, it behooves them to explain exactly how. And that can be done this way:
(a) A statement of the health problem.
(b) An explanation of how MPESA Telemedicine will help.
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MK, it sounds like you were born with a gold spoon in your mouth. I'm going to have to direct you to my health blog: https://kenyamedical.wordpress.com/
The majority of populaces live in villages and can't get to the district hospital. In most instances, transportation and otherwise are organized by the hospital or sponsoring organisation if a local clinic can't treat the pt. Port-of-call when a pt is still very sick after a few days even after consuming malaria tabs, diarrhea tabs etc. is to visit a clinic. At the clinic, the pt is tested for malaria in the local lab. Refer to my post: https://kenyamedical.wordpress.com/2011/02/12/checking-for-falciparum-malaria-in-a-lab-rural/ and are put on drip if found to be malaria +ve: So quinine and saline combinations. In most cases quinine does the trick for everything. In severe cases pts die before reaching a hospital. This happens when the malaria has penetrated the cerebral regions and the pt becomes delirious. I witnessed firsthand the devastating fx of malaria. I get the impression you haven't. There isn't much hospitals do for pts, again, I refer you to my blog: https://kenyamedical.wordpress.com/2011/02/12/common-procedures-in-district-hospitals/
At the district hospital, each month approx. fifty major surgical procedures are performed in theatre. The most common three being:
1. Caesarean section (comprise near half of procedures)
2. Herniotomy
3. Herniorrhaphy
The rest are not as common:
1. Laparotomy
2. Prostatectomy
3. Cystectomy
4. Re-section/anastomosis
5. Splenectomy
6. Hysterectomy
7. Sphincterotomy
8. Scalpingectomy
9. Hydrocelectomy
10. Myomectomy
11. Appendectomy
12. Thyroidectomy
13. BTL
You refer to doctors and medical systems from first world countries but in Kenya it isn't like that. It's like this:
(https://kenyamedical.files.wordpress.com/2011/01/k1.jpg)
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MK, it sounds like you were born with a gold spoon in your mouth ... The majority of populaces live in villages and can't get to the district hospital.
Skipping that little, unhelpful, and unwarranted introduction, which somehow assumes that I know little of the healthcare system in Kenya, I think you've missed the point. And rather badly at that.
Here it is, in summary:
(a) Much of what kills Kenyans is not the lack of access to hospitals; on the contrary, public hospitals in Kenya are extremely dangerous places for anyone's health and especially for those in poor health.
The health of most Kenyans and Africans can be substantially improved in relatively simple ways, none of which requires the mobile-phone "apps" or even the involvement of hospitals. And that, to my mind, is what folks should focus on, even of they have tinker-toy mobile-phone "forums" to play with.
(b) You write that:
In most instances, transportation and otherwise are organized by the hospital or sponsoring organisation if a local clinic can't treat the pt. Port-of-call when a pt is still very sick after a few days even after consuming malaria tabs, diarrhea tabs etc. is to visit a clinic. At the clinic, the pt is tested for malaria in the local lab. Refer to my post: https://kenyamedical.wordpress.com/2011/02/12/checking-for-falciparum-malaria-in-a-lab-rural/ and are put on drip if found to be malaria +ve: So quinine and saline combinations. In most cases quinine does the trick for everything. In severe cases pts die before reaching a hospital. This happens when the malaria has penetrated the cerebral regions and the pt becomes delirious. I witnessed firsthand the devastating fx of malaria. I get the impression you haven't. There isn't much hospitals do for pts, again, I refer you to my blog: https://kenyamedical.wordpress.com/2011/02/12/common-procedures-in-district-hospitals/
All that may be true. And it is relevant how? I don't see how MPESA Telemedicine will help in any way. So, once again:
(a) Please state exactly what the problem at hand is.
(b) Then state exactly how MPESA Telemedicine will help.
Once we are clear on those, I think we will be able to have a more fruitful discussion.
By the way, unlike fly-in/fly-out do-gooders, I actually grew up in Malaria Country. I know full well and first-hand its effects---as in experiencing, as opposed to just "witnessing". And I generally try to keep abreast of ongoing research etc. in that area. So I can't see that there is much for me to learn from that "post" of yours. Try to avoid unwarranted assumptions, and try not to weep louder than the bereaved.
Your "blog" on "common procedures in district hospitals" is, perhaps, a bit more interesting. But, again, I ask: how exactly is MPESA Telemedicine going to help with any of that?
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Very interesting insight Veritas. You want to avoid dealing with our ignorant but argumentative prick who think consulting a doctor over the phone is useless. And that doctors should turn into public health officials and go around preventing diseases....instead of treating them.
MK, it sounds like you were born with a gold spoon in your mouth. I'm going to have to direct you to my health blog: https://kenyamedical.wordpress.com/
The majority of populaces live in villages and can't get to the district hospital. In most instances, transportation and otherwise are organized by the hospital or sponsoring organisation if a local clinic can't treat the pt. Port-of-call when a pt is still very sick after a few days even after consuming malaria tabs, diarrhea tabs etc. is to visit a clinic. At the clinic, the pt is tested for malaria in the local lab. Refer to my post: https://kenyamedical.wordpress.com/2011/02/12/checking-for-falciparum-malaria-in-a-lab-rural/ and are put on drip if found to be malaria +ve: So quinine and saline combinations. In most cases quinine does the trick for everything. In severe cases pts die before reaching a hospital. This happens when the malaria has penetrated the cerebral regions and the pt becomes delirious. I witnessed firsthand the devastating fx of malaria. I get the impression you haven't. There isn't much hospitals do for pts, again, I refer you to my blog: https://kenyamedical.wordpress.com/2011/02/12/common-procedures-in-district-hospitals/
At the district hospital, each month approx. fifty major surgical procedures are performed in theatre. The most common three being:
1. Caesarean section (comprise near half of procedures)
2. Herniotomy
3. Herniorrhaphy
The rest are not as common:
1. Laparotomy
2. Prostatectomy
3. Cystectomy
4. Re-section/anastomosis
5. Splenectomy
6. Hysterectomy
7. Sphincterotomy
8. Scalpingectomy
9. Hydrocelectomy
10. Myomectomy
11. Appendectomy
12. Thyroidectomy
13. BTL
You refer to doctors and medical systems from first world countries but in Kenya it isn't like that. It's like this:
(https://kenyamedical.files.wordpress.com/2011/01/k1.jpg)
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Yeah, go ahead and tell us what our basic health problem is..and how we can help you deal with it. You sure have done something better about this than this brave attempt to do something about it via M-health application that is billable via Mshwari/Mpesa.
And before you do it learn the difference btw public health issues and medical issues. One focus on preventing diseases (access to clean water to prevent dysentery)...the other focus on curing diseases (treating dysentery)..and each is needed...you cannot let folks die from dysentery...as you focus on providing clean water.
Someone does something finally about something and all you hear are the usual 1) it not a priority 2) there are better ideas 3) this won't work. Now what stopping you from doing it.
This idea is laudable...at least for for the single fact...they are trying something. I
It is certainly laudable, in so far as "something is better than nothing"; but that seems to be about it.
It may work. CBA has trail blazed with Mshwari..and has within 2yrs overtaken all banks to have more than 10M bank accounts...and have loaned out billions..and recieved nearly 100B deposits from the poorest.
We had the same same arguments with M-pesa...
Nevertheless matters of health are different. There are serious ethical and legal issues in health that are both different and not easy to get around; in that regard, a reference to "same arguments" is entirely misplaced. (Moreover, the mere fact that something that was scoffed at, by some, ended up working does not necessarily imply that everything that is scoffed at will work; "proof by exception" generally does not work. Each "innovation" must be judged on its own merits.)
And there's another thing to keep in mind here: Whereas more technologically advanced places might not have tried something like MPESA---because there is little use for it---they certainly have been hard at work on telemedicine. So the notion of Kenya/South Africa blazing trails with this "forum" is simply off. What's more, there are important lessons to be learned from the others.
Poor folks in kenya are not stupid...they are very literate...and such ideas may stutter but they will work..because there is NO ALTERNATIVE.
The basic issues have little to do with "stupidity" or "literacy", and there is no need to inject irrelevant "emotion" into this. And it depends on what you mean "will work". Will it work as a "forum"? I don't see why it can't; it might even be useful in that way. Beyond that? One only has to look at the initial ideas in South Africa---diagnosis by phone, prescriptions by phone, etc.---and what Hello Doctor in South Africa currently is.
To my mind, the matter here is quite straightforward, and I will put in thus:
(a) What are the basic health problems that most Kenyans (Africans) face?
(b) What are the prospects that this Hello (Sema) Doctor will be able to address those?
In (a), we have, for example, diarrhea, which you mentioned. Another is malaria. Cholera is never too far away. And so on, and so forth. We know that there would be tremendous improvements in the health of Kenyans (Africans) just by having toilets and latrines, people pooping right and washing hands, having clean drinking water, etc. No type of fancy mobile-phone "app" will change that.
So, unless people will be using mobile phones to plug their butts when they have diarrhea, or using them to whack mosquitos, it's hard to see where this particular "high tech" thing is going in that regard. The basic problems of health in Africa will not be solved with such gimmicks. What is required is real hard and serious work, with attention paid to the fundamentals---and that there is the ALTERNATIVE. To the extent that anyone claims otherwise, it behooves them to explain exactly how. And that can be done this way:
(a) A statement of the health problem.
(b) An explanation of how MPESA Telemedicine will help.
-
Yeah, go ahead and tell us what our basic health problem is..and how we can help you deal with it. You sure have done something better about this than this brave attempt to do something about it via M-health application that is billable via Mshwari/Mpesa.
And before you do it learn the difference btw public health issues and medical issues. One focus on preventing diseases (access to clean water to prevent dysentery)...the other focus on curing diseases (treating dysentery)..and each is needed...you cannot let folks die from dysentery...as you focus on providing clean water.
I'm afraid the question remains unanswered:
What is the exact problem that MPESA Telemedicine is supposed to solve? And how, precisely?
Once we have an answer to that, I think we will be in a good position to discuss all these other issues, including "the difference btw public health issues and medical issues".
As an example, RV Pundit wrote that:
Kenya last year had 40M hospital/dispensary visits..40% of basic diarrhea cases..another 40% on basic respiratory problems....all these overburdened the few doctors unnecessarily.
As soon as we are clear on what MPESA Telemedicine can do, we will be able to get on to discussing how to avoid all that diarrhea in the first place. In fact, it could be that that dealing with the fundamental causes of runny shit would be more effective than relying on "Apps".
Friend Pundit also had other arguments. E.g.
Otherwise many are dying from simple ailments coz they can't get to hospital fast enough..
Perhaps true. And MPESA Telemedicine would help in what way?
And, lest folks misunderstood, I wish to make it clear that I'm almost always for any "brave attempt" to do "something". But, surely, it is not too much to enquire about the "something" and how the said "brave attempt" will help. I'm just saying ...
So, please, one step at a time. Asante sana.
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Very interesting insight Veritas. You want to avoid dealing with our ignorant but argumentative prick who think consulting a doctor over the phone is useless. And that doctors should turn into public health officials and go around preventing diseases....instead of treating them.
