The road ahead: Challenges and innovations in India’s evolving healthcare journey

The healthcare market in India is rapidly expanding, resulting in increased revenue, skill development, and employment rates. Our strengths lie in the fact that we have a huge talent pool of medical and para-medical professionals, as well as being relatively cost effective, making it quite attractive for investors in medical tourism and research and development. Government and private funding and the growth of public-private partnerships (PPPs), improved allocation of budget funds, hand in hand with various ambitious government schemes like Ayushman Bharat, will hopefully lead to the anticipated three-fold growth in the sector to Rs 8.6 trillion (USD 133.4 billion) by 2022, as projected, and improve accessibility to healthcare in a populous nation.
Global healthcare-delivery models differ from country to country, but most developed countries have nationalized insurance schemes, or a mix of private and public insurance schemes in order to provide coverage to a large number of people. Yet, it also comes with lag times, treatment delays, as well as a high regulatory burden, entangled in red tape and bureaucracy.
The United States is struggling with their healthcare system at the moment, making it a key campaign point for candidates in their upcoming presidential elections. The Medicaid and Medicare programs are burdened with rising healthcare costs, leading to a jump in medical tourism. The US has made concerted efforts to move away from their widely debated fees-for-service model toward value-based healthcare-delivery models, in order to provide holistic care at lowered costs.
While India is transitioning toward an insurance-based delivery system, as opposed to payments made out-of pocket, it may be prudent to study the positive and negative effects and employ a model that works with our unique patient demographic and their needs.

On budgetary allocation in healthcare
This year’s budget allocated to healthcare showed focus to improve the current scenario, which in addition to setting up of medical colleges and hospitals to address shortage of medical staff, also mentioned skill development and increased focus on technology and application of artificial intelligence in the industry. The expansion of the Indradhanush National Immunization Program to include five new vaccines, as well as the renewed aim to eradicate TB by 2025, is welcome. Investment in medical devices and pharmaceuticals to be made in India should hopefully reduce costs to health seekers.

On your vision for health and family welfare
In my opinion, improvement in health and family welfare in the country has to be a goal that is worked on at the grass roots level, the crux of which lies in our medical education system. We need an increase in number of health professionals, but without compromising on the quality of skilled workers. This starts with increasing the number of seats in medical colleges, as mentioned in the government’s budget allocation this year; to reduce the shortage of facilities in rural areas and decrease the urban-rural divide in healthcare.
Incentives can be given to doctors who practice in remote areas. The allied health services need to be more robust as well. We need skill development in paramedical fields, health administration, civil and hospital planning, and social work, so that the burden on medical professionals can be alleviated. For example, with the rise of non-communicable diseases like diabetes in the country, we may look into increasing the certification of diabetic counselors or educators, who can work with patients on their lifestyle and treatment options, improve patient interaction with trained professionals, and improve compliance and follow up.

Our medical education system draws strength from the fact that young doctors get hands-on experience, owing to the sheer numbers of patients they get to see, based on a skewed doctor-patient ratio. In addition to medical skills, international exposure in soft-skills training, administration, and governance are also necessary in these changing times. The Global Association of Physicians of Indian Origin (GAPIO) has tied up with medical colleges in the country to provide medical graduates with a unique education model that exposes them to the best of both worlds. Graduates also need to be trained with the concept of standardization, accreditation, and a culture of quality that is a requisite in the current healthcare scenario, instead of learning these skills on the job. The most challenging thing is to change mindsets and attitudes in a constantly evolving healthcare-delivery landscape, where we survive only by continuously adapting.

On monitoring the quality of private healthcare
There are many factors influencing health-seeking behavior that have made patients opt for private as opposed to public healthcare, resulting in a market scenario where international and national chains of corporate hospitals have flourished. Although the inclusion of healthcare services under the Consumer Protection Act in 1986 was meant to protect patients, it led to the birth of defensive medicine.

In 2019, a draft bill stated that healthcare would be removed from the CPA but would still allow complaints of negligence and malpractice to be heard. This may have led private healthcare providers to implement protocols and procedures, which pushed the concepts of quality and standardization into practice.

In India, however, monitoring the adherence to standards remains an uphill climb. We could improve efforts toward accreditation by making it incentivized or mandated, through regulatory bodies like QCI (Quality Council of India). We could establish a national data base to determine hospital rankings on the basis of medical outcomes or quality indicators, and introduce a performance-based payment system, to popularize reporting and assimilation of administrative data. A robust health-management information system with applied healthcare analytics could lead to productive data-driven policies for quality improvement and monitoring.

On public-privtate partnership in making healthcare a success
Public-private partnerships between key players in the healthcare industry and the government could be the cornerstone for India’s progress in providing universal health coverage for citizens. Backed with capital and experience, private companies can bring trained workers and technology to the government’s patient base. This would hopefully bring about a fruitful partnership where the patient benefits with affordable, accessible, quality care. Its application to diagnostics, pathology and radiology, teaching colleges and hospitals, as well as delivery of care is far reaching.

The provision of modern technology and medical skill in regional and district levels may be life changing for rural patients who may be benefited by services that urban consumers take for granted, like reasonable turnaround times owing to operational efficiency and timely intervention owing to preventive healthcare measures available.
If we manage to establish a policy framework at the central and state levels with transparent processes, paying special attention to cost factors, with custom duties, GST requirements and price caps, timely payment schedules, quality control, talent retention and medical outcomes, then the PPP model can ensure value for money and a win-win situation for all concerned.

On areas where government should invest to make healthcare available to all
Investment in primary care in rural districts,

Tier-II and Tier-III cities would improve the availability of healthcare services to the community. Setting up of cost-efficient PHCs, focusing on immunizations, maternal and child health, and nutritional programs will bring much-needed aid, and reduce the burden on specialized centers or hospitals. Building an effective primary screening and referring system will ensure that only cases requiring specialist intervention can be forwarded to larger centers. This could lead to early diagnosis and regular follow up of patients at reasonable cost, which will be beneficial.
On policy interventions that the healthcare sector in the states needs to align with the healthcare objectives at the national level
Preventive healthcare is the need of the day. Rising healthcare costs, coupled with increased risk of non-communicable, chronic diseases, preventive lifestyle measures, and early intervention could lead to better prognosis for patients.

State and central governments need to align themselves with a common goal and judiciously allocate resources. Some initiatives are better put through trials in small controlled settings in the states or at district levels and scaled up only after empirical evidence of efficiency. In order to scale up successfully, representatives at both state and national levels have to be aware of market demands, the need to evolve during implementation, as well as the response of patients and providers to the systems being introduced. A cookie-cutter model rarely works in a diverse market population like India, and requires policy makers to adapt dynamically in a complex environment.