Syam Adusumilli, Vice President and Head India Sales and Solutions, Optum Global Solutions
In India, we have affordable hospitals to treat simple diseases and sophisticated hospitals to treat complicated diseases, but we do not have affordable hospitals to treat complicated diseases. Home to 17.5 percent of the earth’s population, India alone accounts for 20 percent of the global disease burden with a high infant mortality rate of 40 deaths per 1000 live births and maternal mortality rate of 174 deaths per one lakh live births. 70 percent of India’s population resides in rural areas and nearly 90 percent of the rural population travels more than 8 km to access basic health treatment. As is evident from India’s health indicators, our healthcare capacity is significantly short of latent and measured demand. This is true across primary care, specialized secondary care, tertiary care, convalescence, and palliative care.
Our capacity for preventive care, especially for NCDs is statistically insignificant. This is true for both – public and private care – across all economic strata of society. Significant investments are being made in Tier I cities for hospitals and secondary care (diabetes etc.), especially by the private sector. Investment activity and existing capacity are also visible in Tier II cities, if not fully concomitant with demand. The government is also making strides with new AIIMS and the National Cancer Grid.
So, where are the gaps? The challenge lies in catering to the underserved community of urban and rural areas. Specialized and end-to-end healthcare service providers that offer sustainable healthcare through community involvement, technology enablement, and better physical and financial connectivity, can play a pivotal role in bridging the gaps in Indian healthcare. These gaps are highlighted in terms of expectation and what private players can do.
Gap I: Rural Care in all Forms
Expectation. Reliable primary care, maternal and child care, control of communicable diseases, and control of NCDs.
Role the private players can play. The gap in rural healthcare can be bridged by technology enablement of healthcare delivery, made sustainable through community involvement, technology enablement, and better physical and financial connectivity. As per the government’s plan, India will have 1,200,000+ health and wellness centers (sub centers) and about 35,000 primary health centers by 2020. The private sector can easily add another 50 percent capacity for rural primary care and the simplest way to achieve that is with telemedicine. This is a great opportunity for large private hospitals to expand their footprint, without adding a lot of infrastructure and capacity.
Gap II: Tier III, IV, and V – Primary and Secondary Care
Expectation. Reliable primary care, urgent care, and control of NCDs, with some access to specialists.
Role the private players can play. This is a great opportunity to build a lower cost footprint for primary care and specialist follow-ups for NCDs, using telemedicine. This can be paired with capabilities for ambulatory surgeries, lab and basic diagnostic imaging (digital X-ray, ultrasound, extremities MRI), and urgent care centers. A hub and spoke model with a core services center at a central location, connected to health centers for primary care, and health spots for immediate care should work very well, and is a good private investment opportunity.
Gap III: Tier II and III
Expectation. Local alternatives for primary and secondary care, NCDs, and ambulatory care.
Role the private players can play. A similar two-layer hub and spoke model, with a focus on telemedicine, can be positioned in low to middle income areas. Health spots could be set up in malls, apartment complexes, markets etc. to further drive revenue. The hub can be more elaborate, with MRI machines, nuclear scans, etc.
There is a clear technology enablement opportunity in Tier II, III, IV, and V and rural areas. While significant care capabilities exist, they are all fragmented and include pharmacies, labs, diagnostic centers, single doctor clinics, and a smattering of specialty centers. In many cases, technology is old or non-existent. A unified healthcare service delivery solution delivered over local wi-fi and wired bandwidth, with monthly subscription fees could potentially include scheduling, e-prescriptions, e-lab orders, simple bed management, and Fintech integration for payment flexibility, all delivered mobile first. This will allow for centralized procurement and inventory management and potentially also link government programs with private care delivery. Private investments have the potential to make this real.
Public Private Partnership (PPP) Opportunities
To make equitable healthcare a reality in India, and to keep pace with changing healthcare requirements (due to changing demographics, socio-economic mix, and disease incidence profiles), the public and private sectors must come together in a concerted effort to design suitable public health policies for the collection, allocation, and utilization of healthcare resources and funds.
The government at all levels is increasingly interested in PPP, based on utilization, viability gap funding, and subsidization for the below poverty line (BPL) population. In a mature framework, these opportunities can also be good vehicles for private investment.
Similarly, the government in some states has also been keen to outsource non-clinical services in all major hospitals. This is a great opportunity for private investment and participation. Private players in India can support and bring primary healthcare services and access to specialist care in rural areas through various health camps, collaborations, and partnerships with global healthcare service providers.
To cite an example of a PPP model, the IFFCO Group has partnered with Gramin Healthcare, India’s first start-up dedicated to supporting and bringing primary healthcare services and access to specialist care in rural areas. IFFCO and Gramin Healthcare have come together to provide affordable quality healthcare at their planned IFFCO Bazar Centers in 1000 locations pan India. Today, 15 kiosks are operational within IFFCO bazaar centers, in Tier III and Tier IV rural areas.
Pivotal Role of Health and Wellness Centers
To make healthcare inclusive, primary health services can be rendered through health and wellness centers. A health and wellness center has a modular structure and can be set up at an existing PHC or in a cost-effective portable cabin. These centers will bring healthcare systems closer to the homes of people, providing comprehensive care, diagnostic services, and essential drugs without the patients having to travel far from their homes. Health and wellness centers accompanied by effective implementation of information technology can play a pivotal role in making healthcare inclusive and accessible across India.
Such centers offer an integrated solution that can help all stakeholders across the healthcare value chain to take a broader view of citizens’ health to pre-empt treatment through regular monitoring and diagnostics. Health and wellness centers provide several benefits such as real-time transmission of patient health records and diagnostic reports to specialized doctors via video consultation.
The Indian government’s initiative toward this is also expected to catapult the growth of such centers in the country. In his speech during Union Budget 2018, Finance Minister Arun Jaitley called out health and wellness centers as the foundation of India’s health system. The proposed centers are supposed to be the main points of contact for communities with the public health system and better versions of existing health sub-centers and primary health centers. The centers will provide primary, outpatient care, and referral access to secondary and tertiary healthcare when needed.
With Ayushman Bharat leading the way, there is a strong opportunity for the private players to put their best foot forward and prescribe the right dose of healthcare to those, who need it the most.