The red is simply not nice! Please do try to be a bit more friendly. Perhaps this will help:
http://www.amazon.com/How-Win-Friends-Influence-People/dp/0671027034/ref=sr_1_1?s=books&ie=UTF8&qid=1439528333&sr=1-1&keywords=how+to+make+friends+and+influence+people
Nowhere have I stated, or even implied, that consulting a doctor over the phone is useless. Nor have I stated, or implied, that doctors should turn into public health officials and go around preventing diseases ... instead of treating them. My main issues have to do with:
(1) What problems MPESA Telemedicine would solve and how. For example, how would it help with the "40% of basic diarrhea cases" that has been put forward by "For" side?
(2) The legal and ethical issues that would be involved, here including my view that "let people die first" simply won't do.
How about we have some clear answers on blue and then proceed from there?
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You want us to substantiate the obvious. Even when we have given you tonnes of examples.
Most kenyans cannot afford to consult a doctor...due to distance, cost, time,long waiting list , doctor being absent tc. You'd be surprised that majority when they get sick mainly pray that the disease go away, some sleep over it hoping it goes away, others try herbal remedies of the yore and finally those that eventually go to see a doctor, go when it's too late.
Now someone can just pick his phone, use mshwari to buy small time insurance and everytime he feels something not right about them or their children (I know a lot about that, because as a parent sometimes you call everyone trying to figure out why fever is up and should you rush to hospital), they just call a real doctor.
I don't have to know all the details about this mobile app...but I know if it reduce the cost, time and distance to talk to a real qualified doctor...then it has done a great thing. It a good start. And like Mpesa which began as simple tool...you can build on top of that...to unleash the full potential of tele-medicine or e-medicine.
As for legal and ethical issues...when did we become lawyers here? those are the details am least concerned about; I won't bore you with the mechanics of C# or Python programming languages even if they are very interesting...and I don't expect us to go around the "technical" details.
(1) What problems MPESA Telemedicine would solve and how. For example, how would it help with the "40% of basic diarrhea cases" that has been put forward by "For" side?
(2) The legal and ethical issues that would be involved, here including my view that "let people die first" simply won't do.
How about we have some clear answers on blue and then proceed from there?
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I also remember thinking, mistakenly that it will be adopted by a major US cell phone company. Arguing against cookie in that respect.
It's hard to imagine what use something like MPESA would be in a place with a decent banking system:
* Most people, except possibly some criminals, who prefer "cash money", will have bank accounts. And in many places it is easy enough to "send money" from a computer or a mobile phone.
* Folks who don't have bank accounts or the right sorts of plastic cards have other options, such as pre-paid credit cards, and it is possible to put money into those, either by computer/phone or by going to the right place (the equivalent of a MPESA agent).
* Cash (more than trivial amounts) is both "suspicious" and unnecessary. (I am right now reflecting that I hardly ever have cash at hand or the need for it; and that seems to be the case with most folks I see wandering around.)
Yep. I underestimated how difficult it would be to replace entrenched systems. I had thought that plastic would be replaced by the phone. M-Pesa would be competing with banks, payment by fingerprints at POS, online bill payment etc.
This discussion was prior to the widespread adoption of the smartphone. So some functionality, eg wiring funds, while readily available had to be done on a personal computer.
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Very interesting insight Veritas. You want to avoid dealing with our ignorant but argumentative prick who think consulting a doctor over the phone is useless. And that doctors should turn into public health officials and go around preventing diseases....instead of treating them.
MK, it sounds like you were born with a gold spoon in your mouth. I'm going to have to direct you to my health blog: https://kenyamedical.wordpress.com/
The majority of populaces live in villages and can't get to the district hospital. In most instances, transportation and otherwise are organized by the hospital or sponsoring organisation if a local clinic can't treat the pt. Port-of-call when a pt is still very sick after a few days even after consuming malaria tabs, diarrhea tabs etc. is to visit a clinic. At the clinic, the pt is tested for malaria in the local lab. Refer to my post: https://kenyamedical.wordpress.com/2011/02/12/checking-for-falciparum-malaria-in-a-lab-rural/ and are put on drip if found to be malaria +ve: So quinine and saline combinations. In most cases quinine does the trick for everything. In severe cases pts die before reaching a hospital. This happens when the malaria has penetrated the cerebral regions and the pt becomes delirious. I witnessed firsthand the devastating fx of malaria. I get the impression you haven't. There isn't much hospitals do for pts, again, I refer you to my blog: https://kenyamedical.wordpress.com/2011/02/12/common-procedures-in-district-hospitals/
At the district hospital, each month approx. fifty major surgical procedures are performed in theatre. The most common three being:
1. Caesarean section (comprise near half of procedures)
2. Herniotomy
3. Herniorrhaphy
The rest are not as common:
1. Laparotomy
2. Prostatectomy
3. Cystectomy
4. Re-section/anastomosis
5. Splenectomy
6. Hysterectomy
7. Sphincterotomy
8. Scalpingectomy
9. Hydrocelectomy
10. Myomectomy
11. Appendectomy
12. Thyroidectomy
13. BTL
You refer to doctors and medical systems from first world countries but in Kenya it isn't like that. It's like this:
(https://kenyamedical.files.wordpress.com/2011/01/k1.jpg)
I think MOON-Ki is saying that you can solve 90%(random figure) of health problems just by improvement in areas not necessarily directly associated with health. Guaranteeing clean water for everyone can reduce the burden on the undermanned Kenyan healthcare. As can getting rid of stagnant pools of water.
veritas is more concerned with those already sick. MOON-Ki is concerned with prevention. Neither is wrong. But it's legitimate to discuss both of them. Interestingly the ultimate solution to both might lie far away from the hospital and long lines.
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How do you hijack a thread about m-health and turn it into one about public health issues. There are many problems,variables, solutions...and this to me is one of them.
I think MOON-Ki is saying that you can solve 90%(random figure) of health problems just by improvement in areas not necessarily directly associated with health. Guaranteeing clean water for everyone can reduce the burden on the undermanned Kenyan healthcare. As can getting rid of stagnant pools of water.
veritas is more concerned with those already sick. MOON-Ki is concerned with prevention. Neither is wrong. But it's legitimate to discuss both of them. Interestingly the ultimate solution to both might lie far away from the hospital and long lines.
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(https://pbs.twimg.com/profile_images/486497731666776064/us-e3r5I_400x400.jpeg)
Windy… see this owl ? It's MK the buzzkill owl- he needs to R&R stat.
Those who call a doctor over clean water and hygiene for prevention are called hypochondriacs like MK.
Who doesn't want clean water ? Why state the obvious? He's been brainwashed by that "Clean water" NGO. I swear they've bought millions of dollars worth of ad time. It's gone Christian viral.
MK is brainwashed Windy and feeling the fx of withdrawal.
Thank god for sober chaps like RVP. Thank you RVP. :)
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Let me also add, I've extensively studied chaps like MK in this state. I think this pear visualises his current state of mind (quirks, ticks, confusion, fish-out-of-water- I get it):
(http://i865.photobucket.com/albums/ab218/Memetic_Mutation/Misc/buzzkill_pear.jpg)
(https://41.media.tumblr.com/tumblr_lxpknfQ8po1r8eh24o1_400.jpg)
(http://i249.photobucket.com/albums/gg234/pimpedout97x/553082-lol_wut_pear_glasses_super.jpg)
(http://i.imgur.com/ef5Vsto.jpg)
(http://i137.photobucket.com/albums/q201/buckethead_jr/1193411331587.jpg)
(http://www.reactionface.info/sites/default/files/imagecache/Node_Page/images/dat-ass1.jpg)
(http://farm3.static.flickr.com/2340/2157310495_808d526591_m.jpg)
(http://orig15.deviantart.net/c89e/f/2010/265/3/b/french_lolwut_pear_by_neil95-d2zamjd.png)
The man needs to find vision. I wish him well.
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Pundit/veritas,
MOON-Ki's is constructive and healthy skepticism. We all enjoy being right and the like. Personally I also enjoy being shown to be wrong, maybe misguided, or plain silly. He is not off-topic because I think that his ideas bring into question the relevance of m-health.
A good doctor will tell you certain things that may have nothing immediately relevant to your medical complaint, depending on context. In Kenya, he might suggest you refrain from drinking and smoking. In the US he'll in all likelihood give you suggestions and medications that can lower your cholesterol.
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Clean water is a public health issue.
Village folks don't walk for miles and spend pesa to see a doctor who cost ten fold more than a local clinic nurse to be told their problem is because of a lack of clean water and hygiene. Clean water is a govt mandate from a lack of investment in infrastructure and beyond the scope of what a mobile app can do. Grassroots initiatives are not top down.
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Clean water is a public health issue.
Village folks don't walk for miles and spend pesa to see a doctor who cost ten fold more than a local clinic nurse to be told their problem is because of a lack of clean water and hygiene. Clean water is a govt mandate from a lack of investment in infrastructure and beyond the scope of what a mobile app can do. Grassroots initiatives are not top down.
If a patient needs treatment, he should be treated. I am assuming m-health would probably link him to a specialist who can assist, all the caveats MOON-Ki points, applying. Maybe he might learn that boiling water before consuming it is something he should consider. I don't see the ideas as divorced.
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He'd learn that from a public health official/nurse educator if for prevention through posters and info sessions. I did this as a volunteer and routinely visited numerous schools to pop a deworming tab in each child's mouth and give a talk about washing salads, hands, boiling water, STDs, HIV etc. I ran a mobile infirmary in the slums and I assure you they boil their water and this isn't the problem.
A doctor contacts the CDC or local public health official if the pt is tested +ve for cholera or other infectious diseases. The public health official will then ask questions like have you been boiling your water? and investigate further etc. it's considered discrimination for a doctor to make assumptions on infectious disease causes. They can't tell a pt, boil your water ! There are nurse educators who go through info sessions with a pt and family post-treatment/discharge.
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He'd learn that from a public health official/nurse educator if for prevention through posters and info sessions. I did this as a volunteer and routinely visited numerous schools to pop a deworming tab in each child's mouth and give a talk about washing salads, hands, boiling water, STDs, HIV etc. I ran a mobile infirmary in the slums and I assure you they boil their water and this isn't the problem.
A doctor contacts the CDC or local public health official if the pt is tested +ve for cholera or other infectious diseases. The public health official will then ask questions like have you been boiling your water? and investigate further etc. it's considered discrimination for a doctor to make assumptions on infectious disease causes. They can't tell a pt, boil your water ! There are nurse educators who go through info sessions with a pt and family post-treatment/discharge.
Just reading your last paragraph. I think MOON-Ki wants to know how m-Health is going to help in that situation. Isn't that a fair question?
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Windy,
Your friend Moonki is just obnoxiously conceited smart alec hijacking every debate with tangential issues. If this debate is about Call a Doctor then we should confine it there..otherwise like I previously said we can spawn as many problems,challenges and solutions as we can imagine in broad topic like health & medicine.
Nobody has claimed this thing that I am praising is panacea to all our problems; a silver bullet; hell no I have just said this is start ; a great example of private sector innovation into a difficult area and we shoud all laud and wish them well.
Well apparently not everyone is that "patriotic".
