Dr Leena Chatterjee
President, Strategy and Operations,
Dr Dang’s Lab

Healthcare In India: A Perspective

Deloitte Touche Tohmatsu India has predicted that with increased digital adoption, the Indian healthcare market, which is worth around USD 100 billion, will likely grow at a compound annual growth rate of 23 percent to USD 280 billion by 2020. These are hence very dynamic times and those likely to stay ahead of the curve and succeed in all likelihood will be institutions who will remain very alert to ongoing developments, are capable of futuristic thinking as well as have the adaptability to change.

The Indian healthcare market, is a very highly varied market as of now. We have a mix of regulated and unregulated, accredited and non-accredited, cheap and expensive, qualified and unqualified as well as factory mode and personalized niche dotting the landscape. If we look at diagnostic services itself, we find that it has been a long journey for the average customer to be able to understand and accept the concept of quality in diagnostics as well as consciously seek the same.

Globally, the market would vary, with some countries having similar scenarios to the above while others might have poorly equipped capabilities. The developed countries will have a far more regulated structure. I would however like to mention here that there are institutions in India today which offer similar to what the world’s best has to offer. The healthcare information technology (IT) market is also positioning itself well and one can soon expect that market to double.

Healthcare delivery, which includes hospitals, nursing homes, diagnostics centres, and pharmaceuticals, constitutes a huge segment of the overall market. Healthcare services will continue to be in the spotlight considering that healthcare spending as a percentage of gross domestic product (GDP) is expected to rise. The real change is set to happen regarding rural India, which has a significant segment of India’s population and will be seen as the source of demand in future.

Diagnostics markets are expected to rise too, with their ever changing and expanding gamut of offerings, which have cemented their place as the backbone of good and effective prevention and treatment. With  significant research into, as well as an influx of, several newer diagnostic methods and technologies such as personalized genomic services, microfluidic devices, data analytics and machine learning amongst others the path ahead for the industry does look very promising.

On budgetary allocation in healthcare

At a mere 1.2 percent against an expected increase to 2.5 percent of GDP as per the National Health Policy 2017, and the lowest per capita health spend (with China spending 5.6 times more and the United States 125 times more), it is clear that the budgetary allocation in healthcare is way behind where it ought to be. It is already widely known that Indians spend more than half of their health expenses from their personal savings i.e. out-of-pocket expenses. This again varies vastly from data for US, UK, and even China.

Given the above, the fact that the PM however has recently spoken that India is set to increase its public health spending to 2.5 percent of GDP by 2025, is heartening, but does seem some time away still. One will wait to see whether the budgets over the coming two years can help bridge that gap.

On another note, the success of the Pradhan Mantri Jan Arogya Yojana in providing cashless health insurance cover up to `5 lakh per family per year, covering 500 million poor citizens will rest on having adequate fund allocation for the insurance scheme. Similarly, some states which are running parallel schemes also need to have adequate reserves. This is simply due to the fact that a significant number of people will seek out healthcare services now that it is within their ambit.

Increased budgetary allocation for healthcare as well as the sound strategy and success of  the newly launched schemes will define the future road map for India’s healthcare scenario.

On planed budgetary allocation for the procurement of medical equipment and devices

Dr Dangs Lab has set aside an amount of 10 crores for the coming year to expand its portfolio of diagnostic offerings.

On vision for Health and Family Welfare and challenges faced while implementing health services

A significant portion of our patient base being children, our lab has always contributed significantly in the fields of childhood cancers, anaemias, congenitally transmitted infectious diseases, and general health of children.

At a National level, we would also place the greatest focus on maternal and child health, prevention of non-communicable diseases as well as early and accurate diagnosis of cancers.

As an institution which has always placed great importance in patient value over patient volumes, we do not face many challenges in the implementation of health services.

Having said that, the rapidly changing technology and software landscape and its bearing on healthcare in terms of artificial intelligence, newer tests and technology, keep forward looking institutions such as ours on our toes to ensure that they we are always able to provide what is the best available globally to our patients.

On monitoring the quality of private healthcare

As things stand today, the expectation and demand for quality is far higher from private healthcare institutions. The acceptance and success of accrediting bodies such as NABL and NABH has managed to somewhat regulate the deliverables in terms of documentable quality. I also feel several corporate institutions are working hard toward ensuring customer satisfaction as well as improving their benchmarks in quality.

What does remain a concern is the penetration into smaller cities and towns where getting good manpower could be a concern with many skilled manpower gravitating into the metros and Tier-II towns.

On importance of public private partnership in making healthcare a success

Public private partnership (PPP) is certainly the way ahead. The model however as it currently is in India has not been greatly successful. For PPPs to be truly successful, appropriate infrastructure, pricing structure as well as transparent and early clearance of payments for the private partner and effective human resource and financial planning will go a long way in removing the current scepticism that exists.

The government on the other hand does have a larger task at hand to uplift the healthcare delta for India’s 1.3 billion population and must hold the private player responsible for all the assured deliverables in terms of quality, turnaround time, and accreditation. It should also define policies to ensure success of the PPPs.

A PwC report lists political will, transparency, broad stakeholder agreement, contract completeness, flexibility and governance, legislative and regulatory framework, public and private sector capacity, and fiscal space as being key to the success of a PPP .

On areas where government should invest to make healthcare available to everyone on the go

To my mind, effective medical education, skill development as well as steps toward strengthening primary healthcare with deep penetration and universal insurance will be game changers.

While Ayushman Bharat is centred around the latter two, its effectiveness will truly rest on adequate budgets being allocated for the same and appropriate pricing being allowed for the private sector enrolling in the plan.

It is also empirical that steps toward ensuring due respect to and safety for the professional working in healthcare are taken at the earliest.

On policy interventions that the healthcare sector in the state needs to align with the healthcare objectives at large at the national level

Although health is a state subject, it is more often than not aligned to the healthcare objectives at large at the national level. Endemic infectious diseases and diseases where vaccinations can help are some of the programs where states aligning with the national healthcare objectives would be of help.

On responsibilities of healthcare providers in patient satisfaction

Healthcare is a service industry revolving around diagnostics, treatment at hospitals and nursing homes, wellness, and home based care. In this end-to-end spectrum, where a significant amount of healthcare spend is self-paid, every healthcare provider needs to feel fully responsible for the delivery assured to the patient.

In the race to have effective volumes to be able to survive in a highly competitive market, one often sees a drop in value of delivery and services and that leads to an endless cycle of irate patients, lack of trust, and pressure on personnel delivering healthcare.

A conscious decision by organizations to get out of this vicious cycle by taking the required steps will go a long way in ensuring satisfaction both for the patient as well as for the healthcare professionals both asking for as well as those providing the services.

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