The upcoming years look positive but also challenging for the global healthcare sector amidst rising demand, continued cost pressures, lack of or inadequate care facilities, and rapidly evolving market conditions, says Dr Sunil Kr Khetarpal, COO, Shalby Hospitals, Indore on prevailing scenario of healthcare infrastructure with Romiya Das of Elets News Network (ENN)
As the urban spaces are gaining a population influx, it has become a common sight to witness metropolises suffocating for spaces be it in public mobility, housing; the healthcare sector too is facing a crunch in providing suitable infrastructure in its hospitals. It is imperative for the urban planners and policy makers to comprehend the nuances of healthcare infrastructure.
There is a large capital requirement for building a new hospital in Indian cities. Any new venture requires an innovative thinking and has to be planned meticulously with a professional approach. The biggest challenge for our country today is to provide better healthcare delivery at affordable price or free healthcare services to the economically weaker section.
The challenges of the public healthcare providers thus create an opportunity for private healthcare provider to manage cost efficiency at micro level without compromising the quality of care. In addition, changing demographics, disease profiles and the shift from chronic to lifestyle diseases in the country has led to increased spending on healthcare delivery. High equipment and its maintenance costs, increased material cost, increased manpower cost, inadequate funding for capital improvements are the key challenges to startup a hospital from a financial perspective. Other challenges for running a hospital includes increased operating cost, reimbursement by government agencies, empanelled organisations and insurance companies or third party administrators (this includes delayed payment and deductions whether justified or unjustified), decreased footfall in OPDs and bed occupancy, achieving and maintaining quality standards and accreditation, competition from other providers.
A sound financial planning is the key to address this challenge. It is important to be capitalist in approach and looking for optimal resource with a quantified approach.
A comprehensive study report prepared by Mckinesy and Company in 2002 on â€œIndian Healthcare â€“ Inspiring Possibilities Challenging Journeyâ€ for CII has outlined the healthcare reform scenario andÂ role of government and private players in incorporating healthcare reform measures and implementation in 11th and 12th five year plan. The draft 12th five year plan defines the governmentâ€™s strategy to implement â€˜Universal Health Coverageâ€™ which is a major challenge to meet. In the UHC model, all citizens should be entitled to a comprehensive package of healthcare services, and have access to public health and accredited private facilities for attaining services such as diagnostics, medicine, vaccines or surgeries as an entitlement, without having to pay at the point of use. This will widen the scope of access to quality and affordable healthcare to the citizens of the country where 70 per cent of healthcare expenses in India are incurred by people from their pockets, and 70 per cent spent on medicines alone which further leads to impoverishment and indebtedness. As a result of high OOP payments, 40 million Indians are pushed into poverty each year. There has to be strong political will and commitment to address the issues of accessibility, availability and affordability of healthcare to the citizens of the country and optimally maintaining a balance between the cost and quality.
India needs to focus on preventive health, early detection and management of diseases, develop a short-term and long-term public private partnership strategy, increase efficiency through better and optimal utilization of resources, and strengthening the systems and processes. The healthcare reforms should address aspects ofÂ hospital management such as regulatory or legislative reforms, reduce operating costs, supply chain management and value-based purchasing, alignment of hospitals with physicians more closely, well integrated Health Information System (HIS) and data management, ethical and best service practices to avoid penalties, hiring one or more primary care physicians, regular training and education of staff to reduce adverse events and healthcare associated infections.
Government Mandate Necessary
While the US healthcare has norms to safeguard a patientâ€™s right by keeping his medical history confidential, in India, there are no such mandates. Though the Indian healthcare industry is rapidly growing and is set to cross `1.3 trillion by 2020, the country is still working on putting together a set of regulatory framework for the healthcare industry. There is greater underutilisation of IT in clinical healthcare per se. The Medical Council of India (MCI) guidelines mandate hospitals to keep prescription records for three years, preferably on a computer which promotes use of IT in healthcare. However, keeping electronic medical records (EMR) remains a guideline and is not mandatory. EMR is also valid in the court of law.
The Ministry of Health and Family Welfare (MoHFW) has proposed to set up National ehealth Authority â€“ NeHA for development of an integrated HIS in India. It will also be responsible for enforcing laws and regulations relating to privacy and security of patient health information and records. Under this project, a uniform system of EMR for hospitals is developed that will maintain the records of treatment, identification, healthcare providers, cost of treatment, standard of healthcare availability and quality of treatment etc. The proposal is underway and its successful implementation will be an important step towards improving quality of patient care and data management. The government also plans to build a broad basedÂ framework that will include a larger spectrum of standards, including diagnosis, procedure, laboratory coding and clinical standards.
A major concern for the Indian healthcare industry is that, while the tertiary healthcare segment seems to be powered with IT usage, primary healthcare continues to look grim, something that can only be altered with stringent government regulations and mandates in effect.
Technology Aided Growth and Challenges
With the rapid development and advances in technological sciences, medical technology has played a strategic role in improving healthcare delivery towards better healthcare outcomes. Innovations in medical technology, enhances the quality of care and safety. The CII and Delloite study has revealed that despite a strong growth in medical technology market in India, there has been low penetration of technology. Considering heart disease as a major killer in the country, Indiaâ€™s pacemaker penetration is one per cent of the western market at 18,000 pacemakers per year against the requirement of a million pacemakers. There is a need to expand the market.
Healthcare costs are rising dramatically, largely because of tremendous advances in diagnosis, treatment and prevention of diseases. Equipment like CT scan, MRI, ultrasound, mammography, simulator and linear accelerator etc required for diagnosis and treatment, need huge investment. Nowadays, the hospitals are planned and designed as super specialty hospitals manned and managed by super specialist. Tertiary care hospitals require huge investments in terms of infrastructure and equipment.
In contrast to its vast presence in urban area, distribution of medical technology in rural area is a major challenge and the disparity resulting in poor or inadequate healthcare in those areas.
Cost-effective products and solutions in medical technology has always been an issue due to lack of innovation. Due to limited number of options, there is a great demand supply gap in the market.
India has destitute manufacturing base for healthcare technology. This is due to absence of any incentive schemes to attract local or foreign investors to set up a production base in India. The overall growth remains small due to low penetration of products.
Manpower Crunch punches Healthcare
Manpower planning is an important element for hospitals. It depends upon the size of the hospital and specialties it is going to cater. As per World Health Report, India tops for shortage of healthcare workforce in the world, with 53 out of 57 in the ratio of healthcare personnel per thousand populations. The Indian Healthcare system suffers acute shortage of doctors, nurses and paramedics. India has seven doctors and 17.1 nurses per 10,000 populations which is much below WHO recommendation. Situation is worse in rural areas where thousands posts of doctors are vacant in PHCs and CHCs.
Certain states are experiencing an acute shortage of health personnel. Inequalities in the distribution of health workers are highest for doctors and dentists and have a significant effect on health outcomes. As India is striving to achieve universal health coverage by 2020, the realization of this goal remains challenged by the current lack of availability and inequitable distribution of appropriately trained, motivated and supported health workers. There are 387 medical colleges in the countryâ€”181 in government and 206 in private sector. India produces 30,000 doctors, 18,000 specialists, 30,000 AYUSH graduates, 54,000 nurses, 15,000 ANMs and 36,000 pharmacists annually. Although the production of health workers has expanded greatly in recent years, the problems of imbalances in their distribution persist.