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Windy
I guess it would be the e- health system like RVP said. This is a new thing in Australia. It's a medical records web interface which allows pts and health providers access to your medical records. That way you and your doctor can keep abreast with treatment schedules and your medical history. I did case studies of this- medical records getting lost in back room file drawers, different doctors not knowing your medical history, negligence and wrong diagnoses. My lecturer was actively advocating this initiative in the early phases- she had no support because doctors her age could barely type and people branded her a nut. She's now spearheading this govt backed initiative.
With EMR (Electronic Medical Records) you can access your medical records anywhere like your mobile phone and you can page your doctor during emergencies, schedule an appointment online, request a phone appointment call etc. the problem in Australia at the moment is consent. Some are trying to make this mandatory while others cite privacy. In Kenya it could be a godsend revolution in delivering more accessible, convenient, seamless healthcare- so long as it has govt backing and support from health providers.
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Since Kenya has a mobile banking system- pts could pay prepaid credit to speak with their doctor. Takes the hassle out of a medical billing system. Even better if the govt can pay for prepaid credits for low income households or those with serious medical conditions. The potential to revolutionise Kenya's healthcare system using mobile IP technology is huge. I wish I had more time in my life to contribute to this.
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Windy,
Your friend Moonki is just obnoxiously conceited smart alec hijacking every debate with tangential issues. If this debate is about Call a Doctor then we should confine it there..otherwise like I previously said we can spawn as many problems,challenges and solutions as we can imagine in broad topic like health & medicine.
Nobody has claimed this thing that I am praising is panacea to all our problems; a silver bullet; hell no I have just said this is start ; a great example of private sector innovation into a difficult area and we shoud all laud and wish them well.
Well apparently not everyone is that "patriotic".
I see the application as an added value. It is not a bad thing. Especially if one can get in a one-on-one chat with a healthcare professional, anywhere on earth, in a place where the only option might be a witch-doctor. It could offer someone a level of access into a modern health system.
But it has its limits. For instance a healthcare professional in Chicago might be totally unprepared to give useful answers to a patient in a bilharzia prone region. But I guess you could build intelligence in the system to connect to people who are specialists in something like tropical diseases. But I see that potential of creating channels to healthcare intelligence.
To me, the whole topic is interesting, including MOON-Ki's probing questions. I feel like I come away more informed one way or another. Patriotism comes in different flavors I think. I am not patriotic to any country because it's meaningless to me; one homo sapien deserves as much as the next all things even in my book. But I think one can be patriotic by constructive and even persistent criticism.
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Windy
I guess it would be the e- health system like RVP said. This is a new thing in Australia. It's a medical records web interface which allows pts and health providers access to your medical records. That way you and your doctor can keep abreast with treatment schedules and your medical history. I did case studies of this- medical records getting lost in back room file drawers, different doctors not knowing your medical history, negligence and wrong diagnoses. My lecturer was actively advocating this initiative in the early phases- she had no support because doctors her age could barely type and people branded her a nut. She's now spearheading this govt backed initiative.
With EMR (Electronic Medical Records) you can access your medical records anywhere like your mobile phone and you can page your doctor during emergencies, schedule an appointment online, request a phone appointment call etc. the problem in Australia at the moment is consent. Some are trying to make this mandatory while others cite privacy. In Kenya it could be a godsend revolution in delivering more accessible, convenient, seamless healthcare- so long as it has govt backing and support from health providers.
We've had that electronic record for sometime in the US. A lot of information about many things that are totally intimidating and meaningless if you are not a health professional. But I see this particular one as a webMD kind of thing with added element of interactivity.
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What Hello (Sema) Doctor, which started this thread and has been vigorously promoted by some, has to offer will be found on their webpage. Here, for the South African version:
https://www.hellodoctor.co.za/
and here, for the Kenyan version:
https://www.hellodoctor.co.ke/
The Kenyan version has some information on their 15 doctors and explains that:
What is Sema Doc?
Sema Doc is an affordable health care solution, available entirely from your mobile phone!
For just KSh300 per month, Sema Doc gives you:
* 24/7 mobile access to medical doctors
* A Health Account dedicated to help you save for medical expenses
* Access to instant health loans
* A KSh 5000 hospital cash benefit
We understand that you don’t have time to waste waiting in long queues or filling in mountains of paper work, which is why Sema Doc is available entirely from your mobile phone. That’s 24/7 health care, at the touch of a button!
Just dial *220#
It's hard to see where people are getting some of this other stuff.
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What Hello (Sema) Doctor, which started this thread and has been vigorously promoted by some, has to offer will be found on their webpage. Here, for the South African version:
https://www.hellodoctor.co.za/ (https://www.hellodoctor.co.za/)
and here, for the Kenyan version:
https://www.hellodoctor.co.ke/ (https://www.hellodoctor.co.ke/)
The Kenyan version has some information on their 15 doctors and explains that:
What is Sema Doc?
Sema Doc is an affordable health care solution, available entirely from your mobile phone!
For just KSh300 per month, Sema Doc gives you:
* 24/7 mobile access to medical doctors
* A Health Account dedicated to help you save for medical expenses
* Access to instant health loans
* A KSh 5000 hospital cash benefit
We understand that you don’t have time to waste waiting in long queues or filling in mountains of paper work, which is why Sema Doc is available entirely from your mobile phone. That’s 24/7 health care, at the touch of a button!
Just dial *220#
It's hard to see where people are getting some of this other stuff.
It looks like you can chat with one of the doctors. So they have co-opted doctors they can work with. If it is profitable, it might be one way to keep doctors inside the country. Given that they are providing insurance, you might think they might want to move it beyond chat and phone on recommendation - it might be in the details, I am not sure.
It also has cash benefits for admission to the listed hospitals. Collaboration with pharmacies might be an area one might be able to exploit.
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Given that they are providing insurance ... you might think they might want to move it beyond chat and phone on recommendation... It also has cash benefits for admission to the listed hospitals.
From a quick look---I'll have to take a closer look at the details---it looks like the insurance covers the "cash benefits" (to hospitals) to an amount of 5000 shillings per visit, maximum 3 times in one year (but not for the same condition!)***. That's hardly serious money; so "moving it" could be tricky.
If it gets to serious money, then any insurance company (including theirs) will take a close look at some of the statements included in their legal agreements. For example:
Important Disclaimer: Notwithstanding the high level of skills, training, professional qualifications and expertise, the Subscription Services are not intended nor suited to be a replacement or substitute for professional medical advice, diagnosis or treatment relative to a specific medical question or condition.
and
Hello Doctor and the attending doctor:
do not guarantee that a conversation with a doctor via the telephone and/or text message is the appropriate course of action for your particular health care problem.
You add that:
If it is profitable, it might be one way to keep doctors inside the country.
That would depend on the number of Kenyans who (a) have ailments that are on the list the doctors may chat about and (b) consider it worthwhile to chat to a doctor about it. Looking at the list, I don't see much demand on things like jetlag, travel sickness, stop smoking, ...
***
- On insurance: once you have made a claim on a hospital visit for a given condition and got your Sh. 5000, you may not, ever again, make another claim on that condition. (And any claim may be rejected.)
- The Sh 300 is just for the "app" etc.
Fee for the doctor access service: Each time you request access to a doctor, there is a small fee of KSh60 to talk to a doctor and KSh20 to text a doctor.
These are the initial fees, which may increase from time to time.
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Windy
You're starting to sound like MK- hint of misogyny and condescension. I get you defend him but just don't spiral down with him.
The US doesn't have EMR- the proper one. The US has an appalling healthcare system. At least in Kenya it's a British hybrid health system with a transparent subsidiary scheme for pt billing.
Kenya has a health system similar to UK and Oz. In US they charge the pt the full cost of healthcare or the insurance company the full cost. Doctors and hospitals charge whatever they want. I've written a paper about this and I'll post it up if I can find it. EMR - the legit one isn't possible in the US until they adopt a fully fledged public health system divorced from Big Pharma.
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Windy
You're starting to sound like MK- hint of misogyny and condescension. I get you defend him but just don't spiral down with him.
The old last-resort trick of "it's because I am a woman!" ?!? Come on. Surely, you can do better than that. Stop seeing non-existent "hints", and let's stick to facts and logic. As it is, some folks have already been carried away with emotion, and we need to try and reduce that.
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I find you offensive for many reasons not limited to misogyny. It's not my last resort because there was no malevolent motive there to begin with. You present distorted facts for the sake of in your head "logic" when this is about a grassroots initiative that could benefit wananchi. You don't seem to care about that. It's disturbing. I don't wish to throw my pearls to detractors. You and I don't share the same vision. I don't see the point.
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I find you offensive for many reasons not limited to misogyny. It's not my last resort because there was no malevolent motive there to begin with. You present distorted facts for the sake of in your head "logic" when this is about a grassroots initiative that could benefit wananchi. You don't seem to care about that. It's disturbing. I don't wish to throw my pearls to detractors.
What you then need to do is this:
(a) List what you claim are "distorted facts".
(b) Explain clearly the basis on which you consider them distorted.
We can then have a go at an objective discussion of those.
I have no issue with anything that would "could benefit wananchi"; I'm all for such. I have simply asked how Hello Doctor (aka MPESA Telemedicine) will do that. And that question seems especially important given the hyperbole that has accompanied this "Kenyan launch".
As for finding me offensive, please don't let it bother you; I can live with it. The charge of misogyny has no basis, so this is my last word on it: if that's a card you feel you've got to play, then run with it; just don't expect it to change anything from my end.
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I don't need to do that at all you misogynist. You're not my logics instructor or husband. Live in Kenya or just real life for a while then we can debate logically on the same playing field. I feel like you're belittling this laudable grassroots initiative into some undergraduate debate because you have no tangible real world experience. Try experiencing things in the real world and you'll see what a pretentious ass you sound like.
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Windy
You're starting to sound like MK- hint of misogyny and condescension. I get you defend him but just don't spiral down with him.
The US doesn't have EMR- the proper one. The US has an appalling healthcare system. At least in Kenya it's a British hybrid health system with a transparent subsidiary scheme for pt billing.
Kenya has a health system similar to UK and Oz. In US they charge the pt the full cost of healthcare or the insurance company the full cost. Doctors and hospitals charge whatever they want. I've written a paper about this and I'll post it up if I can find it. EMR - the legit one isn't possible in the US until they adopt a fully fledged public health system divorced from Big Pharma.
veritas,
I have no issues with your gender. What's condescending in what I said? Can you quote it?
The way I understand EMR is that it's an electronic medical record. That is available in the US as far as I can tell.
I assume that to be case because a specialist, say a dermatologist, is able to pull up your medical history. On your first visit.
I am not sure how extensive it is or the levels of integration. The devolved nature of the country certainly imposes major constraints.
Is it different from Ozzy? I wouldn't be surprised.
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I don't need to do that at all you misogynist. You're not my logics instructor or husband. Live in Kenya or just real life for a while then we can debate logically on the same playing field. I feel like you're belittling this laudable grassroots initiative into some undergraduate debate because you have no tangible real world experience. Try experiencing things in the real world and you'll see what a pretentious ass you sound like.
