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Affordable, Accessible, And Accountable Healthcare

Indian healthcare is at an inflection point. Today the governments’ spending on healthcare needs is one of the lowest amongst the developing countries. India spends about 5 percent of the total expenditure on health which is around 1.7 percent of the GDP. Public healthcare growth has slowed down over the years. In 1998 about 43 percent of the population was served by public hospitals and today only 30 percent use the public healthcare system. That means almost 70 percent of the healthcare needs are serviced by private players, trust hospitals, and non-profit institutions. This has led to the rapid growth of private players who are growing at the rate of CAGR 16.5 percent year-on-year. The costs of procedures or hospitalization has increased anywhere from 83 percent to 263 percent in 10 years, that is, 2004–2014.

There is also a wide variation of the cost for the same procedure in different hospitals. It is also noted that 86 percent of rural Indian patients and 82 percent of urban Indian patients do not have access to any form of employer-provided or state-funded insurance. The government of India is cognizant of this gap and is taking a 360 degree approach to help the people of India get affordable, accessible, and quality healthcare. They are improving primary care centers, providing dialysis facilities, pharmacy, AIIMS like institutes, acute care coverage, improving education so on and so forth. They have also capped prices for certain lifesaving drugs, stents, and implants. They have created a common entrance examination throughout India. The Medical Council of India is being replaced by the National Medical Commission which has more representation across different states.

Ayushman Bharat is the world’s biggest and ambitious project to cover 10 lakh families, that is, appropriately 50 crore people based on the socio-economic status defined by the socio-economic caste census 2010. Going forward, they also intend to spend 2.5 percent of GDP on healthcare services. Some of the states are also proactively implementing systems to monitor delivery of the healthcare services through state medical establishment acts. Karnataka state private medical establishment act clearly draws roles and responsibilities of patient, organization, and the doctor. Several states are also preparing to implement and align their policies to implement Ayushman Bharat scheme as well.

Globally, healthcare is continuing to grow at a stable rate of 4 percent. World over, due to high spending on healthcare, prices of medical devices and drugs will continue to decline. The focus is also on quality and cost effective care rather than quantity. Value base payment systems are getting matured in markets like US. Technological revolution is also becoming an integral part of the growth with internet of things, artificial intelligence, and data analytics finding place in the healthcare delivery model. General public knowledge on preventive care is very variable, though it is improving due to digital penetration such as diet apps, exercise apps etc.

Medical insurance in our country is yet to become popular for covering outpatient services and also preventive care cost. This will help people to come forward for the preventive health checks and education. Public private partnership is the way to go to help cover large and widespread population of India. The infrastructure already exists in various forms and sizes throughout the country by the private players. If government helps them by understanding their input costs and helps to make it economically viable then I am sure all the private players will agree to cover majority of the population group.

If we look at it from a birds eye view, we are targeting all aspects of the healthcare delivery system hoping to create an impact. We are on the right track as far as the macro picture is concerned. But the following thoughts cross my mind: in a country where more than 70 percent of the healthcare is delivered by private players there seems to be a disconnect between the private players and the government. Though both would like to work with each other’s strength, not enough has been done to take the other party into confidence. The major disagreement has been on the private player’s inability to deliver quality healthcare at the rates fixed by the government.  So, how can we leverage each other’s strength?

Infrastructure. In order to deliver accessible healthcare we need infrastructure that is spread far, wide, and deep into our geographies. Private players already have infrastructure that can be utilized to deliver care. Government is already helping by giving free land for new hospitals but can extend help to existing hospitals by giving tax rebates on property, concessions on electricity, water, sewage, and biomedical waste management. In few states specific areas in the community are earmarked for hospitals, that helps them to spread the infrastructure to serve the community better, but in few other states, the private players apply for permission after constructing the hospitals, this has led to unequal distributions and concentration of the hospitals in few parts and lacunae in others. This need to be corrected in order to achieve our objective of making healthcare services accessible.

Cost of delivering healthcare. In order to make it affordable the costs at all levels have to be controlled. Costing of the healthcare delivery is arduous and there are many variables and standardization is difficult. Private players will need help to ensure we get medications, consumables, implants, and reagents at reasonable costs benefit, and also ensure quality. Government has capped the price of few medications, stents, implants, that helps patients but not necessarily the providers, but we have long way to go. Products that are available in the market are of varied retail price and quality. We will need a body that helps us in certifying the quality of the product and fixes the retail selling price. This helps to bring in standardizing of material cost in the healthcare. Doctor and nurses are integral part of the care delivery system, they are often ignored while planning the cost efficient care. Including them and having their buy not only helps to implement cost reduction strategies efficiently but also helps to sustain it over a long period. There are studies in western countries to show that huge amount of money can be saved if doctors educate patients on importance of adhering to the treatment protocols, follow evidence based medicine, avoid polypharmacy, use generics wherever applicable, and appropriate prescription of antibiotics.

Accountability. Accountability in healthcare plays a very important part, as we deal with precious human lives. Today it is loosely applied by the governing bodies, most of the regulations are based on licensing and statutory requirements or post facto regulations by the medical council, consumer forum, and others. What we need is a proactive monitoring system that captures data on a real-time, monthly, quarterly, and annual basis and analyzes these trends to help us in standardization, implementation of clinical pathways, monitoring of outcomes, establish peer review committees, maintaining of National Data bank of clinical and para-clinical personnel, including database of legal cases and customer feedback.

Training and development. In order to execute and deliver healthcare which is cost-effective, affordable, and accountable, requires a complete change in the mind set and different skill sets for all care givers. Toward that end we will have look at changing the way we train our people, update our curriculum, and make it more clinical-outcome focused and practical.

Re-organizing our healthcare delivery system from training to tertiary level care is no mean a task. Thoughts of our leaders are in the right direction. More involvement of the private players and getting their buy-in will help us to catapult this initiative. This will help private players as well, as it will help them to better utilize their infrastructure, reduce costs, and provide care to a larger patient base. Bringing all the healthcare facilities under the purview of one monitoring system helps to distribute healthcare delivery, curb malpractice, and enables waste elimination and thereby reduces costs.

Columbia Asia is an international private healthcare company owned by a US-based investment fund International Columbia USA LLC (ICU). Columbia Asia started operations in 1996. Currently it has 29 medical facilities across Asia; 12 in Malaysia, 11 in India, 3 in Vietnam, and 3 in Indonesia. The company believes in setting up mid-sized hospitals built in residential areas for accessibility and efficiency, and to better serve the respective communities. This also helps keep costs down for consumers with no compromise on healthcare quality, modern amenities, and highly-trained teams of specialists and nurses. At Columbia Asia, comprehensive medical programs demand ethics, excellence, and strict clinical governance. All of its operations follow international quality assurance guidelines that meet the highest standard of patient care possible.

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