Dr Shakti Kumar Gupta
Medical Superintendent,
All India Institute of Medical Sciences, Dr. R P Centre for Ophthalmic Sciences, New Delhi

Paradigm Shift in Healthcare Delivery

“It is time to adopt the vision of Make in India, Digital India and present to the world a Glocal Healthcare Ecosystem.”

The Indian healthcare market is expanding at an unprecedented pace. The technology loaded health sector is competing with other similarly placed health providers across the globe. The high levels of training of Indian healthcare professionals make them a formidable force.

On the healthcare market

The global healthcare market had a turnover of USD 7 trillion in 2015. In 2016, the Indian healthcare market had a turnover of USD 110 billion and is expected to touch USD 280 billion by 2020. Healthcare delivery constitutes 65 percent of the overall Indian healthcare market. The major drivers of Indian healthcare industry are the proactive measures adopted by government such as the National Health Policy, various Pro BPL health initiatives, provision of emergency services across the country, and skill-development initiatives. Today, the Indian healthcare system is metamorphosing. In the last one decade, even though Indian healthcare has taken leaps in terms of becoming a medical tourism destination, the delivery system both public and private, continues to remain elusive to various strata of our society. With efforts to meet health targets envisioned under Millennium Development Goals getting hazy, it becomes imperative for Indian healthcare stakeholders to revisit the policy and identify any gaps in actions taken.

The National Health Policy 2017 includes a comprehensive primary healthcare package, health card for access to primary healthcare facility services anytime, anywhere, free drugs and diagnostics, free healthcare to victims of gender violence, digital intervention – tele consultation, national knowledge network, National Digital Health Authority, and introduction of electronic health records. Stress on AYUSH is also increasing. Ayurveda researchers and practitioners are working across the globe to turn India into a global hub for knowledge, research, practice, and developmental projects on traditional medicines. Thus the government is actively trying to position India as a highly preferred healthcare destination, but the demographic divide and social disparity stands in between achieving the basic tenets of accessibility and affordability in healthcare.

On vision of Indian healthcare system

Healthcare delivery in India is at cross-roads. One has to appreciate the basic fact that India as a country has its responsibility of providing universal health coverage to all. It is imperative that rural healthcare should have the topmost priority. We have to understand that resources in terms of money, manpower, and materials are limited whereas the demand for the same is increasing day by day in any healthcare set-up. The basic principle of economics has to be the guiding beacon for any healthcare delivery stretching limited means to meet unlimited ends. It is time to develop skill-centric individuals for performing various roles. Expert healthcare professionals also have the ability to present convincingly to individuals and group the evidence to support a point of and scientific interpretation of data augmenting the strengths and developmental needs of the health ecosystem in totality. This is a technology-driven era. Hence, professional experts are better placed to charter the course of successful healthcare delivery. Presently Smart hospitals and Smart healthcare is the order of the day. The concept of Smart hospital has been designed to achieve safety, clinical quality, productivity, service excellence, and optimal integration of technologies. Internet of things and Mobile Health care delivery will boost up the technology-driven healthcare. The central government of India has prepared a blueprint for the development of SMART cities in the country. With the advent of Smart cities in our country, Smart hospitals will synergize the efforts of delivery of holistic healthcare.

Hospitals of tomorrow should be IT-enabled, flexible, paperless, filmless, and green hospitals. These hospitals will be boundaryless and will aim for optimal conservation of resources. Healing architecture and aesthetic design will make hospitals more of a temple of healing than a corporate structure. India has a universal system of healthcare and it is the concurrent responsibility of both state as well as central governments to ensure affordable, accessible, and quality health coverage to the entire population. India is a country of villages and the outreach of healthcare delivery is a very challenging task. Healthcare covers not merely medical care but also all aspects of promotive and preventive care too.

It is time to think futuristic. I would flag the relevant issues of healthcare technology, accreditation, nanomedicine, robotics in healthcare, reaching out to rural populace, quality issues, and patient safety. Overall there is a huge opportunity for players from all sectors to augment the healthcare canvas of Indian scenario.

On budget allocation for the fiscal year 2017–2018

Government is doing the budget allotment of AIIMS, which is a need-based allocation and essentially there is never a dearth of resources. Respective expert groups do the planning of procurement on a long-term basis depending on the need analysis. It is relevant to understand that India’s medical device market worth is about USD 2.5 billion. The current annual growth rate for the medical device sector is more than six percent. Some innovative technologies like RFID, barcode, smart cards, dictaphones, and speech-to-text software have been the driving forces of innovations in healthcare. Innovations have made day-to-day functioning much more easy. Medical device industry has to customize themselves with disruptive innovations and contribute to the ease of delivery of healthcare.

On areas requiring government investment

Government is doing an enormous task in providing quality healthcare to citizens of our country. It has taken great initiatives to reach out to the rural population. It has rightly identified the needs of the Indian ecosystem.

The important issues are:

Improvement in emergency medical services. Government is making serious efforts to institute accident and trauma services across the region. Government has notified the National Ambulance Code, which governs the standardization of ambulances and their design parameters. The planning is to provide adequate infrastructure and training to doctors and paramedics in ALS, BLS measures. Pre-hospital care is being planned to be fast and accessible to victims and Accident Rescue Squads will be strategically located. Awareness about available EMS facilities should be publicized far and wide. Training in emergency medical services should be held at Medical colleges regularly.