See, right there is a fine example of what I mean by excessive and unhelpful emotion. As the forum owner and admin, I hoped you would be aiming to set a positive example. Please try to calm down.
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Point taken.
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Without sounding unpatriotic ala Mooki....hahaha. whatever that means
The idea sounds good, but I am not really sure how this is going to work, given that we can access most healthcare questions on google. What if the e-doc misdiagnoses a patient and something bad happens…..will M-shwari take full responsibility? If the patient doctor is 1:100,000, where is that doctor suddenly going to get time to chat with remote patients? And how does he get paid?
And how do we define non-life-threatening. Malaria, typhoid etc are normally ‘non-life-threatening’, however people are dying because of them. Is this considered a public health or personal medicine....do we need mshwari to tell us we need clean water. Let’s remember that, this is healthcare and we are dealing with human beings not machines…..mistakes here can and do cost lives. Comparing this to Mpesa is missing the mark…money lost can be replaced. Lives lost because we want short cuts are not replaceable.
The idea like I said sounds good, after all in the US we have Tele health. What we also have that Kenya doesn’t yet have is electronic medical records that the physician can quickly pull and gloss over. In these records are all medications, other disease conditions, blood sugars, blood pressure readings etc.
If a doctor would then send you to pharmacy xyz (actually they now send prescriptions electronic too), to get medications, he already knows what you are on, and what wont work. If you then have an anaphylaxis reaction which is deadly by the way, 911 can reach you in 5 mins in some places. These are good in a functioning government. There are no short cuts.
In Kenya we have fake doctors with no medical background treating patients; there is no way, especially in rural areas, to verify their authenticity….. they can send you to buy anything, and the uninformed sheeple will gladly follow, unbeknownst to them the risk that they could be placing themselves into.
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I don't need to do that at all you misogynist. You're not my logics instructor or husband. Live in Kenya or just real life for a while then we can debate logically on the same playing field. I feel like you're belittling this laudable grassroots initiative into some undergraduate debate because you have no tangible real world experience. Try experiencing things in the real world and you'll see what a pretentious ass you sound like.
See, right there is a fine example of what I mean by excessive and unhelpful emotion. As the forum owner and admin, I hoped you would be aiming to set a positive example. Please try to calm down.
I agree, we set the standards, lets abide by them.
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Windy
You're starting to sound like MK- hint of misogyny and condescension. I get you defend him but just don't spiral down with him.
The US doesn't have EMR- the proper one. The US has an appalling healthcare system. At least in Kenya it's a British hybrid health system with a transparent subsidiary scheme for pt billing.
Kenya has a health system similar to UK and Oz. In US they charge the pt the full cost of healthcare or the insurance company the full cost. Doctors and hospitals charge whatever they want. I've written a paper about this and I'll post it up if I can find it. EMR - the legit one isn't possible in the US until they adopt a fully fledged public health system divorced from Big Pharma.
veritas,
I have no issues with your gender. What's condescending in what I said? Can you quote it?
The way I understand EMR is that it's an electronic medical record. That is available in the US as far as I can tell.
I assume that to be case because a specialist, say a dermatologist, is able to pull up your medical history. On your first visit.
I am not sure how extensive it is or the levels of integration. The devolved nature of the country certainly imposes major constraints.
Is it different from Ozzy? I wouldn't be surprised.
The US healthcare has EMR,
It has always had EMR, but was optional in some corners.
Starting with the affordablecare ACT, all entities are required to implement EMR
If the dont implement it by a certain grace period, they will be fined large fees
For those smaller healthcare facilities, the goverment is willing to offer subsidies in revamping the whole thing.
Just like if you did not buy into Obamacare by the deadline, you will be charged in your taxes.
Doctors cannot just make up fees and charge patienst what they want unless it is a private practice.
That is the same in most countries even the ones with public health systems
All other healthcare facilities, most of them state owned and accept insuarances have to bill according to set rates
These rates were largely determined by medicare/medcaid which carse for almost all senior citizens
To bill you must have a diagnsos, backed up by evidence and tests done... price for the diagnosis is set
Insuarace pays, and you pay your copay which can be $ and up depending on your plan.
I dont know what Very means by what she wrore, given her relatively short stint.
Comparing the Kenyan healthcare system with the US one is laughable to say the least.
Kenya doesnt have the US kind of problems, and the US doesnt have the Kenyan kind of problems
More in this later.
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Healthcare is complex. For health economic matters I suggest you at least read a textbook on Health Economy. I did this as a course subject. It's a tricky subject.
I can understand why you seem a bit confused on health service fees.
Kenya and Oz have a similar health model because both countries fall under the Commonwealth. For instance, medical practitioners charge a set fee and a fixed rate and these price checks are regulated by the govt. A doctor cannot take on lots of pts and can only claim a certain amount of benefits per pt per year from the govt. Specialists on the otherhand can charge whatever they want but the cap is usually at $200 per consult- anything more in Oz and Kenya a pt can seek compensation through the govt and the medical practitioner subject to a penalty/warning letter.
In Oz, the Medicare system was adopted in the 70s and is not the same as Medico in the States. Medico is an insurance company. Medicare in Oz is not an insurance company- there is no monthly/yearly fees. It is a universal healthcare system afforded to all Oz citizens. It is regulated and subsidized by the govt. For instance, they subsidize drug costs through a steering committee (PBS) who conduct cost benefit analyses on which drugs should be subsidized so that it would benefit x amount of citizens. They put together clinical practice guidelines for health practitioners based on evidence-based or systematic reviews- things not yet established in USA.
EMR in the USA is not the same as the EMR proposed in Oz. There are stimulates in the latter tethered to govt regulated healthcare checks- which is not possible in the USA. They are two completely different systems which happen to share an electronic platform. It's not actually called "EMR" in Oz. There are different parts to it not all implemented yet. The most obvious one for the pt is called "EHealth" or "PCEHR" the govt has yet to pan out all stages of the fully fledged Ehealth system.
The health system in USA is way behind the Commonwealth system. You can also tell by the medical articles the Yankees churn out- sensationalized rubbish in most instances. Also, it's not hard to do well in American universities whereas in the Commonwealth system they fail students so the govt doesn't have to pay for university fees. Korea's medical and university system is similar to America. Those with money can afford healthcare and get a top spot at university and life.
In USA, doctors can charge whatever they want. It can range from nothing, $35 to $200 to $1500. There is no PBS system. Big Pharma offer different amount of subsidized drug costs to those insured by certain insurance companies or depending on which doctor or pharmacy. One pt could pay $150 for an asthma puffer and the other could pay $10 because they happen to be a pt of a certain doctor with ties to Big Pharma. In Oz, it's the same rate for the asthma puffer regardless of who your doctor is, who your private insurance is, or whether you have medicare, a citizen or not. In actual fact one doesn't need private medical insurance in Oz because medicare covers for hospital fees so long as it's not a cosmetic/specialty related procedure.
In USA, if you were rushed to a hospital with no insurance cover, they are not going to waive that fee. You, your insurance or some charity need to pay for it. It's completely free in Oz. In Kenya, a public hospital or clinic may charge a small fee for treatment but the majority of costs is paid for by the govt.
In Kenya, each clinic from rural to hospitals send a statistical tally of every drug used, and then the county ministry subsidizes and allocates free drugs (like immunization drugs for babies) depending on demand. If something is off, like a clinic claiming a lot more than their usual stock, they investigate. The system is similar to the PBS system in Oz.
Public health uses a completely different treatment and cost model. It's not "medical" it's more army and national security.
I could go on but I won't.
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Healthcare is indeed a very complex issue….but I am not confused about anything. Just because the US does not yet have a comprehensive universal government subsidized healthcare system, does not mean they don’t have some form of system in place. That is what the trend towards the affordable care act was meant to accomplish. To bridge the gap that currently exists and offer those that aren’t yet insured or are excluded by some stipulations coverage.
I don’t need to read a book on the US healthcare matters …I deal with healthcare on a daily basis, so I do know a thing or two of what I am talking about…….it maybe different reading it in books, some of which may actually be outdated. I have nevertheless read on other countries like the UK (has the best system in the world), Canada Swiss, Japs and I am aware of their subsidized healthcare systems. The Kenya system is an attempt to model these systems, but its far from being comprehensive that is why people are dying right outside hospitals because they do not have money.
The US is a country of almost 300, 000 and about only 48 mill didn’t have some form of health insurance coverage as of 2010, meaning the other 262 mill had coverage. As of 2015 only 11% does not yet have health coverage. The US healthcare isn’t exclusively a government issue, most of it is private, however the government keeps the checks and balances in place so that the private insurance companies do not run amok with costs. That is why we have ICD codes in place established by the government.
So statements such as the ones you have previously stated are not only false but misleading and I would like to correct the misconceptions.
1. EMR in the Us simply means electronic record of any form…nothing else. May mean something else in other countries.
2. Medicare/Medicaid are not private insurance companies per say. They are two slightly different federal government insurance programs that cover medical coverage of all forms for all those over 65 yr, uninsured children, disabled, ESRD, and veterans. The Medicaid piece even covers low-income and financially needy people and differs in its provision by states. They do not have to pay anything into the program. It is fully funded by our tax dollars. I am not sure where you get Medico.
In US they charge the pt the full cost of healthcare or the insurance company the full cost. Doctors and hospitals charge whatever they want
3. In the US specialized medicine is expensive and can cost quite a bit, that is the same in most of those other countries, (but not quite as expensive as the US) but the basic fundamental internal medicine or family practice is relatively the same. Hospitals depend on the governments Medicare/Medicaid programs and cannot just charge patients' just what they want. Fees are set in collaboration with the government and private insurance companies.
4. In the US if you are rushed to the hospital sick, they must treat you no matter what, whether you have health insurance or not. They will have to sort out who pays what later and it can be quite costly if you do not have health insurance. The government however reimburses most of the costs incurred by the uninsured. All hospitals have to abide by this rule otherwise they will not get federal money, which to a large extent they depend on.
5. The argument can be made, about whether the US healthcare system is better or worse that other Westernized nations, but you cannot make the argument that the US does not have a system in place, a functioning one for that matter.
6. The idea that common wealth countries fail students just so that the government does not pay fees is the most ridiculous I have ever heard. I think they call it socialism
They put together clinical practice guidelines for health practitioners based on evidence-based or systematic reviews- things not yet established in USA
7. This assertion is not true. Healthcare in the US is large evidence based and there practice guidelines of all forms to guide practitioners on their treatment methodologies. This are very extensive studies with level I type of evidence and meta-analysis. You just need to know where to go to find them.
8. The argument here is based on two opposing schools of thought between the US and these other countries. see below
The central arguments in the socialism vs. capitalism debate are about economic equality and the role of government. Socialists believe economic inequality is bad for society, and the government is responsible for reducing it via programs that benefit the poor (e.g., free public education, free or subsidized healthcare, social security for the elderly, higher taxes on the rich).
On the other hand, capitalists believe that the government does not use economic resources as efficiently as private enterprises do, and therefore society is better off with the free market determining economic winners and losers.
The U.S. is widely considered the bastion of capitalism, and large parts of Scandinavia and Western Europe are considered socialist democracies. However, the truth is every developed country has some programs that are socialist.
This sums it up pretty well.
