Dr Jayasshree S Todkkar
Laparoscopic, Gastrointestinal, and Bariatric Surgeon,
L.H. Hiranandani Hospital, Mumbai

Moving from Sickness to Wellness

In any economy, the healthcare market has a few key players, namely, government and private hospitals, medical equipment and supplies, pharmaceuticals, diagnostics, medical insurance, and upcoming technologies. Healthcare market in India is expected to reach USD 322 billion by the year 2022. It has been the fourth largest employment provider in 2017. Out of various components, hospital industry makes the largest part of the healthcare market, and it is expected to reach USD 133 billion by the year 2023. Difference between investment done by private and public sector makes Indian market different from the global market. In comparison to developed and developing nations across the globe, the share of private sector among total healthcare expenditure is the highest, i.e., 74 percent. Private sector’s contribution in China is 44 percent and in USA it is 52 percent. Over the years, private sector has emerged as a key force in improving international reputation of India. Presence of world-class hospitals and skilled medical professionals has strengthened India’s position as a preferred destination for medical tourism. We saw the growth of medical tourism by 50 percent from 2017 to 2018. Yoga, Ayurveda, and naturopathy are among other services leading to growth of medical tourism.

Over the years, we are seeing gradual shift in public awareness from communicable to non-communicable diseases. Lastly, it is believed non-communicable diseases like cancer, diabetes, and obesity are expected to comprise more than 75 percent of India’s disease burden by 2025.

On budgetary allocation in healthcare

Budgetary allocation of 2018-19 has seen rise of 13 percent over the previous year allocation. Though the rise is in absolute terms, the spend is still 1.3 percent of GDP, much lower than the global average of 6 percent. Over the years, as announced by the government, the spend needs to increase.

With only 34 percent penetration of health insurance (NHP 2018) and private insurance making about one-fourth of the pie, healthcare spends have been majorly out-of-pocket costs, i.e., about 67 percent (WHO Health Financing Profile 2017). This has led to ignorance among people in combating non-communicable diseases like diabetes and other cardiovascular ailments. Implementation of Ayushman Bharath, world’s largest national health insurance program, which will provide annual health cover of `5 lakh per family to over 10 crore poor families, will help in bringing down the out-of-pocket costs hugely. Most importantly, the focus will be on secondary and tertiary care. If properly implemented, the program would not only bring down costs but also improve productivity of people, ultimately increasing GDP of the nation.

On public private partnership

Rising income level, growing health awareness, increased incidence of lifestyle diseases, improved access to medical insurance, mismatch between demand for and supply of healthcare services and infrastructure, and shift to non-communicable diseases are pointing toward massive investment opportunities for the private sector.

However, these opportunities come with complex set of challenges. Limited availability of skilled workforce, high land and infrastructure costs, and ever-changing medical technology are a few factors increasing the cost of running a healthcare enterprise. Though social and demographic factors are favoring healthcare investment, return on investment is low compared to other business ventures. Hence, FDI-encouraging policies, tax benefits, favorable government policies, and equal participation by government will play a major role in bringing private investments in the healthcare segment. In a country like India with huge population, PPP is most important in making healthcare a success, as it increases trust and confidence among private investors. Investment largely dominated by private sector will lead to development of healthcare facilities only in urban areas and higher healthcare spends for public; hence, equal partnership of the government is needed to widen the focus.

On budgetary allocation for the fiscal year 2019-20

Medical devices play a role not only in screening, diagnosing, and treating patients but also in restoring patients to normal lives and in regularly monitoring health indicators to prevent diseases. With technological advancements, the role of medical devices is now expanding to improve quality of care across each stage of the healthcare.

As a medical service provider, it is my duty to provide best solution possible to the patients; hence, high quality of the medical devices is of highest importance to me. Like any industry, quality-price relationship holds in medical device industry as well; hence, purchase of medical devices does make a large part of the budget.

On challenges

My vision is to shift focus of Health and Family welfare from treatment of disease and sickness to prevention and wellness. Explaining the benefits of preventive care to patients is a big challenge. We see patients usually delay the treatment unless it becomes necessary.

In India, where large part of population is employed in informal sector, employer-based healthcare is not a viable solution. Insurance premium, being out-of-pocket cost, is considered a worthwhile investment. There is large middle-class population which is being ignored by private health insurers. Also, most of the insurance coverage today concentrates on treatment. Lack of right information, low insurance penetration, and out-of-pocket costs are big challenges of healthcare industry today.

Anything else you would like to tell us

Health is one of the basic requirements of a human being. Article 21 of Indian constitution mentions Right to health and medical aid to protect health of an Indian citizen. Still India is lacking in proper healthcare facilities, proper awareness, knowledge especially about non-communicable diseases and lifestyle diseases.

It is important to move focus of healthcare from sickness to wellness. There are some areas which the central and state government should look at strategically. Obesity and non – communicable diseases(NCD) particularly diabetes should be declared as serious diseases because it is affecting 3/5 in Indian population. These diseases altogether together lead to 60 percent burden on Indian healthcare economy. Prevention, early detection and proper treatment at right stage of disease can have a significant impact on reduction of cost of disease and serious complications caused by the disease. Everyone should understand that obesity is just not about higher weight, but it is having many co-morbidities like hypertension, Type II diabetes mellitus, cardio vascular diseases, osteoarthritis, sleep apnea, PCOD, infertility and many more. We are second largest country with childhood obesity; we are largest population with cardiovascular diseases below the age of 40 years; we were given warning on childhood obesity by WHO almost a decade back.

American medical association has declared obesity as a serious disease in 2010, we as experts of this field expect the Indian government to be very responsive in this matter. Till now no serious effort has been seen. 

At Maharashtra state level, we approached the health department and fortunately we were able to convince the authorities to create obesity and NCD taskforce. We shared a complete program to implement in phase wise manner. Unfortunately, even though there was good initiation not, much could happen at task force level.

As an individual expert in this area, with passion towards public health JT Obesity Solutions and JT Foundation took up this task at individual level and worked at following things. We created first in India fellowship program for obesity, nutrition and metabolism for doctors to update and equip them with knowledge to manage disease in advanced scientific manner. With help of rotary club, we took up movement to prevent childhood to public in which we created a documentary, explaining the problem. We also conducted drawing competition in around 45 schools to affectively reach population from all social economic groups. This has helped us a lot in increasing awareness among parents and children about their nutrition and importance of healthy lifestyle. We have created the chapters for the inclusion in school curriculum at primary, secondary and higher secondary level, and college level. They have been submitted to the state government education department. We are expecting their inclusion soon.

We also initiated for the first-time obesity and NCD OPDs in medical colleges, government hospitals affiliated to medical colleges (tertiary care centers) to create awareness within the doctors, staff and public within the hospital. We approached the FDA and were successful in getting calories written on the menu card.

We are also part of smart city project of Pune for nutrition and health.

What we expect from government is to collaborate with experts like us in designing the programs pertaining to this disease. Only a methodical approach and consistent efforts can save our population from this silent killer disease complex.

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