Healthcare has become one of India’s largest sectors – both in terms of revenue and employment generation. An industry that is expected to touch USD 372 billion by 2022 is currently undergoing huge transformation in terms of mergers and acquisitions with domestic and foreign companies to drive growth and gain access into newer markets, on the one hand. On the other hand, there is the recently rolled out Ayushman Bharat, which is all set to revolutionize healthcare delivery across the country.
India’s competitive advantage lies in its large pool of well-trained medical and para-medical professionals. India has a huge price advantage over Asian and Western markets as we all know that the cost of surgery in India is about one-tenth of that in the United States of America or Western Europe and herein lies the potential to further grow this segment. The medical devices also cost relatively cheaper here resulting in more patients coming from far off countries. India is also emerging as a preferred destination for R&D activities due to the low cost of clinical research. Creation of new drug testing laboratories and further strengthening of the existing 31 labs will certainly put R&D on a stronger pitch.
The existence of favorable policies for encouraging FDI, tax benefits have helped the Indian healthcare market to draw in private equity, venture capital, and foreign players. Medical value travel opportunity in India is expected to reach USD 10.3 billion by 2020 and this is mainly due to much lower costs, the availability of latest medical technologies, a growing compliance to international quality standards, and a large English speaking population, not to forget the highly skilled pool of medical and paramedical professionals.
A key aspect to watch out for in the healthcare space is the healthcare technology which is growing by leaps and bounds. Adoption of AI into hospital operations is making healthcare much more organized and speedy resolution of problems. Access to information is just at the fingertip with the aid of AI based applications. In the coming years, it is foreseen that many healthcare players shall resort to IoT based applications to do inventory management which has a huge cost implication and directly correlated with patient safety and operational efficiency. IoT based platforms will enable to have better insights into hospital operations, inventory management, and human resources management thereby will lead to reduced operational costs. Simultaneously Internet of Medical Things (IoMT) shall go on to impact positively as mobile and wearable devices will be used more effectively to identify risk factors in the patients and thereby extend preventive treatment options.
On budgetary allocation in healthcare
The National Health Policy aims to double the government spend – from the existing 1.15 percent of the GDP to 2.5 percent by 2025, though the budgetary allocation of `52,800 crore for health in 2018-19 was just 5 percent more than 2017-18. To meet the objectives of the policy, both the central and state governments should raise their total allocation on health to `800,000 crore, up from the current `200,000 crore by year 2025. To get to this, the health budget alone should increase at least 20 percent year-on-year for the next 7-8 years. But I do feel that building healthcare infrastructure for 50 crore patients is a daunting task and that is where the real challenge lies. Building such infrastructure in tier II and III cites where the rural population can reach, is a tough call.
Ayushman Bharat is going to be one of the biggest reasons for transformation in this sector. It is indeed a welcome initiative by GoI. The challenge from the infrastructure perspective is to deliver these benefits to those these are intended for. The flow of the allocations while the roll-out is ongoing shall be crucial to measure its efficacy in the time to come. In a recent report of PWC-CII on Ayushman Bharat, it has been stated that the government shall require the right kind of infrastructure to cater to the rise in demand in bed capacity due to this scheme. It is estimated that at least 33 percent of the covered population will have no previous health insurance coverage and they will have a 6 percent probability of hospitalization with approximate 3 days’ stay. One of the most important feature of this scheme is that the poor will now no longer have to struggle to avail treatment, or fall prey to money launders’ or touts’ grip and do not rot into the vicious circle of poverty due to loans/mortgages for treatment.
In a vast country like India, out-of-pocket expense (OOPE) contributes up to 60 percent of all health related expenses and this pushes 63 million people into abject poverty due to absence of financial support to meet their healthcare needs. Ayushman Bharat will fill this gap hugely and with 26 states joining hands and more to follow, this scheme, if implemented well, will change the scenario in healthcare in the coming years. The scheme will augment growth of healthcare in tier II and III cities/towns that will be robust in nature encompassing new hospitals, expansion of existing ones, health equipment/medical devices industry, generic pharmaceutical industry, and manpower-both clinical and non-clinical.
On monitoring the quality of private healthcare
India’s healthcare is dynamic and complex. Recent government data indicates that there is one formally qualified registered doctor for 862 people and one hospital bed for 693 people. The problem is, the distribution is lopsided, with the bulk of services located in urban areas, and dominated by the private sector. The issues related to the private health sector have not been addressed majorly by the planners and policy makers in our five-year plans so far. The growth of the private sector was not planned or promoted as part of an overall healthcare system. Over the years, the private sector emerged as a powerhouse in curative healthcare and it is the need of the hour that an equally matching strategy for public health reforms is required, for us to achieve the desired results from our health system, if we want to take it all encompassing.
On government support to the private sector
The percentage of the population which is coming to avail services from private healthcare has grown over the years substantially and with the constraints in public healthcare delivery prevailing, we cannot actually undermine the importance of the private healthcare system in India. Rather than typical monitoring or controlling, what is needed now is using technology to smoothen out the undulations in the private healthcare system.
The internet has brought about a social revolution cutting across all strata of the society. Even though the internet is all around, the number of connected devices/objects is comparatively lesser than those that are not connected within the healthcare. The sooner we replace the disconnected devices with connected ones, and make these more intelligent, the sooner we can bring things under better control.
In the world of internet of things (IoT) for healthcare, these devices can assimilate, analyze, and communicate real time medical information to open, private, or hybrid clouds, making it possible to collect, store, and analyze big data streams. I personally think that we can overview and monitor better if we make healthcare surveillance IoT enabled. On a micro level it would help us to address both major and minor health issues in a structured way that is more data supported. Let us not look at monitoring in the policing perspective, rather evolve surveillance in a way that is scientific, industry friendly, and patient centric. Only technology can drive this effectively to its logical objective.
On contribution of public private partnership in making healthcare a success
To put in simplistic terms, the public private partnership (PPP) model has its own advantages and disadvantages. In a PPP model, the government invites tenders from private players and the one who quotes the lowest price usually gets awarded the order. In such cases there is a narrow margin and so you have to carve out profit based on a huge volume of business. Currently, India has a total bed density of 1.84 per 1000 people against the global average of 2.9 and WHO guideline of 3.5 in 2022. If we intend to better this then the private sector has to be roped in to play an important role complementing the public healthcare.
We have quite a few examples of successful models of PPP in India. Yeshasvini Health Scheme in Karnataka, contracting Sawai Man Singh Hospital in Udaipur, Uttaranchal Mobile Hospital and Research Center, and Emergency Ambulance Services in Tamil Nadu are a few examples which can well be cited in support of PPP. PPP has emerged as a viable source to address constraints in government healthcare programs. To make PPP effective we have to ensure that the models envisaged have rewards to offset the risks involved.
On areas where the government should invest to make healthcare available to everyone
Healthcare insurance for all such as Ayushman Bharat, more essential medicines and lifesaving cancer medications under price control, and adding more beds via the PPP route especially in tier II and tier III cities are some areas where the government must invest. Emphasis should also be thrust upon indigenous devices, implants, and stents, so that these may be used up at a relatively lower cost which will go on to benefit a larger section of the society.
On training and development of non-clinical manpower
We have a huge resource pool of non-clinical manpower that forms an integral part of successful healthcare delivery. The training and development of this resource pool is very crucial with so much changes happening in the way healthcare is being delivered now. Youngsters aspiring to come to the healthcare industry must be trained on all aspects of healthcare functionalities starting from operations, strategizing, and commercials. A structured curriculum shall be of great help to this generation and industry experts can be roped in to share their views and inputs to get this in place.