Morning MEDtalks with Dr KK Aggarwal 23rd September 2018

Dear Colleague

Here are two links for videos to watch. Share them with your colleagues and friends.

1. What is FDC? https://www.youtube.com/watch?v=tGv6BRIG8UA
2. TEDx Video: Doctor-patient relationship https://www.youtube.com/watch?v=i9ml1vKK2DQ

Ayushman Bharat to roll out today across the country

Today onwards, nobody will be poor in India, from the health point of view. Now, all needy people will have an insurance of Rs 5 lakh with the premium paid by the government. 

The Prime Minister, Shri Narendra Modi, will launch the Ayushman Bharat scheme, officially known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY) today in Ranchi, Jharkhand.

The scheme will provide insurance cover of up to Rs 5 lakh per family per year at any government or empanelled private hospital all over India, for secondary and tertiary care hospitalization. More than 10 crore poor and economically deprived families and more than 50 crore people will benefit. There is no restriction on family size, age or gender. All pre-existing conditions are covered from day one of the policy. The benefit cover includes both pre and post hospitalization expenses.

All workers in India, who earn less than 21,000 INR per month are already covered under the Employees’ State Insurance (ESI) Scheme. 

Getting the insurance premium paid by the government will now be a fundamental right for those who are eligible for the scheme.

All hospitals and health care establishments, who have committed 10% free work for the economically weaker section (EWS) of the society will now get paid under the scheme; also, all government hospitals will start getting some reimbursements under the scheme. So, more and more people will now opt for private wards in government hospitals. 

Health is already a fundamental right under Article 21 of the constitution of India and improvement of the public health is a primary duty of the government under Article 47, under the Directive Principles of State Policy, based on the means available, which mandates the government “to raise the level of nutrition and the standard of living and to improve public health”. And, if the required means are not available, the state government can then mandate all private hospitals to enroll under this scheme.

Because all emergent health conditions will be paid for under the insurance scheme for the poor and the needy, hospitals will no more have an excuse to refuse treatment and 100% hospitals will have to comply. 

Time has come for universal health coverage and to make quality health care “available”, “accessible”, “affordable” to all and also “accountable”. The Ayushman Bharat scheme is one step towards this end. For those who can pay, it must be mandatory to get an insurance for at least Rs 5 lakh, which will become a minimum benchmark for health insurance in India.

Once 100% people are insured, health care will become affordable over time to everyone. Treatment costs will automatically reduce. The two types of insurance (Ayushman and non Ayushman), two types of premiums, two types of packages and two types of treatment will also invariable undergo auto correction. 

Poor sleep habits may be related to low levels of physical activity, high blood pressure and obesity. A link between high levels of daytime sleepiness and high blood pressure has been shown in a study of black women, who were overweight or obese, presented at the recently concluded American Heart Association’s Joint Hypertension 2018 Scientific Sessions in Chicago. Women who reported high levels of daytime sleepiness also reported much less vigorous and moderate physical activity and had higher BP than women who said they had normal levels of daytime sleepiness. Hence, the authors suggest addressing sleep quality to also be part of the strategies to control high BP and obesity.

Harmful use of alcohol kills more than 3 million people each year, most of them men, according to a report “Global status report on alcohol and health 2018” released by the WHO. Of all deaths attributable to alcohol, 28% were due to injuries, such as those from traffic crashes, self-harm and interpersonal violence; 21% due to digestive disorders; 19% due to cardiovascular diseases, and the remainder due to infectious diseases, cancers, mental disorders and other health conditions. 

There is a proof that over use of antibiotics can harm. Use of prophylactic antibiotics in cesarean-section delivery other than the standard recommendation of first-generation cephalosporins, such as cefazolin, is linked to an increased risk of adverse events. "Use of both standard alternative and inappropriate alternative antibiotics was associated with higher odds of surgical site infections compared with use of cefazolin for prophylaxis at the time of cesarean delivery" as reported in a new analysis of more than 6500 cesarean-section deliveries published online September 7 in Obstetrics & Gynecology.

What are my chances of getting sued if I practice for 40 years? GPs can expect to be sued once every 10 years as per a report in BMJ published September 21, 2018. The latest figures show that in less than a fifth of cases (17%) doctors are found to be negligent.

Do we need statins for above 75 non-diabetic persons and above 85 diabetics?  A large observational study has shown no benefit from statin therapy for primary prevention of atherosclerotic cardiovascular disease or all-cause mortality in nondiabetic adults aged 75 and older. Atherosclerotic CVD was a composite of coronary heart disease (fatal and nonfatal angina, fatal and nonfatal myocardial infarction, or cardiac revascularization), and stroke (fatal and nonfatal ischemic stroke). However, for those with type 2 diabetes, statins did reduce the risk for atherosclerotic CVD and death, but only up to age 85. The study was published online September 5 in the BMJ.

Another large Denmark study has shown that eating more whole grain foods (rye bread, whole grain bread, or oatmeal/muesli) is tied to 30% lower risk of developing type 2 diabetes. Moreover, the association persisted whether the whole grains were rye, wheat, or oats. The study from the Danish Diet, Cancer, and Health Cohort was published in the September issue of the Journal of Nutrition.

Dr KK Aggarwal

Padma Shri Awardee

President Elect CMAAO

President HCFI