Debrishi Chatterjee
Assistant Superintendent
Purulia Government Medical College & Hospital, Dept. of Health & Family Welfare, Govt. of West Bengal

Transforming Indian Healthcare For Enhanced Value Delivery And Leadership

The times are changing for healthcare. Needs of the business of medicine are undergoing huge transformations in the current-day scenario. The days of business as usual are coming to a halt. Around the cosmos, healthcare systems of almost every country are faced with several problems, ranging from rising healthcare delivery costs to variance in quality. The best brains in healthcare management are trying to fix the bugs by enforcing several strategies – reducing fallacies, enforcing standard treatment guidelines, implementing electronic health records, and such other measures.

On views on the healthcare market in India
Healthcare has become one of India’s largest sectors – both in terms of revenue and employment. Healthcare comprises hospitals, medical devices, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment, though medical tourism and insurance sectors in healthcare have a wide scope for further development.

Indian healthcare delivery system is categorized into two major components – public and private. The government, i.e., public healthcare system, comprises of a hierarchical health system starting from the PHCs to the medical colleges. The private sector provides majority of secondary, tertiary, and quaternary care institutions with major concentration in metros, Tier-I, and Tier-II cities.

India is cost-competitive as compared to its peers in Asia and Western countries. The cost of surgery in India is about one-tenth of that in the US or Western Europe. India ranks 145th among 195 countries in terms of quality and accessibility of healthcare. The healthcare market can increase three-fold to Rs 8.6 trillion by 2022, estimates Indian Healthcare Industry Report, January 2020.

On budgetary allocation in healthcare
There is a significant scope for enhancing healthcare services, considering that healthcare spending as a percentage of gross domestic product (GDP) is rising. The Government of India is planning to increase public health spending to 2.5 percent of the country’s GDP by 2025. The healthcare allocation in the Union Budget 2020-21 is just a modest increase of 5.7 percent, and falls short of the target of spending 2.5 percent of GDP on healthcare, experts note as per the budgetary reports of 2020.

Health insurance is gaining momentum in India. Gross direct-premium income underwritten by health insurance grew 18.2 percent Y-o-Y to Rs 24,864.01 crore (USD 3.56 billion) in FY20, states Indian Healthcare Industry Report, January 2020.

To achieve our objectives in healthcare, the government should scale up to spend at least 5 percent of GDP on healthcare. The government initiatives and the greater political will toward improving healthcare can ultimately make a significant impact in healthcare in the current scenario.

On vision for health and family welfare and the challenges you faced while implementing health services
My vision for health and family welfare is aligned with the vision of the MoHFW, Government of India, which comprehensively may be summed up in stating that we should aim for affordable and accessible healthcare for all. This objective must be fulfilled by giving priorities to preventive and promotive healthcare and enhancement of public health initiatives, targeted at various levels of the population. The other major focus is to provide quality health services at all levels of care at an effective cost that may be borne by universal health-coverage policies. Ayushmaan Bharat is a commendable initiative in this direction.

Multiple challenges surface while implementing health services. In government set ups, the patient loads are huge in comparison to the available beds; hence, the system is always running in a burdened state. The lack of trained manpower, mostly the specialist doctors, adds up to the misery. The government’s initiative for setting up medical colleges in every district of all states is a great game changer. Initially, the proposal may face some difficulties with inadequate number of medical educators, but once the plan starts to roll and we start scaling up the production of doctors, we might be able to mitigate the shortage to a great extent.

Various skill-development initiatives like Skill India are also providing us with the additional technical manpower for the healthcare system. The escalation of health insurance reach is also a major factor, and the mindset of the Indian masses in regard to health insurance enrolment is also a stumbling block, which we need to overcome.

On monitoring the quality of private healthcare
The spectrum of quality within the private providers is quite varied. Large networks are digitally enabled to monitor clinical-excellence parameters and create structures and processes for the JCI (Joint Commission International), which is considered a gold standard for healthcare accreditation and NABH certifications.

In the absence of a clear categorization of hospitals, the 10-bedded clinic, a 50-bedded nursing home, and a 1000-bedded hospital are all seen through the same prism. There is no comprehensive monitoring mechanism that enables patients to compare clinical outcomes. Consequently, the bedrock of quality healthcare delivery, i.e., clinical outcomes and patient experience, remains a nebulous area. However, if we start maintaining a national database of major quality indicators, and rank the existing private hospitals on the basis of these, the process would be more rational, scientific, and transparent. With the advent of advanced hospital management information system with applied healthcare analytics, we could make better decisions toward the areas of focus from quality perspective.

In addition, the steps taken by IRDAI, making pre-accreditation NABH mandatory for all private hospitals for insurance empanelment and settlement, would augment the quality of private hospitals to some extent. Introduction of a performance-based payment system can further accelerate initiatives in the sector.

On importance of public-private partnership in making healthcare a success
PPP models are the need of the hour. In several states like West Bengal, Maharashtra, and Bihar, many kinds of services have already been outsourced and contracted through PPPs. The services provided under PPPs range from diagnostic services (digitized radiology, CT scan, MRI, pathology, and biochemistry), dialysis services, supportive services like diet, security, and waste collection.

On areas where government should invest
The prime focus of the government investment always should be public and preventive healthcare to boost our health system. Establishment of a greater number of hospitals in Tier-II and Tier-III cities, targeting establishment of a medical college hospital in every sub division, focusing on services toward reduction of maternal and infant mortality rates, working toward augmentation of drinking water, sanitation, and hygiene are other major focus areas of investment. The government should also invest in recruiting specialized health and hospital managers, and in their capacity building for managing the national health programs and the government health systems from the primary to the tertiary levels.

Outlook
There cannot be a perfect cure for Indian healthcare as a whole. We need to constantly keep on developing strategies and test them in various states segment-wise, and address the issues locally first and, if found suitable, it can be applied on a widespread basis to all states. Deployment of well-trained management staff at all levels in healthcare can be a panacea for management loopholes in the health system. In addition, we must focus on quality management in healthcare, based on major indicators and implementation of Lean, Kaizen, and Six Sigma methodologies. The health-seeking behavior of the population also needs to be studied deeply before arriving at solutions. The penetration of health insurance through public and private players needs to be escalated at a massive level to cover costs.

Summarily, through strategized systematic and rational methods in the backdrop of sincere political intent, the healthcare system of India can reach an optimum level and become a leadership case for the world.

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