With the Government aiming to take healthcare to the last mile, as reflected in ‘Modicare’ during the Budget 2018, it has opened a huge scope for innovation-led healthcare in India, Sandeep Datta of Elets News Network (ENN) explores the challenges and scope for industry.
Experiencing a new wave of opportunities, the Indian healthcare sector is drawing much attention, especially of the industry leaders. Various solution providers seem to be reinventing existing delivery models to ensure healthcare gets unexpectedly closer to the needy.
While supplying an estimated over 20% of the world’s generics and about half the vaccines sold globally, India today enjoys a reputation as a credible, cost-effective medicine manufacturer.
A Health Survey conducted by the NSSO indicated that during a 15- day reference period 89 individuals per 1,000 persons reported illness in rural India against 118 persons-Proportion (per 1000) of Ailing Persons (PAP) in urban areas.
However, un-treated spell was higher in rural (both for male and female) than urban areas.
Private doctors were the most important single source of treatment in both the sectors (Rural & Urban). More than 70% (72 per cent in the rural areas and 79 per cent in the urban areas) spells of ailment were treated in the private sector. Inclination towards allopathic treatment was prevalent (around 90% in both the sectors), the government communiqué added. Be it rural or urban landscape, various household surveys conducted across India show a significant prevalence of and a preference for private healthcare delivery, according to media reports.
Scope in Indian Healthcare
- Our country offers a big scope to improve, rectify and cater a lot of new solutions to perhaps a population of unimaginable scale. The enormity of the scope can be gauged from a government communiqué of 2015.
- The National Sample Survey Office (NSSO), Ministry of Statistics and Programme Implementation, had released the key indicators of Social Consumption in India: Health, generated from the data collected during January to June 2014 in its 71st round survey.
Looking at NSS findings over the last two decades clearly depicts a decline in the share of public hospitals in treating patients. This has created an asymmetric healthcare distributive network across States in India that is disproportionately scattered between the public and private healthcare sector.
Private Sector – A Boon for Indian Healthcare
In last three decades, private sector has been making a steady contribution. It is serving as a big supporting factor in the heavily burdened public health institutions at every level. The private sector today provides 58 percent of the hospitals and 81 percent of the doctors in India. It comes as a big support to public health institutions from primary care to tertiary care like AIIMS.
It maybe noted that India’s non-communicable disease (NCD) burden continues to expand. It is responsible for around 60% of deaths in India. Moreover, out of pocket expenditure (OOPE) constitutes over 60% of all health expenses, a major drawback in a country like India where a large segment of the population lives below poverty line.
The Government with its National Health Policy 2017 aims to bridge the gaps by increasing public spending to 2.5% of GDP by 2025. The policy looks at the problems and the solutions holistically with private sector as strategic partners.
To achieve the goals of the universal coverage, the government would need the support of private sector at primary to tertiary care levels. The support comes in the form of large investment, new technology, innovations and quality services.
India’s healthcare industry is one of the fastest growing sectors providing plethora of opportunities to stakeholders of this field.
According to a report by Assocham and research firm RNCOS, the Indian Healthcare Industry may see three-fold jump in value terms to $372 billion by 2022.
Lifestyle diseases and rising demand for affordable healthcare delivery systems due to increasing healthcare costs, are driving healthcare market in India.
In addition, rapid health insurance penetration and mergers and acquisitions are also the leading factors contributing to the growth of Indian healthcare sector.
In an article posted on linkedin, Prime Minister Narendra Modi has stated while the world is talking about eliminating TB by 2030, “we in India have committed to eliminate the disease by 2025 itself! I have faith in the people of India and the skills of those associated with the medical profession”.
“Like many other sectors, working in silos was affecting the health sector and thus denying access to good healthcare. We have changed this and integrated various ministries to work towards a common goal- of a healthy India.”
“Thus, in the last four years, we have moved from silos to solutions, integrated various stakeholders and are poised towards creating a Swastha Bharat.”
“Our aim to make India cleaner is connected with our focus on preventive health. In 2014, if 6.5 crore homes had toilets, the number stands at 13 crore today! Sanitation coverage has risen from 38% to 78%. The message of cleanliness has gone to every home and it is the youth of India that is taking the lead in making the Swachh Bharat Mission a success,” he added.
Speaking at Global Digital Health Partnership Summit in Australian city of Canberra, Union Minister for Health and Family Welfare J P Nadda recently said the ICT holds great potential to deliver quality and accessible healthcare services. “India is committed to reforms in health service delivery using ICT under Digital India Program of Government of India.”
