The paradigm of the Indian healthcare is witnessing brisk growth today due to recent advancement of technology and innovative solutions, which have not only helped to bridge infrastructural gaps but also led enriched healthcare experience to people at large. Despite technology-led Indian Healthcare giving hope to masses, concerted efforts on policy level is needed to bridge wide gaps in the delivery of healthcare services. In this light, Government is working on a mission in terms of robust planning and strategy to create healthy India where quality patient care will be within the reach of every single citizen of the country. In this mission, eHealth Magazine has also been organising health conferences in various parts of the country to get top policymakers, industry leaders and international experts under one roof to deliberate on different facets of healthcare ecosystem and playing the role of catalyst to drive transformation through knowledge platforms. Mukul Kumar Mishra of Elets News Network (ENN), tries to analyse the Government’s vision & strategy for laying strong foundation of healthcare, and associated challenges on different fronts.
The Indian healthcare is at crossroads today with emerging technology and innovative practices coupled with active participation from both public and private providers giving positive insight about delivery of healthcare services to masses while at the same time it presents a number of paradoxes on front of infrastructure especially in primary care and overall clinical outcome.
As India advances towards Rs 5 trillion dollar economy by 2024- 25 and healthcare being one of the important components contributing to overall growth and prosperity of the nation, vision of the Government in terms of strategy and planning to create robust healthcare delivery system holds a huge significance. With a slew of measures, the Government has set the pitch; nonetheless, it will take some years before one could feel the real difference.
A LITTLE INSIGHT ABOUT THE INDIAN HEALTHCARE INDUSTRY
The healthcare industry is one of the fastest growing sectors in India, providing a plethora of opportunities to stakeholders of this field. According to a report by the industry body Assocham (Associated Chambers of Commerce of India) and research firm RNCOS, the Indian healthcare industry may see three-fold jump in value terms to $372 billion by 2022. The sector is expected to generate 40 million jobs in India by 2020. Over 100,000 jobs are expected to be created from Ayushman Bharat, the National Health Protection Scheme.
“The affordable medical services have resulted in a growth in the country’s healthcare tourism, attracting patients worldwide and making India, the new ‘Medical Tourism Destination’,” says Dr Rakesh Gupta, Chairman, Sarvodaya Hospital Group, Faridabad.
Holding health budget a major constrain Ishiqa Multani President, Sagar Group of Hospitals, says, “While India currently spends approximately 1.3% of its GDP on healthcare, its public spending on healthcare as part of its total expenditures is lower than any other Asian country with the exception of Pakistan.”
HEALTHY POPULATION HOLDS KEY FOR A PROSPEROUS NATION
The Government has fair idea that till masses get reasonably well access to quality and affordable care, the larger goal to create healthy, happy and empowered India would not be accomplished. With this objective, the Government is toying with all possible ideas to make things improve, paving path for sustainable and inclusive healthcare facilities to people at large. Under the National Health Mission plan, the Government has clearly stated that it is committed to improve healthcare infrastructure in rural and urban areas for—reproductive-maternal- neonatal –child & adolescent health (RMNCH+A), and communicable & non-communicable diseases.
The NHM envisages achievement of universal access to equitable, affordable, and quality healthcare services that are accountable and responsive to people’s needs. Recently released report ‘Health Systems for a New India: Building Blocks— Potential Pathways to Reforms,’ by Niti Aayog speaks volumes about the Government’s intent to reform the Indian Healthcare sector. The report identified five focus areas of future health system –to deliver on unfinished public health agenda, change health financing away from out of pocket so spend into large insurers, integrate service delivery vertically and horizontally, empower citizens to become better buyers of health, and harness the power of digital health.
Dr Shuchin Bajaj, Founder Director, Ujala Cygnus Hospitals says “Our contribution to inclusive healthcare development agenda and commitment to ‘universal healthcare for all’ mission, have to be an integral part of our service delivery within the entire healthcare ecosystem, by ensuring free medicines and discounts on pharmacy, consultancies and surgeries to the economically weaker population of the society.”