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You're conflating and compounding issues not related to the scope of this private initiative. Nobody said this was a silver bullet. But I see lots of use of these kind of medical care that is leveraging on the m-pesa, m-shwari and mobile telephony. It pretty self-evident. Not everyone in Kenya can google. Nor have heard of Google.
But I understands. It akin to M-pesa debate we had.....it hard for some of your to really grasp this...because you're used to systems that function.
Where options exist (including working 911), doctors, insurances, name...then you go for the "best system".
Where options do not exist....like in most of kenya...you go for "any system". Should we shut down M-health because somebody will be misdiagnosed and end up dead? Of course not! Many more are dying because they never get to any doctor..including to those on the phone or on the internet..they either pray or take herbs.
M-pesa may look sophisticated now...but it is based on very simple technology..a blow back maybe to telegram or morse code...but it works in it's unique way because there is pent up demand for modern banking in kenya.
The same can be said of M-shwari which built on that...and now M-health is trying to build on that.
Without sounding unpatriotic ala Mooki....hahaha. whatever that means
The idea sounds good, but I am not really sure how this is going to work, given that we can access most healthcare questions on google. What if the e-doc misdiagnoses a patient and something bad happens…..will M-shwari take full responsibility? If the patient doctor is 1:100,000, where is that doctor suddenly going to get time to chat with remote patients? And how does he get paid?
And how do we define non-life-threatening. Malaria, typhoid etc are normally ‘non-life-threatening’, however people are dying because of them. Is this considered a public health or personal medicine....do we need mshwari to tell us we need clean water. Let’s remember that, this is healthcare and we are dealing with human beings not machines…..mistakes here can and do cost lives. Comparing this to Mpesa is missing the mark…money lost can be replaced. Lives lost because we want short cuts are not replaceable.
The idea like I said sounds good, after all in the US we have Tele health. What we also have that Kenya doesn’t yet have is electronic medical records that the physician can quickly pull and gloss over. In these records are all medications, other disease conditions, blood sugars, blood pressure readings etc.
If a doctor would then send you to pharmacy xyz (actually they now send prescriptions electronic too), to get medications, he already knows what you are on, and what wont work. If you then have an anaphylaxis reaction which is deadly by the way, 911 can reach you in 5 mins in some places. These are good in a functioning government. There are no short cuts.
In Kenya we have fake doctors with no medical background treating patients; there is no way, especially in rural areas, to verify their authenticity….. they can send you to buy anything, and the uninformed sheeple will gladly follow, unbeknownst to them the risk that they could be placing themselves into.
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You're conflating and compounding issues not related to the scope of this private initiative. Nobody said this was a silver bullet. But I see lots of use of these kind of medical care that is leveraging on the m-pesa, m-shwari and mobile telephony. It pretty self-evident. Not everyone in Kenya can google. Nor have heard of Google.
But I understands. It akin to M-pesa debate we had.....it hard for some of your to really grasp this...because you're used to systems that function.
Where options exist (including working 911), doctors, insurances, name...then you go for the "best system".
Where options do not exist....like in most of kenya...you go for "any system". Should we shut down M-health because somebody will be misdiagnosed and end up dead? Of course not! Many more are dying because they never get to any doctor..including to those on the phone or on the internet..they either pray or take herbs.
M-pesa may look sophisticated now...but it is based on very simple technology..a blow back maybe to telegram or morse code...but it works in it's unique way because there is pent up demand for modern banking in kenya.
The same can be said of M-shwari which built on that...and now M-health is trying to build on that.
Without sounding unpatriotic ala Mooki....hahaha. whatever that means
The idea sounds good, but I am not really sure how this is going to work, given that we can access most healthcare questions on google. What if the e-doc misdiagnoses a patient and something bad happens…..will M-shwari take full responsibility? If the patient doctor is 1:100,000, where is that doctor suddenly going to get time to chat with remote patients? And how does he get paid?
And how do we define non-life-threatening. Malaria, typhoid etc are normally ‘non-life-threatening’, however people are dying because of them. Is this considered a public health or personal medicine....do we need mshwari to tell us we need clean water. Let’s remember that, this is healthcare and we are dealing with human beings not machines…..mistakes here can and do cost lives. Comparing this to Mpesa is missing the mark…money lost can be replaced. Lives lost because we want short cuts are not replaceable.
The idea like I said sounds good, after all in the US we have Tele health. What we also have that Kenya doesn’t yet have is electronic medical records that the physician can quickly pull and gloss over. In these records are all medications, other disease conditions, blood sugars, blood pressure readings etc.
If a doctor would then send you to pharmacy xyz (actually they now send prescriptions electronic too), to get medications, he already knows what you are on, and what wont work. If you then have an anaphylaxis reaction which is deadly by the way, 911 can reach you in 5 mins in some places. These are good in a functioning government. There are no short cuts.
In Kenya we have fake doctors with no medical background treating patients; there is no way, especially in rural areas, to verify their authenticity….. they can send you to buy anything, and the uninformed sheeple will gladly follow, unbeknownst to them the risk that they could be placing themselves into.
You are right about that, that is why I do not discredit the system all together, but merely asking questions as to how it will work. Of course in a country where there aren’t really any options, you try anything.
My concern is that we don’t view this as a substitute to doctor visits because the repercussions can be detrimental. Asking questions should by no means be regarded as being unpatriotic.
The problem is that we tend to jump on any bandwagon without really thinking issues through and later have to backtrack because we failed to test the system. This should also not be regarded as the solution to all issues health.
The Mpesa was successful in Kenya because there was a need for such a system in place. It hasn’t picked up anywhere else in the west because there are functioning systems in place.
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This is a private company initiative. They've done their homework and are working with their own projections.
Secondly there is no better way to know if something will work or not apart from trying it.
Thirdly and most importantly...this system is leveraging exciting tech...m-shwari customer buy 1 yr medical insurance -cheaply -micro-insurance (CHECK) using M-pesa (as always CHECK) and that allows them the ability to call any contracted doctor any time anywhere....sort of customer care...for 1yr.
That is WONDERFUL news.
You are right about that, that is why I do not discredit the system all together, but merely asking questions as to how it will work. Of course in a country where there aren’t really any options, you try anything.
My concern is that we don’t view this as a substitute to doctor visits because the repercussions can be detrimental. Asking questions should by no means be regarded as being unpatriotic.
The problem is that we tend to jump on any bandwagon without really thinking issues through and later have to backtrack because we failed to test the system. This should also not be regarded as the solution to all issues health.
The Mpesa was successful in Kenya because there was a need for such a system in place. It hasn’t picked up anywhere else in the west because there are functioning systems in place.
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This is a private company initiative. They've done their homework and are working with their own projections.
Secondly there is no better way to know if something will work or not apart from trying it.
Thirdly and most importantly...this system is leveraging exciting tech...m-shwari customer buy 1 yr medical insurance -cheaply -micro-insurance (CHECK) using M-pesa (as always CHECK) and that allows them the ability to call any contracted doctor any time anywhere....sort of customer care...for 1yr.
That is WONDERFUL news.
You are right about that, that is why I do not discredit the system all together, but merely asking questions as to how it will work. Of course in a country where there aren’t really any options, you try anything.
My concern is that we don’t view this as a substitute to doctor visits because the repercussions can be detrimental. Asking questions should by no means be regarded as being unpatriotic.
The problem is that we tend to jump on any bandwagon without really thinking issues through and later have to backtrack because we failed to test the system. This should also not be regarded as the solution to all issues health.
The Mpesa was successful in Kenya because there was a need for such a system in place. It hasn’t picked up anywhere else in the west because there are functioning systems in place.
Again, a private company's initiative....their aim is profit making.....who is keeping them in check to make sure they actually deliver what they say?
Who is to say there are actual doctors on standby to call Pts within the hour...in a country with a pt:dr ratio of 1:100,000. Where do all these doctors all of a sudden come from?
Who is really behind the screen? How well are they versed on matters health? Who is accountable for errors made? Try they must, I only advice caution.
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Thirdly and most importantly...this system is leveraging exciting tech...m-shwari customer buy 1 yr medical insurance -cheaply -micro-insurance (CHECK) using M-pesa (as always CHECK) and that allows them the ability to call any contracted doctor any time anywhere....sort of customer care...for 1yr.
This is not correct. They make it clear that there will be a doctor (or doctors) "on call" at any given time, and that is who the "clients" will talk to; they will not have the ability to arbitrarily call any of the doctors.
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Semantics.I said exactly the same thing. If I am in Turkana or Mandera and I have paid for this medical cover; then I can call a doctor anytime;
This is not correct. They make it clear that there will be a doctor (or doctors) "on call" at any given time, and that is who the "clients" will talk to; they will not have the ability to arbitrarily call any of the doctors.
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I have no idea where they'll get extra doctors; but I know most of our doctors are not being fully utilized due to many reasons; and if somebody is paying them top dollar to receive calls; this is great news; as for regulation; how does the medium of contact; change the regulations? the doctor is licensed and knows the rules; whether they meet the pt face to face or via gmail chat room.
Again, a private company's initiative....their aim is profit making.....who is keeping them in check to make sure they actually deliver what they say?
Who is to say there are actual doctors on standby to call Pts within the hour...in a country with a pt:dr ratio of 1:100,000. Where do all these doctors all of a sudden come from?
Who is really behind the screen? How well are they versed on matters health? Who is accountable for errors made? Try they must, I only advice caution.
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The Hello Doctor doctors will deal with just a limited set of conditions. Here is the list they give:
1. Acne
2. Acid Reflux
3. Bacterial Conjunctivitis – uncomplicated
4. Cold sores
5. Contraception
6. Cystitis
7. Eczema
8. Emergency Contraception
9. Erectile Dysfunction
10. Flu/Common cold
11. Gastro-enteritis
12. Gout
13. Hayfever / Seasonal Allergies
14. Hair Loss- male pattern
15. Irritable Bowel Syndrome
16. Malaria
17. Migraine
18. Period Delay
19. Short Term Insomnia and Jet Lag
20. Stop smoking
21. Thrush
22. Travel Sickness
23. CHRONICS (HPT , Diabetes, Cholesterol, Asthma, Thyroid)
Whether those conditions affect Kenyans to such an extent that telephone/SMS texts can make a significant impact on health in Kenya is far from clear. I don't see much in that list of which I would say "now people who would otherwise die will be able to consult a doctor", "that desperate person in Turkana or Mandera finally gets help".
Malaria is certainly huge and an exception in that list, but I am unclear as to what a chat/text will do about somebody who has a bad case of malaria. The same applies, but perhaps to a lesser extent, with the CHRONICS.
