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Book Review: In Search of the Perfect Health System

One of the most glaring deficiencies of medical education in India is a lack of focus on health systems and policy. While considerable emphasis on disease and its management is central to any medical curriculum, the absence of exposure to the workings of the healthcare system can prove to be a huge handicap once students graduate and enter the ‘real world’.

In Search of the Perfect Health SystemOur health system is much more complex today than it was in the initial decades of independence, and it is going to get more and more complex. This calls for medical curriculum reform that will include more classes and serious discussions on, for example, health policy, health economics, and politics and public health. But such a nationwide reform is still quite distant, and current doctors and medical students have to manage themselves if they wish to know more about healthcare outside of their wards and operating theatres.

It is precisely for these reasons that the book ‘In Search of the Perfect Health System’, released recently, is highly significant in the Indian context. It is authored by Mark Britnell, currently Chairman for Global Health Practice at the UK professional services firm KPMG, with a work experience that includes several years in leadership positions at the National Health Service. It is a concise, easily readable book, with short chapters on the health systems of 25 countries/regions each of which can be read, as the author says, in the time it takes to drink a cup of coffee. Then there are eight equally short chapters which touch upon broader aspects of health systems and policy.

Mark Britnell says he has ‘had the privilege of working in 60 countries’, and that first-hand experience prominently shows in the profound and precise analyses he has written. Completely immersed in our own complex health system and its daily hassles, we hardly get to know much about how things are in other countries (except perhaps the US and the UK). Thus the most useful aspect of this book is that it enlightens busy Indian doctors about the state of the world in terms of health, and without making them wade through esoteric academic language or give up many hours of their day.

The country chapters are highly informative and interesting: I got to know about Australia’s progressive ‘community approach’ to mental health; about Indonesia having the ‘largest single-payer health insurance’ in the world; and about the mind-blowing amount of money Qatar is investing in healthcare and health research. I also read with concern how Russia is in a deep healthcare crisis currently, how corruption and lack of transparency is rife in China’s health system (much like India’s), and how in the United States’ highly inefficient system ‘everybody recognizes the need for change but is waiting for it to start with someone else’.

Mark Britnell doesn’t just provide a plain description of what’s happening in different countries, but also spices it up with his own insights and comments, which provide a better understanding to someone who hasn’t been exposed to much health systems talk. Of course, there are some technical terms occasionally which many Indian doctors might find hard to understand due to poor exposure to such topics. This book is also not exactly the right one for those looking for an in-depth understanding of healthcare internationally (although the references mentioned after each chapter can be useful for such individuals). Many Asian countries which have done commendable work in recent years, like Bangladesh, Thailand and Sri Lanka, are unfortunately not represented; nor is any African country other than South Africa.

The final chapters sort of sum up the wisdom the author has attained through his decades-long experience and his extensive travels. The chapter titled ‘Patients As Partners’ is especially important from the Indian perspective, with public distrust in and disillusion with the healthcare system at an all-time high in our country. It is heartening to see that Britnell’s commentary is fairly balanced, and despite having the knowledge of multiple health systems, he doesn’t seem to be overly enamoured by any — his conclusive chapters mention inspiring aspects of health systems from several countries together, providing us with a highly comprehensive perspective which we might not have had otherwise. Indian readers will also be pleased to see him suggesting that the care models of Aravind Eye Care System, Narayana Hrudayalaya and Vaatsalya Healthcare should be replicated in other countries.

For those of us who don’t want to stop at being just good clinicians, but also wish to be good ‘clinician citizens’ — since a medical professional who also has sound knowledge of healthcare and policy, both national and international, is a significant asset to a nation’s civil society — ‘In Search of the Perfect Health System’ is indeed perfect reading.

In Search of the Perfect Health System
Author: Mark Britnell
Paperback: 248 pages (Rs 2,209)
Publisher: Palgrave Macmillan (Sep 2015)

The reviewer, Dr Kiran Kumbhar (MBBS, MPH) is a healthcare writer and commentator.

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