NATIONAL HEALTH STACK ENVISIONS TO CREATE DIGITAL HEALTH INFRASTRUCTURE
In a bid to develop robust digital and IT health infrastructure, NITI Aayog is also working on a plan called National Health Stack (NHS). The National Digital Health Blueprint (NDHB) is the architectural document for the implementation of the NHS. Experts believe the Government’s objective is to manage population health in better manner leveraging analytics platform like Big Data and AI with Machine Learning. As per reports, unique health identification cards (IDs) would be provided to citizens so that health history of a person could be accessed at the click of a mouse. The idea is to aggregate data so that it would help patients, doctors, diagnostic chains and policymakers in order to make evidence-based interventions.
GOVERNMENT’S MEASURES TO TACKLE CHALLENGES OF 5 As
Challenges of the Indian healthcare is mostly centred around 5 As- -Accessibility, Affordability, Awareness, Absence or human workforce crisis, and Accountability. To improve record on this front, the Government is working on all fronts—planning to create robust digital framework, chalking out innovative ways, seeking partnership with private players to ramp up required healthcare infrastructure. With this objective, several initiatives have been announced like Ayushman Bharat and Pradhan Mantri Jan Aushadhi Yojana, capping of price of essential drugs and medical equipment, 100 percent FDI for pharma sector, medical device parks, and setting up of R&D centres to give a boost to the sector in holistic manner. “Government initiative like ‘Prime Minister Health Scheme – Ayushman Bharat’ along with other state sponsored schemes like CGHS, ECHS etc. provides good access of healthcare to the masses but probably at the cost of medical fraternity which is already paid low as compared to their counterparts across the globe,” Gupta says. “Many of the nation’s current challenges related to healthcare could be resolved by prioritizing preventative health and health education in our states and national healthcare programmes, and capitalizing upon the wide range of knowledge, skills, and experience within the private sector through collaborative initiatives,” Multani opines.
TODAY’S EMPOWERED PATIENTS SEEK VALUE FOR MONEY IN TERMS OF CLINICAL OUTCOME
As patients are getting empowered due to easy access to large swathe of information, healthcare service providers including both public and private one are expected to come up with smart ways to live up to their high expectations pertaining to patient care. A spurt in the incidences of lifestyle and non communicable diseases are making people seek quick and best care in hassle free manner. With the aim to cater informed patient, providers are leveraging modern-day technology trends and applications at smart hospitals to provide optimum care in hassle free manner.
It is a matter of agony that patients don’t find facilities up to the mark at public hospitals, especially those which deal in tertiary care. Lack of infrastructure in terms of medical equipment and unavailability of required number of doctors and nurses are some of the possible reasons which jeopardize care delivery at government hospitals. In this light, patients veer towards private facilities which at times take toll on health of poor and vulnerable people.
“About 60% of our healthcare expenses are out of pocket, which is one of the highest in the world. Such is the lack of trust in the public health system that not only do 80% of the wealthy seek treatment in the private sector, but a similar percentage of the poor also goes to private practitioners, even though the treatment may be of low quality and provided by untrained practitioners,” believes Dr Bajaj. “Patients have few feasible options: the private healthcare system is largely unregulated and often unscrupulous, while the public healthcare system lacks the staff, resources, and infrastructure necessary to provide adequate healthcare services to a large population,” says Multani. Dr Nandakumar Jairam, CEO, Chairman, and Group Medical Director, says, “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.”
“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,” Jairam states.
PRIMARY CARE NEEDS TO BE BOLSTERED TO REDUCE LOAD ON TERTIARY CARE HOSPITALS
Primary care system is considered as first line of defence against disease. It includes the day-to-day care needed to prevent, maintain, or cure any health issues. Best part of primary care is that people get the services in their vicinity and they need not to go far away except in some exceptional emergency situation. The Alma-Ata Declaration, 1978 highlighted the role of primary care to boost inclusive healthcare system.