There also seems to be the notion that this thing is "novel" in the way MPESA was. Actally there is nothing new here. Hello/Sema Doctor sort of stuff has been going on in the USA for 10+ years, and what we have here appears to be just a low-end, less-thought-out version of Teladoc:
http://www.teladoc.com/
There is a great deal to be learned from that business, including lessons on what such a system can be good for and how good it can be, lessons on regulation, etc
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The Hello Doctor doctors will deal with just a limited set of conditions. Here is the list they give:
1. Acne
2. Acid Reflux
3. Bacterial Conjunctivitis – uncomplicated
4. Cold sores
5. Contraception
6. Cystitis
7. Eczema
8. Emergency Contraception
9. Erectile Dysfunction
10. Flu/Common cold
11. Gastro-enteritis
12. Gout
13. Hayfever / Seasonal Allergies
14. Hair Loss- male pattern
15. Irritable Bowel Syndrome
16. Malaria
17. Migraine
18. Period Delay
19. Short Term Insomnia and Jet Lag
20. Stop smoking
21. Thrush
22. Travel Sickness
23. CHRONICS (HPT , Diabetes, Cholesterol, Asthma, Thyroid)
Whether those conditions affect Kenyans to such an extent that telephone/SMS texts can make a significant impact on health in Kenya is far from clear. I don't see much in that list of which I would say "now people who would otherwise die will be able to consult a doctor", "that desperate person in Turkana or Mandera finally gets help".
Malaria is certainly huge and an exception in that list, but I am unclear as to what a chat/text will do about somebody who has a bad case of malaria. The same applies, but perhaps to a lesser extent, with the CHRONICS.
There also seems to be the notion that this thing is "novel" in the way MPESA was. Actally there is nothing new here. Hello/Sema Doctor sort of stuff has been going on in the USA for 10+ years, and what we have here appears to be just a low-end, less-thought-out version of Teladoc:
http://www.teladoc.com/
There is a great deal to be learned from that business, including lessons on what such a system can be good for and how good it can be, lessons on regulation, etc
That list is quite telling...jet lag is now a medical condition requiring that you contact the e-docs. Most other things such as thrush, diabetes, asthma, cholesterol and thyroid are complex diseases that require a face to face evaluation with an MD and strict follow-up. The app can be used by the treating MD's to check progress. Not sure a stranger behind the screen without the Pt's history can be able to offer much help. But lemme not rain on anyone's parade.....we shall see.
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Medico is insurance. The underwriters are insurance companies and not taxpayers. Just because it's a govt handout, doesn't mean it means veterans receive universal healthcare benefits. They get benefits because they served in the army and army and civilian are two different populations in the USA. Anyone in the military get benefits for everything. They have their own army hospitals and I've been to veteran army hospitals and their health policies are completely different to civilian hospitals because they are/were in the army and not because they're entitled to universal healthcare. Same goes with pensioners because they're pensioners and not because of universal healthcare. Universal healthcare doesn't discriminate based of age or profession.
Health economics adhere to a capitalist model not communism. Communist healthcare systems like in Cuba don't leave healthcare systems to market forces. In capitalist countries they do. For instance, medical premiums can change for insurance companies and drug subsidies alter according to the stock market.
Please also read a politics 101 textbook- the difference between capitalism and communism.
A mark of 65 in Australia is equivalent to 75 in USA. It's common to hear of an average student in Oz transferring or studying at an Ivy League institution in the states. Having studied in the states I can say with certainty the syllabus level is way below. Failing students at a certain rate is policy in Oz. 50% for first year students etc. international students fare better because universities need their money. I suggest you check the Hansard records.
Hospitals don't have a duty of care to treat uninsured pts or a health commissioner to investigate negligence in the USA. All treatments must be paid for by insurance companies or individuals. Taxpayers don't pay for your health. In Oz taxpayers pay insurance companies or hospitals to treat you for free.
Healthcare is indeed a very complex issue….but I am not confused about anything. Just because the US does not yet have a comprehensive universal government subsidized healthcare system, does not mean they don’t have some form of system in place. That is what the trend towards the affordable care act was meant to accomplish. To bridge the gap that currently exists and offer those that aren’t yet insured or are excluded by some stipulations coverage.
I don’t need to read a book on the US healthcare matters …I deal with healthcare on a daily basis, so I do know a thing or two of what I am talking about…….it maybe different reading it in books, some of which may actually be outdated. I have nevertheless read on other countries like the UK (has the best system in the world), Canada Swiss, Japs and I am aware of their subsidized healthcare systems. The Kenya system is an attempt to model these systems, but its far from being comprehensive that is why people are dying right outside hospitals because they do not have money.
The US is a country of almost 300, 000 and about only 48 mill didn’t have some form of health insurance coverage as of 2010, meaning the other 262 mill had coverage. As of 2015 only 11% does not yet have health coverage. The US healthcare isn’t exclusively a government issue, most of it is private, however the government keeps the checks and balances in place so that the private insurance companies do not run amok with costs. That is why we have ICD codes in place established by the government.
So statements such as the ones you have previously stated are not only false but misleading and I would like to correct the misconceptions.
1. EMR in the Us simply means electronic record of any form…nothing else. May mean something else in other countries.
2. Medicare/Medicaid are not private insurance companies per say. They are two slightly different federal government insurance programs that cover medical coverage of all forms for all those over 65 yr, uninsured children, disabled, ESRD, and veterans. The Medicaid piece even covers low-income and financially needy people and differs in its provision by states. They do not have to pay anything into the program. It is fully funded by our tax dollars. I am not sure where you get Medico.
In US they charge the pt the full cost of healthcare or the insurance company the full cost. Doctors and hospitals charge whatever they want
3. In the US specialized medicine is expensive and can cost quite a bit, that is the same in most of those other countries, (but not quite as expensive as the US) but the basic fundamental internal medicine or family practice is relatively the same. Hospitals depend on the governments Medicare/Medicaid programs and cannot just charge patients' just what they want. Fees are set in collaboration with the government and private insurance companies.
4. In the US if you are rushed to the hospital sick, they must treat you no matter what, whether you have health insurance or not. They will have to sort out who pays what later and it can be quite costly if you do not have health insurance. The government however reimburses most of the costs incurred by the uninsured. All hospitals have to abide by this rule otherwise they will not get federal money, which to a large extent they depend on.
5. The argument can be made, about whether the US healthcare system is better or worse that other Westernized nations, but you cannot make the argument that the US does not have a system in place, a functioning one for that matter.
6. The idea that common wealth countries fail students just so that the government does not pay fees is the most ridiculous I have ever heard. I think they call it socialism
They put together clinical practice guidelines for health practitioners based on evidence-based or systematic reviews- things not yet established in USA
7. This assertion is not true. Healthcare in the US is large evidence based and there practice guidelines of all forms to guide practitioners on their treatment methodologies. This are very extensive studies with level I type of evidence and meta-analysis. You just need to know where to go to find them.
8. The argument here is based on two opposing schools of thought between the US and these other countries. see below
The central arguments in the socialism vs. capitalism debate are about economic equality and the role of government. Socialists believe economic inequality is bad for society, and the government is responsible for reducing it via programs that benefit the poor (e.g., free public education, free or subsidized healthcare, social security for the elderly, higher taxes on the rich).
On the other hand, capitalists believe that the government does not use economic resources as efficiently as private enterprises do, and therefore society is better off with the free market determining economic winners and losers.
The U.S. is widely considered the bastion of capitalism, and large parts of Scandinavia and Western Europe are considered socialist democracies. However, the truth is every developed country has some programs that are socialist.
This sums it up pretty well.
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Who is to say there are actual doctors on standby to call Pts within the hour...in a country with a pt:dr ratio of 1:100,000. Where do all these doctors all of a sudden come from?
The numbers certainly suggest that any scaling of this will be limited, and at 60 shillings for a chat and 20 shillings for text large numbers would be required. The other thing is that even if the doctors were there, it would not necessarily save on "doctor's time", as some of the proponents believe: 15 minutes is 15 minutes, whether in person or on the phone.
Who is really behind the screen? How well are they versed on matters health?
The significance of this point---and it is of the utmost importance---does not appear to be well understood.
Who is accountable for errors made?
Looking at Hello/Sema Doctor's "legal agreements", it's hard to imagine anyone working harder to avoid taking responsibility for anything. That probably helps with the tinker-toy insurance they offer, but whether the "clients" will actually go through all that stuff and appreciate its implications is another matter.
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Political models like capitalism, communism, socialism depends on which framework for interpretation. One may identify themselves as a lenin-marxist, liberal democrat, constructivist etc. A lenin-marxist may pitch class differences as defining the types of political models I.e. capitalism enshrines status whereas communism values a classless system. A liberal democrat may pitch capitalism upholding freedom whereas communism upholds equality. One needs to identify with a framework and perspective before trying to interpret the healthcare system in a political matter.
As my favourite lecturer used to say, one needs to find the right operating system to make a computer work. A linux person won't see the same as an APPLE person. Power is not about one uniform perspective. That's not what the great game is about.
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Medico is insurance. The underwriters are insurance companies and not taxpayers. Just because it's a govt handout, doesn't mean it means veterans receive universal healthcare benefits. They get benefits because they served in the army and army and civilian are two different populations in the USA. Anyone in the military get benefits for everything. They have their own army hospitals and I've been to veteran army hospitals and their health policies are completely different to civilian hospitals because they are/were in the army and not because they're entitled to universal healthcare. Same goes with pensioners because they're pensioners and not because of universal healthcare. Universal healthcare doesn't discriminate based of age or profession.
Health economics adhere to a capitalist model not communism. Communist healthcare systems like in Cuba don't leave healthcare systems to market forces. In capitalist countries they do. For instance, medical premiums can change for insurance companies and drug subsidies alter according to the stock market.
Please also read a politics 101 textbook- the difference between capitalism and communism.
A mark of 65 in Australia is equivalent to 75 in USA. It's common to hear of an average student in Oz transferring or studying at an Ivy League institution in the states. Having studied in the states I can say with certainty the syllabus level is way below. Failing students at a certain rate is policy in Oz. 50% for first year students etc. international students fare better because universities need their money. I suggest you check the Hansard records.
Hospitals don't have a duty of care to treat uninsured pts or a health commissioner to investigate negligence in the USA. All treatments must be paid for by insurance companies or individuals. Taxpayers don't pay for your health. In Oz taxpayers pay insurance companies or hospitals to treat you for free.
Healthcare is indeed a very complex issue….but I am not confused about anything. Just because the US does not yet have a comprehensive universal government subsidized healthcare system, does not mean they don’t have some form of system in place. That is what the trend towards the affordable care act was meant to accomplish. To bridge the gap that currently exists and offer those that aren’t yet insured or are excluded by some stipulations coverage.
I don’t need to read a book on the US healthcare matters …I deal with healthcare on a daily basis, so I do know a thing or two of what I am talking about…….it maybe different reading it in books, some of which may actually be outdated. I have nevertheless read on other countries like the UK (has the best system in the world), Canada Swiss, Japs and I am aware of their subsidized healthcare systems. The Kenya system is an attempt to model these systems, but its far from being comprehensive that is why people are dying right outside hospitals because they do not have money.
The US is a country of almost 300, 000 and about only 48 mill didn’t have some form of health insurance coverage as of 2010, meaning the other 262 mill had coverage. As of 2015 only 11% does not yet have health coverage. The US healthcare isn’t exclusively a government issue, most of it is private, however the government keeps the checks and balances in place so that the private insurance companies do not run amok with costs. That is why we have ICD codes in place established by the government.
So statements such as the ones you have previously stated are not only false but misleading and I would like to correct the misconceptions.