Upgradation of medical colleges. It is the endeavor of government to upgrade various medical colleges. This endeavor will help quality healthcare to reach a wider population. Introduction of information technology, patient safety norms, and medical technology is gaining momentum across various healthcare delivery systems in the region. The major constraint is about training and retaining trained manpower. It is important that quality and communication find a major role in the training curriculum.

Health insurance. Health insurance is being made an integral part of healthcare delivery, more so for below poverty line (BPL). Government has initiated Rashtriya Swasthya Bima Yojana (RSBY) launched by Ministry of Labour and Employment, Government of India to provide health insurance coverage for BPL families. The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization. Government has even fixed the package rates for the hospitals for a large number of interventions. Good successful models like Yashaswini can be the guiding models for the schemes.

Smart hospitals. This is a technology-driven era; hence, professional experts are better placed to charter the course of successful healthcare delivery. Presently Smart hospitals and Smart healthcare is the order of the day. The concept of smart hospital has been designed to achieve safety, clinical quality, productivity, service excellence, and optimal integration of technologies. Internet of Things and mobile healthcare delivery will boost up the technology-driven healthcare. The central government of India has prepared a blueprint for the development of smart cities in the country. With the advent of smart cities in our country, Smart hospitals will synergize the efforts of delivery of holistic healthcare.

On the accusation of meddling with pricing policy

All countries – big or small, developed or emerging – keep taking such steps. For example, countries like Malaysia, Uganda, Jordan, and China provide 15 percent (or even higher) price preferences in public health procurement to medical devices made in their own country. This means that all technical parameters remaining the same, they will opt for a device that is made in their own country as long as it is not priced 15 percent higher than the competing imported devices. Similar provisions exist in World Bank tenders or the World Health Organization and other donor-driven projects too. The United States applies Buy American provisions under the American Recovery and Investment Act 2009 to support its domestic manufacturers. The government has rightly planned introducing PPP in the medical devices sector. First, India has a huge import dependency in medical devices, and India-made devices lose out to imported devices in public procurement due to more reliance on imported issues. It is time to give the indigenous device industry a boost. India-made goods are not to be seen as devices made by an Indian company owned by an Indian but simply as a company which is Making in India, rather than a company which is just importing and labelling a device as Made in India.

On impact of GST on healthcare industry

Goods and service tax is a major game changer and driving factor which has a potential to cover and ease up the tax planning across all the sectors in Indian economy. India’s pharmaceutical industry as of now is the third-largest as far as volume of production is concerned. As populace is persistently growing, so is the requirement for good healthcare services, which brings the growing need of more qualified personnel to fill the ever growing demand of the health sector. It is expected that GST would have a constructive effect on the healthcare industry particularly the pharma sector. It would help to consolidate the eight different types of taxes which are paid today. An amalgamation of all the taxes into one uniform tax will ease the way of doing business in the country, as well as minimize the cascading effects of manifold taxes that are applied to one product. Moreover, GST would also energize the supply chain. GST would help the pharmaceutical companies in rationalizing their supply chain; the companies would need to review their strategy and distribution networks. One more benefit likely to accrue due to GST is the reduction in the overall cost of technology. The things to watch for are how it is going to impact the lifesaving drugs and what tax planning will be done for imported devices.

On healthcare infrastructure

It is time now to move ahead and declare the objective of being a wellness nation. Healthcare delivery must not be constrained by dysfunctional physical infrastructure, poor health financing, and lack of adequate human workforce. Availability of healthcare facilities is highly skewed toward urban centers when the urban population accounts for only 28 percent of the country’s population. The remaining 72 percent has access to only one-third of the total beds available in the country. India would need a combination of innovation and regulatory reforms in order to address these challenges. Presently, it is plagued by inequitable distribution of resources both infrastructure wise and Human Resource wise. There is a huge divide between rural and urban healthcare set-up. The rural healthcare infrastructure in the country is not sufficient to meet the current population norms, according to Rural Health Statistics 2014-2015 released by the government. The figures of rural health infrastructure in tribal areas indicate that there is a shortfall of 6796 sub centers, 1267 primary health centers (PHCs), and 309 community health centers (CHCs). The bed to population ratio is very low compared to global standards. India has just 90 beds per 100,000 population against a world average of 270 beds. Government at its end is doing an incredible job of bridging the existing gap.

There is an urgent need for the government to work toward strengthening the public healthcare system in order to make healthcare available to the masses. India needs to increase percentage GDP share on healthcare expenditure to meet the challenges of availability, accessibility, affordability. We also need to strengthen our social schemes such as Jan Ausudhi, RSBY, etc. which will empower the common man. Quality is another area of concern and some time-bound steps are required from all stakeholders to curb spurious drugs manufacturing and sales. Moreover, technology can play a key role in improving the health outcomes of the country. The government needs to develop an appropriate vision to mobilize and use ICT tools in order to create outcomes. Technology can also improve transparency in the costs along with co-ordination and management of the private sector to improve the access to quality and affordable healthcare. It is time to adopt the vision of Make in India, Digital India and present to the world a Glocal Healthcare Ecosystem.

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