Covid pandemic – An opportunity to transform India’s healthcare system

The Indian health system can justifiably claim credit for multiple achievements in the last couple of decades. Contrary to expectations, we were able to achieve the Millennium Development Goals in respect of the maternal mortality ratio and almost succeeded in meeting the under-5 child mortality target. Disability adjusted life years (DALY) have been reduced from 61,335 to 34,821 per one lakh population, and under the healthy life expectancy (HALE) at birth, India stands at 59.3 years against the global average of 63.3 years. There are significant interstate and intrastate differentials in health outcomes.

Currently, the government spends roughly 1.2 percent of the GDP on health, but 58.7 percent of healthcare spending is financed by households through out-of-pocket expenditure at the point of care. India is the world’s second-most populous nation (1.3 billion people in 2011), and is expected to reach 1.54 billion by 2035 and 1.6 billion by 2050. To cater to the health needs of the people, the health system needs to evolve rapidly. India’s health system reveals a story of multiple fragmentations – a fragmentation of payers and risk pools; providers of healthcare services;

Covid pandemic has helped expose the shortcomings of the current healthcare system and the need for a modern and more robust healthcare system

• Inadequacy of public healthcare system;
• Inadequate public-private partnership;
• Non-robust private sector;
• Missing healthcare-delivery regulator;
• Missing data;
• Inadequate social security system; and
• The suboptimal role played by IRDAI.

The window of opportunity
The ‘brick and mortar reset’ businesses go online as even though crisis may end, the threat of resurgence lingers.

• Healthcare goes digital. The Covid crisis has acted as a major catalyst for digital health, just like demonetization did for Fintech;
  • Major players have witnessed a 100–300 percent uptake in e-consultations, and an up to 50 percent increase in enrollments, leading hospitals to design and launch home quarantine packages, single-doctor clinics offering online consults, etc.
  • The Medical Council of India, in partnership with the NITI Aayog, on March 25, 2020, also released the Telemedicine Practice Guidelines, as a guidance document for telemedicine.
• More efforts on self-reliance on medical kits and devices.
• Efforts are being made for testing capacities and infectious disease management blocks in each health institution up to block level;
  Joint participation by the government, public, and hospitals; and
• An opportunity is created for domiciliary health care. (home-based) and simple monitoring tools like digital thermometers, pulse oximeters, and home-based and home-based ICU care.

Changes expected to be made/happening in the healthcare system

• Increase in public healthcare spend. The 15th Finance Commission as expected has recommended an increase in public spending for the creation of health infrastructure;
• Advancement of public healthcare agenda. An increase in public healthcare capacity in terms of the addition of new beds, ICUs, ventilators, testing labs, etc., across all the states in India;
• Reforms in the social security scheme;
• Roll out of National Digital Health Mission (NDHM) with its availability of unique patient ID, hospital digitization, and e-pharmacy;
• Increase in health insurance penetration; and
• Increased adoption of telemedicine, e-pharmacy, home monitoring, usage of trackers, and wearables for monitoring purposes.

Strengthening health systems through strategic stewardship on the part of the government will also lead to a substantial positive impact on the productivity of the working-age population, enabling India to realize its demographic dividend over the next 10–15 years, and boosting economic growth.

Our vision for a healthy India requires us to holistically transform the delivery of health services in both the public and the private sectors, across levels of care. India’s health system needs to be prioritized and escalated through infrastructure, investment, and manpower.

India now needs to build on its many opportunities to achieve further progress on the health of its citizens and respond to the growing aspirations and needs of a new India.

“Innovation is the ability to see change as an opportunity, not as a threat.”