1. EMR in the Us simply means electronic record of any form…nothing else. May mean something else in other countries.
2. Medicare/Medicaid are not private insurance companies per say. They are two slightly different federal government insurance programs that cover medical coverage of all forms for all those over 65 yr, uninsured children, disabled, ESRD, and veterans. The Medicaid piece even covers low-income and financially needy people and differs in its provision by states. They do not have to pay anything into the program. It is fully funded by our tax dollars. I am not sure where you get Medico.
In US they charge the pt the full cost of healthcare or the insurance company the full cost. Doctors and hospitals charge whatever they want
3. In the US specialized medicine is expensive and can cost quite a bit, that is the same in most of those other countries, (but not quite as expensive as the US) but the basic fundamental internal medicine or family practice is relatively the same. Hospitals depend on the governments Medicare/Medicaid programs and cannot just charge patients' just what they want. Fees are set in collaboration with the government and private insurance companies.
4. In the US if you are rushed to the hospital sick, they must treat you no matter what, whether you have health insurance or not. They will have to sort out who pays what later and it can be quite costly if you do not have health insurance. The government however reimburses most of the costs incurred by the uninsured. All hospitals have to abide by this rule otherwise they will not get federal money, which to a large extent they depend on.
5. The argument can be made, about whether the US healthcare system is better or worse that other Westernized nations, but you cannot make the argument that the US does not have a system in place, a functioning one for that matter.
6. The idea that common wealth countries fail students just so that the government does not pay fees is the most ridiculous I have ever heard. I think they call it socialism
They put together clinical practice guidelines for health practitioners based on evidence-based or systematic reviews- things not yet established in USA
7. This assertion is not true. Healthcare in the US is large evidence based and there practice guidelines of all forms to guide practitioners on their treatment methodologies. This are very extensive studies with level I type of evidence and meta-analysis. You just need to know where to go to find them.
8. The argument here is based on two opposing schools of thought between the US and these other countries. see below
The central arguments in the socialism vs. capitalism debate are about economic equality and the role of government. Socialists believe economic inequality is bad for society, and the government is responsible for reducing it via programs that benefit the poor (e.g., free public education, free or subsidized healthcare, social security for the elderly, higher taxes on the rich).
On the other hand, capitalists believe that the government does not use economic resources as efficiently as private enterprises do, and therefore society is better off with the free market determining economic winners and losers.
The U.S. is widely considered the bastion of capitalism, and large parts of Scandinavia and Western Europe are considered socialist democracies. However, the truth is every developed country has some programs that are socialist.
This sums it up pretty well.
veri,
The way I understand it, in the US, Medicare is a government program, as is Medicaid. Medicare is for old people, Medicaid is for poor people. That is a simplification, but it is largely the purpose that these two programs serve.
So you could say that universal healthcare is not a guarantee in the states and you would be right. Healthcare is heavily privatized.
I am not sure about the relevance of academic scores and comparisons in the medical field. These seem kind of besides the point to me. Because both countries have advanced healthcare and deal with more or less the same problems effectively. If you are qualified to practice in the US, you are definitely among the best in your field.
If you have medical cover and find yourself falling dangerously ill in the states, you should like your chances just as much as if not better than anywhere else. But if you are not covered, you will be saved and could become bankrupt; you may also avoid necessary doctor's visits that could prevent a dangerous condition from developing because of costs.
The biggest driver of healthcare costs in the US from that I have heard is insurance companies, and biotech companies that do cutting edge research.
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The comparisons between the USA and Commonwealth countries are interesting, even if one excludes the fact that only a small handful of the latter have anything that even remotely resembles a decent healthcare system.
My own personal observations---and, of course, these are not determinative---is that if it comes to overall quality, I'll take the US system any day. On the other hand, when it comes to the direct payment for prescriptions, the UK, Canada, etc. may be considered to have an "advantage".
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Windy,
Medicaid in the United States is a social health care program for families and individuals with low income and limited resources. The Health Insurance Association of America describes Medicaid as a "government insurance program for persons of all ages whose income and resources are insufficient to pay for health care."
It's insurance. Oz has that too for pensioners and youth in the form of discounts and insurance underwriters. That's not universal healthcare.
Universal health care, sometimes referred to as universal health coverage, universal coverage, or universal care, usually refers to a health care system which provides health care and financial protection to all citizens of a particular country.
Both quotes are from Google. I'm not sure if some peeps have been drunk posting or genuinely retarded when it comes to healthcare.
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The comparisons between the USA and Commonwealth countries are interesting, even if one excludes the fact that only a small handful of the latter have anything that even remotely resembles a decent healthcare system.
My own personal observations---and, of course, these are not determinative---is that if it comes to overall quality, I'll take the US system any day. On the other hand, when it comes to the direct payment for prescriptions, the UK, Canada, etc. may be considered to have an "advantage".
Basic healthcare is considered a privilege in the States when it shouldn't be. If you can't afford health insurance you have no access to basic healthcare. I'd imagine that would include lots of able bodied college students and working households budgeting for other things. Australian doctors are boring poor compared to the exciting rich corrupt American doctor. An American doctor will promise you the world with the intention of prescribing a Big Pharma product you probably don't need. You can't just walk in there and demand this drug of this brand but you can in Oz. Also, American doctors can't churn out quality medical research nor influence the health world. On the otherhand if you have money, you can have any procedure done in the States whereas Oz has a waiting list and limited treatment options for certain conditions like cancer. If you have cancer, you need Big Pharma- move to the States.
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Windy,
Medicaid in the United States is a social health care program for families and individuals with low income and limited resources. The Health Insurance Association of America describes Medicaid as a "government insurance program for persons of all ages whose income and resources are insufficient to pay for health care."
It's insurance. Oz has that too for pensioners and youth in the form of discounts and insurance underwriters. That's not universal healthcare.
Universal health care, sometimes referred to as universal health coverage, universal coverage, or universal care, usually refers to a health care system which provides health care and financial protection to all citizens of a particular country.
Both quotes are from Google. I'm not sure if some peeps have been drunk posting or genuinely retarded when it comes to healthcare.
From my assessment of your postings and the tendency to mix issues, you could be accused of drunk posting yourself. Since google seem to be your friend, use it more to learn about the American health system. No one here ever made the argument that it was universal yet...merely that we are leaning towards universal. And yes with all that good stuff you talk about in the common wealth, you will still have to get on the waiting list to get specialist treatment, while all I need to do is look up one, call and walah... I have an appointment for whatever procedure I needed.
http://www.hhs.gov/healthcare/rights/law/index.html (http://www.hhs.gov/healthcare/rights/law/index.html)
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Secondly there is no better way to know if something will work or not apart from trying it.
Indeed. But haven't we already had a trial?
I just got some email from a friend, to the effect that Safaricom has been down this road before, with some gimmick called Daktari 1525. That was back in 2011. That too was going to save the Kenyan healthcare system in exactly the same way as the new-and-improved is going to:
Safaricom, Kenya's largest telecoms operator, is trying to take the pressure off overstretched medical and health systems with a new mobile health service. Its 24-hour health advice and referral service is called 'Daktari 1525' and lets people call and speak with a doctor or an expert to get advice on any health issue.
...
The new service hopes to relieve outpatient departments in government hospitals and health facilities with its advice and referrals.
...
Not everyone is convinced the service will work.
http://www.southerninnovator.org/index.php/innovation/195-new-kenyan-services-to-innovate-mobile-health-and-farming
It appears that there weren't enough suckers clients to sustain the system. A year later, fees were halved. Another year later and things folded quietly.
One of the things that is different with this new scheme relates to the insurance aspect, of which you write that:
Thirdly and most importantly...this system is leveraging exciting tech...m-shwari customer buy 1 yr medical insurance -cheaply -micro-insurance (CHECK) using M-pesa (as always CHECK) and that allows them the ability to call any contracted doctor any time anywhere....sort of customer care...for 1yr.
On the face of it, this actually looks quite attractive and could well attract people to the new-and-improved. Looking below the surface, I would note that:
* The basic insurance "element" is for KSH 5000 and that's only if a hospital stay is involved. By the time one pays the annual 300*12 KSH plus the cost of phone calls etc., I'm not sure they would be getting a great deal. Even in Kenya, it should be possible to get insurance at a lesser cost.
* Getting that money requires hospitalization, and their list of conditions does not include many things for which Kenyans end up in hospital. And one can also argue that the annual limit on the insurance payoff for hospitalization is up to KSH 15,000. On that:
- The frequency with which the average person gets hospitalized is actually not very high. Even in Kenya.
- In the list of "acceptable conditions", Malaria and the CHRONICS could easily put one into hospital more than once. But the "fine print" states that once you've claimed on a particular condition, you may not ever again claim on that same condition.
- That means that in order to keep benefitting from the insurance, you must (a) be ill enough to be hospitalized on each occasion and (b) be ill from something that has not previously required hospitalization (as far as that policy is concerned). You have to keep getting very ill from new things.
Let's consider just one year. So, what is the likelihood that an average person in Kenya will get hospitalized for 3 different things on this list:
1. Acne
2. Acid Reflux
3. Bacterial Conjunctivitis – uncomplicated
4. Cold sores
5. Contraception
6. Cystitis
7. Eczema
8. Emergency Contraception
9. Erectile Dysfunction
10. Flu/Common cold
11. Gastro-enteritis
12. Gout
13. Hayfever / Seasonal Allergies
14. Hair Loss- male pattern
15. Irritable Bowel Syndrome
16. Malaria
17. Migraine
18. Period Delay
19. Short Term Insomnia and Jet Lag
20. Stop smoking
21. Thrush
22. Travel Sickness
23. CHRONICS (HPT , Diabetes, Cholesterol, Asthma, Thyroid)
And if one manages the first year, what is the probability that one can keep "finding" new things to get hospitalized on?
mya88 wrote that:
Again, a private company's initiative....their aim is profit making.....
Folks have to eat, and that frequently means making money. Nothing wrong with that; the revolution is over and the "capitalist pigs" won. But we should be wary when we see the same at-long-last-salvation! being peddled with the only change being a bit of spit and polish.
It could work, in the sense that the M-* folks could end up making money. That would be great---for them and their shareholders. But radically change the healthcare system in Kenya or have a significant effect on the health of Kenyans? Alchemy. We'll just have to wait and see.
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And yes with all that good stuff you talk about in the common wealth, you will still have to get on the waiting list to get specialist treatment, while all I need to do is look up one,
People sometimes overlook this when making comparisons. In the USA if you need to (or even merely want to) see a specialist, you simply find one (Google, Yellow Pages, etc.) you think you might like, call or send email, and then off you go. That's not possible in places like the UK: there the NHS system used to claim that they would guarantee one within 18 weeks, but that hasn't worked and all it's done is get people extremely pissed off at the long waiting times. It looks like the government will now scrap any attempt at a guarantee and simply say "you get to see one when you get to see one".
I also note that there are some interesting claims being made for the Australian healthcare system. One of them is that, beyond basic taxes, everything is free for all and that doctors there (unlike greedy Americans) must charge a fixed fee. On that:
* Australian doctors can, and quite a few do, charge whatever fee they like. Medicare will cover only the "schedule fee", and it is up to the patient or insurance company to pay the rest.
