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Practical and ethical issues for delivery of advanced ENT services in the Indian subcontinent

efforts to ‘Bridge the Gap’

Kumar, Raghu Nandhan Sampath; Kameswaran, Mohan

Current Opinion in Otolaryngology & Head and Neck Surgery: June 2019 - Volume 27 - Issue 3 - p 212–218
doi: 10.1097/MOO.0000000000000542

Purpose of review The Indian healthcare industry, one of the largest in the world, caters for 1.3 billion people. The modern middle class addresses its needs by visiting private hospitals, which provide comprehensive services but at a high cost. The low socioeconomic individuals visit government hospitals where all basic services are available, but there is a struggle to provide advanced healthcare. In order to rectify this dichotomous approach, new initiatives are being implemented to provide uniform healthcare across the society.

Recent findings Technological advancements have been rapid and modern methods have reached the shores of India at the same pace as in the western world. In otolaryngology, advanced services especially for restoration of hearing loss and multimodality treatments for head and neck cancers have been two areas where practical and ethical dilemmas have existed to provide the most optimal treatment at subsidized costs. This article explores these two areas as examples to understand the specific problems encountered in delivering advanced ENT care in a low-resource setting in a large populous country.

Summary Introduction of government health insurance schemes have helped the poor to make use of advanced healthcare. The highlight of this scheme has been the inclusion of expensive interventions like cochlear and auditory brainstem implantation, whereby cost of the device, surgery and habilitation have all been delivered cost free for eligible children.

Department of Neurotology, Auditory Implants and Skullbase Surgery, Madras ENT Research Foundation, Chennai, Tamil Nadu, India

Correspondence to Mohan Kameswaran, DSc, MS, FRCS (Ed), FICS, FAMS, DLO, Professor, Department of Neurotology, Auditory Implants and Skullbase Surgery, Madras ENT Research Foundation No.1, First Cross Street, Off. Second Main Road, Raja Annamalai Puram, Chennai 600028, Tamil Nadu, India. Tel: +91 44 24311411 x412/413/414/415; e-mail:

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