Challenge of Government Expenditure
Though various governments and researchers have underlined the need to spend at least 2.5% of the gross domestic product (GDP) on health sector, the Central government only spent about 1.4% of the GDP on the sector (in 2014). This has perhaps given a big room for private players to enter the healthcare space.
It is pertinent to mention till recently the private health spending in India was more than double the government’s expenditure, at 3.3% of the GDP in 2014, according to a recent PricewaterhouseCoopers report.
Out of Pocket Medical Expenses
In December, 2017, Insurance Regulatory and Development Authority of India (IRDAI) Chairman T S Vijayan during a FICCI event said that the out of pocket medical expenses make up about 62 percent of all healthcare costs in the country. Stressing upon “a need to bring down out of pocket expenses of patients” which was about 62% of all healthcare costs, Vijayan said, “This is extremely high and leads to impoverishment of patients.”
Blockchain technology has taken a lot of industries by storm. It can be said particularly in the post-Union Budget 2018 scenario. During his budget speech, Union Finance Minister Arun Jaitley said the government aimed to organise and streamline various sectors using blockchain technology.With the government announcing massive investments in making healthcare available to everyone via ‘Modicare’, various players in the industry seem keen on exploiting blockchain technology to the hilt.
Speaking on innovations-led healthcare, Dr Seth said, “IT will develop into artificial intelligence. Smart phones have revolutised every form of delivery of any kind what we need in small towns.” Dr Seth, a Padma Shree and Padma Bhushan awardee, nobody needs bypass surgery, nobody expects robotic surgery or heart transplant in villages. They need sanitation, hygine, clean drinking water, nutrition, control of infection, hypertension and diabetes. These things must be controlled at basic level. “If one can control these eight things, 90 per cent healthcare delivery is done. And moreover out of these eight, five are the basic right of public.”
Innovation needs to be classified by its impact on stakeholders as disruptive or non-disruptive.We need to understand that nondisruptive innovation improves something that already exists in a way that supports the realisation of new incremental opportunities or solves known issues. It is also referred to as evolutionary, incremental, linear, or sustaining innovation.Disruptive innovations refer to innovations that fundamentally disrupt old systems, create new market constituents and new markets while marginalising old ones. Also termed as radical, revolutionary, transformational, or exponential innovations, these innovations deliver dramatic new value opportunities to those who successfully implement and adapt to the innovation.
‘Ayushman Bharat’ A Step in Right Direction
The Government of India was recently praised for its health initiative when a top WHO official said India’s mega healthcare initiative — the ‘Ayushman Bharat’ — is a bold and ambitious move holding potential to improve health and move people out of poverty.
Underlining the significance of spreading public awareness about health related issues at initial stage of life, WHO Director General Tedros Adhanom Ghebreyesus said it was essential to educate people at the primary level about health and well-being.
He was delivering a special address on ‘Universal Health Coverage’ before a gathering at NITI Aayog. “Announcement of Ayushman Bharat is bold, ambitious and courageous. The NHPS has the potential to not only improve health but also lift people out of poverty,” the think tank quoted the WHO DG as saying in a tweet. The Ayushman Bharat programme was announced in the general budget on Feb 1 this year.
The government has announced, as a part of ‘Ayushman Bharat’, two path-breaking initiatives that address health holistically, impacting primary, secondary and tertiary care system as well as prevention and health promotion. These include opening of 1.5 lakh health and wellness centres to provide people-centric comprehensive primary healthcare including for common noncommunicable diseases closer to the homes of people, including providing free essential drugs and diagnostics.
The second initiative under ‘Ayushman Bharat’ is the National Health Protection Scheme (NHPS), under which over 10 crore poor and vulnerable families (approx. 50 crore beneficiaries) will be provided treatment coverage up to Rs 5 lakh per family per year for secondary and tertiary care hospitalisation.
Conclusively saying, though the Indian health sector appears to have remained largely ignored vis-a-vis expectations and huge requirements of people across the country for decades, an endeavour to ensure a big change in healthcare is visible now. It is hoped modern technology will be more relied upon to reach out to even people living in the unreachable terrains, beyond the confines of metropolitan cities. A better future in terms of healthcare facilities is seeming possible, as finally impetus is being given on a transformation which involves an all inclusive and affordable healthcare through innovative solutions. One can hope for ‘Acche Din’ (the better days), the biggest poll promise of Narendra Modi government to turn realistic in the years to come at least in the healthcare landscape of the country.