* The Australian system actually forces many people---and deliberately so---so buy private health insurance, amidst this claimed cornucopia of freebies. This is done via something called the Medicare Levy Surcharge. The government basically says "we think you make enough to afford private insurance, so if you don't get it we'll tax you some more". People look at the tax and the insurance rates, and it's called an offer one can't refuse.
Oh, the Aborigines are simply screwed, no matter what. None of the above, or anything else applies to them. Apparently.
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And you think folks in Turkana have no business calling a doctor?
, you simply find one (Google, Yellow Pages, etc.) you think you might like, call or send email, and then off you go. That's not possible in places like the UK: there the NHS system used to claim that they would guarantee one within 18 weeks,
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Windy,
Medicaid in the United States is a social health care program for families and individuals with low income and limited resources. The Health Insurance Association of America describes Medicaid as a "government insurance program for persons of all ages whose income and resources are insufficient to pay for health care."
It's insurance. Oz has that too for pensioners and youth in the form of discounts and insurance underwriters. That's not universal healthcare.
Universal health care, sometimes referred to as universal health coverage, universal coverage, or universal care, usually refers to a health care system which provides health care and financial protection to all citizens of a particular country.
Both quotes are from Google. I'm not sure if some peeps have been drunk posting or genuinely retarded when it comes to healthcare.
From my assessment of your postings and the tendency to mix issues, you could be accused of drunk posting yourself. Since google seem to be your friend, use it more to learn about the American health system. No one here ever made the argument that it was universal yet...merely that we are leaning towards universal. And yes with all that good stuff you talk about in the common wealth, you will still have to get on the waiting list to get specialist treatment, while all I need to do is look up one, call and walah... I have an appointment for whatever procedure I needed.
http://www.hhs.gov/healthcare/rights/law/index.html (http://www.hhs.gov/healthcare/rights/law/index.html)
The problem with you is your ego and not being able to admit you're wrong. You have a tendency to ignore facts and obviously don't possess the cognitive capacity to understand complex issues. That is why you are retarded.
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veritas,
I thought we agreed to keep this kind of attitude off the site. Are you okay?
Since you enjoy impunity, I think you should apologize to mya88.
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Veritas, this is not nice.
The problem with you is your ego and not being able to admit you're wrong. You have a tendency to ignore facts and obviously don't possess the cognitive capacity to understand complex issues. That is why you are retarded.
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Windy,
Medicaid in the United States is a social health care program for families and individuals with low income and limited resources. The Health Insurance Association of America describes Medicaid as a "government insurance program for persons of all ages whose income and resources are insufficient to pay for health care."
It's insurance. Oz has that too for pensioners and youth in the form of discounts and insurance underwriters. That's not universal healthcare.
Universal health care, sometimes referred to as universal health coverage, universal coverage, or universal care, usually refers to a health care system which provides health care and financial protection to all citizens of a particular country.
Both quotes are from Google. I'm not sure if some peeps have been drunk posting or genuinely retarded when it comes to healthcare.
From my assessment of your postings and the tendency to mix issues, you could be accused of drunk posting yourself. Since google seem to be your friend, use it more to learn about the American health system. No one here ever made the argument that it was universal yet...merely that we are leaning towards universal. And yes with all that good stuff you talk about in the common wealth, you will still have to get on the waiting list to get specialist treatment, while all I need to do is look up one, call and walah... I have an appointment for whatever procedure I needed.
http://www.hhs.gov/healthcare/rights/law/index.html (http://www.hhs.gov/healthcare/rights/law/index.html)
The problem with you is your ego and not being able to admit you're wrong. You have a tendency to ignore facts and obviously don't possess the cognitive capacity to understand complex issues. That is why you are retarded.
wow...ego...retarded...just because I don't ascribe to your narrow minded school of thought?.........and I thought I was corresponding with a sane human being. You have issues lady, and I don't think I am one of your issues. Maybe you should take time of line and sort your issues out.
Actually, now thinking about it..... I consider this type of behavior harassment or even intimidation. That is the same reason you referred to Moonki as Misogynistic earlier. I am going to tell you something and this may come as news to you veri.........(1) don't ever freakin think that anyone here is scared of you. (2) you do not have monopoly when it comes to insults...
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And yes with all that good stuff you talk about in the common wealth, you will still have to get on the waiting list to get specialist treatment, while all I need to do is look up one,
People sometimes overlook this when making comparisons. In the USA if you need to (or even merely want to) see a specialist, you simply find one (Google, Yellow Pages, etc.) you think you might like, call or send email, and then off you go. That's not possible in places like the UK: there the NHS system used to claim that they would guarantee one within 18 weeks, but that hasn't worked and all it's done is get people extremely pissed off at the long waiting times. It looks like the government will now scrap any attempt at a guarantee and simply say "you get to see one when you get to see one".
I also note that there are some interesting claims being made for the Australian healthcare system. One of them is that, beyond basic taxes, everything is free for all and that doctors there (unlike greedy Americans) must charge a fixed fee. On that:
* Australian doctors can, and quite a few do, charge whatever fee they like. Medicare will cover only the "schedule fee", and it is up to the patient or insurance company to pay the rest.
* The Australian system actually forces many people---and deliberately so---so buy private health insurance, amidst this claimed cornucopia of freebies. This is done via something called the Medicare Levy Surcharge. The government basically says "we think you make enough to afford private insurance, so if you don't get it we'll tax you some more". People look at the tax and the insurance rates, and it's called an offer one can't refuse.
Oh, the Aborigines are simply screwed, no matter what. None of the above, or anything else applies to them. Apparently.
Moonki
I think the common wealth system is good in the sense that it allows medicine to be practiced at the primary, preventative level. Most people are required to have at least a primary care MD who follows them throughout, tracks progress, makes changes as they go.
This is supposed to ensure the most common chronic illnesses such as hypertension, high cholesterol, diabetes, asthma etc, that are so rampant in other countries like the US, are controlled, or reduced if not eliminated all together. This overall is an excellent strategy of keeping the society healthy, and reducing unnecessary costs. It also keeps people out of hospitals. Children get all their required immunizations and followed by the clinician. If they could achieve that in its entirety, then there wouldn't be as much need for specialist care. In that sense it is actually and excellent system.
Now apply this to Kenya....if the government could ensure that the basics such as childhood vaccinations for pneumonia, cholera, typhoid (not sure if these even exist) etc are mandatory, infant and child mortalities could be significantly reduced. If those local dispensaries were functioning like they did, when we were growing up, the hospitals would be empty....this is where the government needed to focus their efforts on, revamp local clinics and staff them with competent people. They could use clinical officers for most of the routine needs of the society....that in itself will ease the burden on the MD's.
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I have no remorse for misogynists like MK or Mya88.
I've been in this business long enough to detect an insecure woman hater who never acknowledge a woman's expertise and experience in any matter and resort to cutting them down by trolling and undermining in whichever capacity.
My last say on the matter.
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I have no remorse for misogynists like MK or Mya88.
I've been in this business long enough to detect an insecure woman hater who never acknowledge a woman's expertise and experience in any matter and resort to cutting them down by trolling and undermining in whichever capacity.
My last say on the matter.
Not so fast
Actually Mya88 is a woman which renders your argument mute....do not hide behind a skirt to hide your insecurities. Just know to every action there is an equal and opposite reaction. I will take you head on any-day anytime...just try me... and I am not new to online forums, just so you know.
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I'm sorry Mya88. I must've mistaken you for someone else.
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I have no remorse for misogynists like MK or Mya88.
I've been in this business long enough to detect an insecure woman hater who never acknowledge a woman's expertise and experience in any matter and resort to cutting them down by trolling and undermining in whichever capacity.
My last say on the matter.
Not so fast
Actually Mya88 is a woman which renders your argument mute....do not hide behind a skirt to hide your insecurities. Just know to every action there is an equal and opposite reaction. I will take you head on any-day anytime...just try me... and I am not new to online forums, just so you know.
Oops. Looks like the Detection System needs some fine-tuning. Even after such a long time in the business.
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Moonki
I think the common wealth system is good in the sense that it allows medicine to be practiced at the primary, preventative level. Most people are required to have at least a primary care MD who follows them throughout, tracks progress, makes changes as they go.
It does have its good aspects, certainly. Both systems do, which is why I would never categorically claim that one is better than the other (although I might indicate personal preferences here and there).
The other thing, though, is the generic "commonwealth system" is perhaps not very helpful, given the huge variety in Commonwealth systems. Kenya's, for example, is now a very confusing (and not particularly effective) mish-mash. In particular, Kenyans, especially the poor, proportionately spend so much that the idea of it even resembling something like "universal healthcare" seems out of place. It's hard to think of any basis to say that the sort of "commonwealth system" Kenya has in practice is better for the populace than America's is for Americans.
http://www.healthpolicyproject.com/index.cfm?id=KenyaCHE
Now apply this to Kenya....if the government could ensure that the basics such as childhood vaccinations for pneumonia, cholera, typhoid (not sure if these even exist) etc are mandatory, infant and child mortalities could be significantly reduced. If those local dispensaries were functioning like they did, when we were growing up, the hospitals would be empty....this is where the government needed to focus their efforts on, revamp local clinics and staff them with competent people. They could use clinical officers for most of the routine needs of the society....that in itself will ease the burden on the MD's.
Indeed. Yet in Kenya's new system there seems to be a higher priority of PR/photo-op type of things---the sorts of things of which the public will say "I saw it with my own eyes!" and "He is really doing something!". Like ambulances. That "duller" expenditures might actually improve people's health and reduce the need for ambulances and even hospitals does not seem to be a consideration.
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Some recent comments on the Great Digital Future (Kenyan version) reminded me of this thread and The Coming M-Health Revolution (v. Kenya). A lot of noise back then. Plenty of folks unable to take their hands off it, getting all wet like there's no tomorrow ... M-Health is coming. At all levels in the country. Technological gimmicks as substitutes for reflection, discipline, and hard work.
Now, one thing about The Future is that it eventually and always arrives. On time. And I imagine that some of it has arrived in this case.
Some of my views back then:
To my mind, the matter here is quite straightforward, and I will put it thus:
(a) What are the basic health problems that most Kenyans (Africans) face?
(b) What are the prospects that this Hello (Sema) Doctor will be able to address those?
In (a), we have, for example, diarrhea, which you mentioned. Another is malaria. Cholera is never too far away. And so on, and so forth. We know that there would be tremendous improvements in the health of Kenyans (Africans) just by having toilets and latrines, people pooping right and washing hands, having clean drinking water, etc. No type of fancy mobile-phone "app" will change that.
So, unless people will be using mobile phones to plug their butts when they have diarrhea, or using them to whack mosquitos, it's hard to see where this particular "high tech" thing is going in that regard. The basic problems of health in Africa will not be solved with such gimmicks. What is required is real hard and serious work, with attention paid to the fundamentals---and that there is the ALTERNATIVE. To the extent that anyone claims otherwise, it behooves them to explain exactly how. And that can be done this way:
(a) A statement of the health problem.
(b) An explanation of how MPESA Telemedicine will help.
So, then. How is M-Health (Kenya) doing these days? Any concrete numbers of happy, healthy Kenyans or whatever? Any bright prospects of The More that is yet to come?