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Gazing into the Crystal Ball—The Next Decade for Healthcare

Dr Nandakumar Jairam

The changes in Indian healthcare over the last three decades have been substantial; in the 80’s there was an establishment of corporate hospitals, the bigger the better kind of concept was very strongly there. Soon, it was realised, that while private healthcare of this kind enables urban healthcare and healthcare for those who can afford, it does not satisfy the requirements of the large Indian population in the rural & semi-urban setting as they cannot afford it.

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In the more recent times, the government is looking at ways to ensure health of the masses, not just by their own initiative but by a joint effort between the government and the private healthcare players. Therefore in my opinion, the next decade will be ruled by partnership between various stakeholders.

The establishment of a low cost, high efficiency, large volume model which enables the government and the private healthcare players to establish healthcare institutes of substantial capability to meet the healthcare needs of the masses, is needed. This is not an easy undertaking and the experience of various other countries clearly shows that the insurance-based healthcare projects have always fraught the danger of a highly demanding financial impact which may dent the economy.

The initiative of the Prime Minister is laudable but I think there will have to be several versions before it matures to see the light of day. This ambitious project which is perhaps the biggest project in the world is there to stay but the manner in which it is guided is extremely important.

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LET ME STATE SOME CLEAR AREAS:

1. It is important to note that it is impossible for private healthcare players to provide care below their own cost. While cost can be curtailed, there is a certain point at which further cutting of costs impinges on the quality of care and hence detrimental to the very product of insurance that the government is so keen on establishing. Therefore, a suitable solution which enables a win-win situation between the government, the private healthcare player and the insurance is the need of the hour.

2. The clear requirement for the stakeholders of healthcare to work together, i.e. the medical device manufacturers who have substantial interest in growing their business in India should invest into healthcare along with healthcare providers so that there is a lower investment burden on each player involved in this entire process. This will enable a greater confidence in private healthcare to invest in rural and semi-urban India.

3. Monitoring, accountability and quality of care that is extremely important in this entire scenario. While the government has taken very strong and laudable steps in this regard, it is the implementation part that is most important.

While we talk about all these issues, it is also fair to state there is a widening skill gap which the government is addressing by starting newer medical & nursing colleges. However, it is important that while the quantity of people may improve, there has not been enough emphasis on quality of people who are being produced, which is vital for the sustenance of healthcare. The issue needs immediate attention and should be addressed simultaneously while improving the medical and nursing schools.

There is also a need for us to shift from an Illness to Wellness. The government has thought about it but many private healthcare players have not looked at wellness as a concept to reduce the burden of tertiary healthcare. To many, this may not be priority but it is important that the government looks at more plans to ensure that even the private healthcare players invest substantially in the wellness of the population because if one understands the disease burden prevalent today, it is based upon non-communicable diseases.

This is expensive in its treatment and fraught with various other complications that are financially very impactful. Therefore if the government pushes for wellness and preventive health, then these complications will reduce in number. Simultaneously, the cost of care will also reduce which in turn will be better for the society.

There is one clear point to be noted, that is the need for wellness or treatment programmes to be evidence based.

While the government is very strong on evidence-based and the need for it, I don’t believe it has percolated to the private healthcare players or private medical practitioners which is indeed counter-productive to the very fact of preventive care.

These are some random thoughts of someone who has been in the area of healthcare for more than four decades, while as I stated, gazing into the crystal ball can only give you thoughts, what is reality will unfold as we look-in and walk the next years into healthcare. I am confident that with the intelligence and the capability that is available in India, healthcare will move forward and become as strong as is required. Not only to provide care but also to be an economic driver and an employment opportunity to many people.

As a born optimist, I am sure that whatever is mentioned above will be addressed and we will see a HEALTHIER, HAPPIER and a BETTER COUNTRY with our people being looked after well, by both government and private healthcare.

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