A quick look at the map of the world and you will see a healthcare crisis across the globe. These challenges can be broadly divided into accessibility, affordability, and quality. Most of the countries have interplay of all three in varying proportions. In the west, the major challenge is affordability and in Africa it is accessibility and affordability. In India also, the major challenge is accessibility. Once the problem of accessibility is answered, the next challenge will be affordability combined with quality.
That being said, healthcare in India is currently undergoing a major transformation trying to solve all these problems. It has seen a lot of interest from private equity investors and many hospitals chains getting listed on the stock exchange. Healthcare is expected to almost double from USD 145 billion to USD 280 billion in 2025. There is increased organization within the sector as evidenced by emergence of hospitals chains, diagnostic labs, penetration of private and government insurances, and emphasis on quality with NABH and JCI accreditations. It is definitely an exciting time to be a part of healthcare in India.
On budgetary allocation in healthcare
Healthcare has essentially been a neglected issue in India. With only 1 percent of the GDP in healthcare, India is way behind most countries in the world. Modicare is the ambitious government project that aims to provide healthcare to almost 10.5 crore families. This is certainly a step in the right direction but the major challenge will be implementation and sustainability. If this is implemented correctly, this has the potential to change the entire landscape in the country. It is important to remember, that a healthy nation is a wealthy nation.
On monitoring the quality of private healthcare
There is no doubt that India has some of the best doctors in the world. However, there is a difference in quality of healthcare across the country and sometimes even within the same neighborhood. Patients would come from far and wide for consultation and their diagnosis and treatments were a complete mess. More than doctors, the ancillary staff lacked basic education and most had learned on the job.
The government and insurances companies’ emphasis on NABH accreditation is a step in the right direction. Getting these accreditations requires various permissions and implementation of various checks and balances to reduce errors in the hospital. This requires a significant investment, both in terms of finance and personnel, but leads to an increase in the quality of healthcare. This means better employee satisfaction, improved systems, and process finally leading to improved patient care. Given the commitment, this will help identify institutions that care for quality and patient outcomes. It is important that NABH and other such quality metrics be introduced in healthcare. But they will only be adopted if they are linked to payments and reimbursements, for example tracking surgical infections, hospital acquired infections, and door-to-balloon times.
The Medical Council should also consider recertification exams and CMEs as a requirement for maintaining the medical license for both medical and paramedical staff. When a patient is admitted, the doctor spends 15–20 minutes reviewing the patient every day. The ancillary staff delivers the rest of the care, so it is important that their quality also be kept in check. One thing to remember is that quality and affordability do not always go hand-in-hand. The increased expenses undertaken to improve quality, will have to be passed to the patient in the end increasing the cost of care. To give an example, most quality driven healthcare institutions will find it impossible to deliver healthcare at the proposed rates under Modicare/Ayushman Bharat.
On importance of PPP in making healthcare a success
Against the WHO recommendation of 2.9, India has 1.84 beds per 1000 people. The private sector caters to 90 percent of hospitals, 80 percent of doctors, and 60 percent of inpatients beds. However, healthcare costs in the private sector can become prohibitive for a part of society. PPP has the ability to provide the synergy required for solving some of these healthcare challenges. This model has been working successfully in various states like Karnataka, West Bengal, Andhra Pradesh, and Tamil Nadu. This has many benefits like improved access to healthcare, higher accountability, better quality, and reduction in out-of-pocket expenses.