Dr Hem Chandra
Vice- Chancellor,
HNB Uttarakhand Medical Education University

Healthcare Market In Present Scenario

For the healthcare sector in the 21st century, the stakeholders around the globe are looking for quality of care along with the best outcomes. Innovative and cost-effective ways should be adopted to deliver patient-centered, technology-enabled smart healthcare. Opportunity to enter the market is ripe but India spends only 4.69 percent of total GDP on healthcare services (whereas the US spends 17.9 percent) out of which government spends 1.41 percent and private sector spends 3.48 percent of GDP.

According to WHO, this figure should be raised to 3.5 percent (excluding private sector) thus meeting the requirement. India’s staggering population lives in rural areas where there is limited or no access to hospitals and clinics. They can be a subject of harm in the hands of quacks who mislead the poor and maltreat them in name of medicine and cure. More often rural population is dependent on alternative medical sources or government aided programs. This needs to be rectified.

On budgetary allocation in healthcare financing

India spends 4.69 percent of total GDP in healthcare.  Whereas government spends 1.41 percent and private spends 3.48 percent of GDP. The government spends healthcare financing should be raised a minimum 3.5 percent excluding the private healthcare financing thus meeting the requirement of WHO. A 0.23 percentage-point decline over 2017-18 in the Union Budget’s share of funding to the Human Resource Development (HRD) ministry, making it the lowest since 2014-15; a 7 percent cut in allocation for the Swachh Bharat Mission. Budget from 2017-18’s revised estimates.

National Health Protection Scheme is the latest avatar of the Rashtriya Swasthya Suraksha Yojana (RSSY), which was previously the Rashtriya Swasthya Bima Yojana (RSBY) under the labor ministry. There has only been a 2.7 percent increase in allocations to the health sector, from `53,198 crore in 2017-18 (revised estimates) to `54,667 crore (Budget estimate). The government has allocated `6400 crore for the Pradhan Mantri Jan Arogya Yojana (PMJAY) for 2019-20. PMJAY is known popularly as Ayushman Bharat.

On planned budgetary allocation for the fiscal year 2018-19 and proportion allotted for procurement of medical equipment and devices

My previous employer, the Sanjay Gandhi Post Graduate Institute of Medical Sciences (S.G.P.G.I.M.S.), Lucknow, Uttar Pradesh, India a pioneer Autonomous Medical Institution (as deemed university by Act of  U.P. assembly) and tertiary care super specialty hospital is known for using  modern and innovative management techniques. The funding of the institute is done by the state government. The planned budgetary allocation for the fiscal year 2018-19 for the institute is `71,022.40 lakhs (revenue) and `13,300 lakhs (capital) making total `84,322.40 lakhs. The budget allotted for procurement of medical equipment and devices is `7300 lakhs (8.65 percent) which includes equipment for the newly established apex trauma center and tertiary care cancer center. Presently I had joined as Vice- Chancellor, HN Bahuguna Uttarakhand Medical Education University, Dehradun in Sept 2018, which is an affiliating university primarily. Therefore fraction of amount budgetary allocation has been done.

On vision for health and family welfare and challenges faced while implementing health services

To establish the most effective and efficient healthcare delivery system with a sustainable approach and simultaneously maintaining the highest standards of quality based services shall be the vision statement of health and family welfare. Healthcare organizations are continually battling conflicting priorities wherein collaborating hospitals’ own policy with external services, the financial challenges, patient safety, patient satisfaction, hospital security, compliance with regulatory standards and fulfilling the demand and supply of health services are the most common challenges faced during implementation of health services.

On private healthcare monitoring

The private medical sector in India remains the primary source of healthcare for 70 percent of households in urban areas and 63 percent of households in rural areas. Healthcare generally consists of hospital activities, medical and dental practice activities, and other human health activities. The last class involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, patient advocates, or other allied health professions.

The general perception about private healthcare system is that their sole purpose is to generate money. This perception is based on massive exploitation done by several private healthcare chains on the common public. Hence, it is of utmost importance to have a proper nationwide integrated private healthcare monitoring system which can prevent such large scale exploitation. This system will have a responsibility to check and assess the quality of all healthcare services, checking the infrastructure of the centers, verifying the billing methodology, and getting feedback from both the patients and the service provider.

The huge extent of private healthcare prevents such monitoring system to dependent on manual intervention. Hence such kind of system has to be technology driven with manual supervision on the system. For example, it can be mandated for the bills generated by these centers to be valid for payment until they are verified by an online system. That online system can do checks on the services and its charges, and if there is any overcharging done that bill can be canceled or the centers could ask for the reasons for such high rates.

Further quality of services can be managed by placing feedback devices in the centers where patient or patient’s caretaker is free to report any issue with the center along with it can also be mandated for these centers to maintain an e-diagnosis which will contain all records of medications, procedures etc done with the patient. That e-diagnosis can be checked on the online system to red-flag any wrong medication or procedure being done against the disease and update it to the center.

Likewise, many other ways can be devised to ease the monitoring and causing minimum interference with the daily work of those centers, thereby improving the quality of service of those centers.

On importance of is public-private partnership in the success of the healthcare sector

Public-private partnerships (PPPs) have been acknowledged for their role and contribution by enabling the government to collaborate with the private sector in pooling resources to improve the efficiency of services thereby also providing them the ultimate supervision. Various successful projects have been initiated through central and state governments that have successfully helped in improving the healthcare sector like the following:

Awareness programs: Central and state governments and international agencies have partnered with NGOs to conduct awareness programs in various fields, specifically for HIV-AIDS – family welfare, MCH, disasters preparedness;

Medical interventional services: Conduct family planning clinics, HIV testing and counseling services, MCH, provide primary and secondary curative services; and

Contracting for maintenance services: Cleaning and maintenance of the buildings, security, waste management, laundry, catering, immunization, counseling, blood bank, blood donation camps, eye camps, and allied services.

On areas where government should invest to make healthcare available to everyone

India is undergoing epidemiological and demographic transition, thus making the domain of public health very dynamic. Population burden further complicates the situation. The extensive and planned integration of information technology is of utmost importance for proper implementation and regulation of health policies, revolutionizing school health programs, urban and rural planning for basic healthcare facilities reach the grass root level, promote participation of public volunteers in spreading health education and making the population aware of facilities offered by the government.

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

Our strength and at the same time challenge of governance in health is the distribution of responsibility between the center and the states. Better assistance to states should be provided to develop state-specific strategic plans, through the active involvement of local self-government and through community-based monitoring (CBM) of health outputs. Panchayats should be strengthened to play an enhanced role at different levels. There is need of appropriate distribution of doctors, paramedics, and other staff, especially at borders and other sensitive and remote areas. Human resource management in the healthcare sector should be dealt with by senior/experienced persons in public health management cadre.

Information technology (IT) must be integrated into the healthcare sector effectively and efficiently and all the staff related to healthcare must be trained in utilizing information technology according to their work. Grievance redressal systems must be better implemented especially at the grass root level. The legal framework must be improved to check and control flaws in the implementation of health programs.

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