Despite India is having a huge network of such centres, they are ill-equipped to treat patient who are often found to be whimpering about basic facilities—shortage of expert doctors and nurses, lack of basic infrastructure including diagnostic equipment, and short supply of drugs. The sorry state of primary care in our country highlights the fact that administration needs to pay urgent attention to make things improve on this front. “We have a large scheme offering free dialysis to many communities, but we forget that more than three quarters of kidney failures are caused by uncontrolled diabetes and hypertension, which can easily be treated at the primary health centre level, if we have the will to do it,” Bajaj says. There are many successful models worldwide which could be replicated to provide preventive care to masses at local level. Family clinics in Brazil and polyclinics and offices in Cuba are good examples of systems with nationwide coverage. Cuba has one of the most effective primary healthcare systems in the world, whose centrepiece is the community-based polyclinic.
HUMAN WORKFORCE AND RURAL CARE
There is an old saying that any war can’t be fought well until one has got enough foot soldiers. Similar rule applies in healthcare as well. In view of India being one of the worst affected countries with NCDs and emerging infectious diseases, required number of skilled health workforce is needed. But available data says otherwise. India has shortage of an estimated 600,000 doctors and 2 million nurses, as per data. In addition, asymmetric distribution of doctors and nurses, their merit and qualification, their reluctant attitude to work in rural areas further aggravates situation. Though the Government has taken measures in terms of increasing seats in medical colleges & seats, and toying with the idea to incentivize skilled medical professionals to work in rural areas, it will take some time before it will produce rich dividends.
“We must capitalize on the strength of our universities to encourage enrollment in the healthcare industry and to ensure that our graduating students should be given incentives to remain in India for their careers and to work in areas which are currently underserved,” Multani holds the opinion.
Hemraj Parmar, Group Chief Executive Officer, BR Life, says “Government must adequately incentivise private healthcare providers to spur investments and extend good quality healthcare to the people staying in rural areas who cannot afford more expensive treatment available in bigger cities.
Many state governments are going in for PPP projects to make healthcare more affordable, thus minimising risks to both the parties.”
MODERN TECHNOLOGY INCLUDING ARTIFICIAL INTELLIGENCE AND TELEMEDICINE TO BE LIKE BIG SUCCOR TO AUGMENT CARE
There are empirical evidences which prove that emerging technology have proved to be a game-changer in enhancing healthcare experience. In rural areas, these tools have played a vital role to bolster care. The industry is being disrupted globally with advancements in technology, new protocols and innovations in EHR, AI, Big Data, 3D printing, genomics, blockchain, AR/VR, wearables, telemedicine to name just a few. “While Artificial Intelligence (AI) is still in a nascent stage in the country, it holds immense potential to minimise costs while improving accuracy of diagnosis and consequently treatment. It’s slowly finding usage in radiology and oncology,” Parmar says. “Telemedicine and teleradiology are already finding usage in rural areas devoid of basic infrastructure, clinical talent and facilities,” he further states.
Dr Aloke Mullick, Group CEO, OMNI Hospitals, says, “Today patient carries on his smartphone his ICD coded clinical problem list, diagnostic results, images, medication lists, allergies, and past discharge summaries. His whole healthcare experience gets simplified, and the smartphone becomes the center of his healthcare experience.”
SINGLE REGULATOR FOR MEDICAL DEVICE INDUSTRY AND BIOMEDICAL RESEARCH HOLD KEY
The Indian medical devices market is currently valued at approximately at $10 billion and growing at an average annual pace of 12-15%. But sad part is the industry is regulated by multiple regulatory bodies which create a lot of confusion and deter investment by foreign and Indian companies. There is a compelling need for a unified regulator for ease of doing business.
“A strong and fair regulatory environment will help the Make in India campaign by encouraging the growth of this industry,” says Rajiv Nath, Forum Coordinator of Association of Indian Medical Devices Industry (AiMeD).
Another area which needs immediate attention is biomedical research. The ICMR, the premier Government body for medical research has very few interventions — in terms of new drug, vaccine, diagnostic test or treatment procedure — developed by its hundreds of scientists over a period of last couple of years. Lack of adequate funding, infrastructure, manpower, wage disparity, paucity of relevant data are some of the reasons why health research in India is hamstrung.
Issues are on many fronts and that needs concerted efforts. Nonetheless, a holistic approach is needed to develop an ideal healthcare delivery model where every single person would get quality care at their doorsteps. Hopefully, all the steps undertaken in this direction by the Government in coherence with private bodies will prove effective to create healthy and empowered India.