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CONTROVERSIES IN MEDICINE
Year : 2020  |  Volume : 1  |  Issue : 2  |  Page : 129-132

Re-imagining private healthcare in India


Chairman and Managing Director, Medanta-The Medicity, Gurugram, Haryana, India

Date of Submission08-Oct-2020
Date of Decision09-Oct-2020
Date of Acceptance10-Oct-2020
Date of Web Publication15-Dec-2020

Correspondence Address:
Prof. Naresh Trehan
Medanta . The Medicity, Sector 38, Gurugram - 122 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_173_20

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How to cite this article:
Trehan N. Re-imagining private healthcare in India. J Med Evid 2020;1:129-32

How to cite this URL:
Trehan N. Re-imagining private healthcare in India. J Med Evid [serial online] 2020 [cited 2021 Apr 13];1:129-32. Available from: http://www.journaljme.org/text.asp?2020/1/2/129/303562



The present article is written from a very interesting vantage point: Private healthcare in India is still relatively young and therefore malleable. It commenced to scale about two decades ago. While that's a long period of time, it is still early mid-life for this sector given its position of impending inflection, actualisation and then gaining of maturity. Overall, the situation and circumstance are fluid because the government with robust measures on public health increasingly seeks to co-opt private healthcare providers and private healthcare providers seek to co-create the aspirational healthcare ecosystem with the government. At the same time, unforeseen dynamics like the COVID-19 situation, chronic legacy issues, and the disruptive, still evolving interplay of technologies and applications, demographic changes and socioeconomic vectors, all add to the mix. Amidst this ferment of emerging and forming contours, the scope and scale of private healthcare in India must be defined and must be realised with vision, with compassion and with a higher ambition which creates enduring value for all stakeholders. Moreover, this must be seen as within and closely interlinked with the overall healthcare imperatives of this country.

According to the National Sample Survey Organisation (NSSO), the private sector accounts for 'most of the health expenditures in the country'. According to NSSO, 79% of people in cities and 71% of people in villages visit private institutions for healthcare.[1] This is due to a multiplicity of factors ranging from missing links in government-owned healthcare facilities to the ubiquitous nature of what passes as private healthcare. At the same time, the plurality of private health sector must be emphasised upon. The private sector is not a homogeneous entity. It has both formal and informal providers as well as for-profit and not-for-profit entities under it. The non-corporate private sector comprises single-doctor dispensaries, 2–10-bed nursing homes and medium-sized facilities. In addition, India has the facilities of the recognised traditional systems of medicine. Meanwhile, the formal sector comprises large corporate hospitals, diagnostics chains and stand-alone superspeciality facilities. There are very less comprehensive data available on the size and composition of the private sector. In 2005, the National Commission on Macroeconomics and Health had done some estimates.[2] There is a PwC report from 2014 on estimates of private sector and public sector in India.[3] What is clear is that private sector is the bedrock of our health infrastructure and will become even more vital. Within the ecosystem of private healthcare providers, disproportionately large healthcare services are delivered by the private sector in India. Therefore, the role of private healthcare providers is key to the health of India and its public health ambitions.

Hence, it is essential to see healthcare delivery overall and in a more comprehensive manner because public and private are interlinked, interdependent and melded to a very large extent. At the same time, the present and the future, both demand an approach in unison. Our focus must be to view healthcare as a key national imperative. We must optimise all aspects and all players in it and must create synergies of collaboration, partnership and mutual complements if we are to realise our goal which is also our moral duty. The forces manifesting are tectonic and within these lies negotiation of the best and most appropriate ingenuine ideas for India.

Consider the fact that by 2050, India's population is expected to reach 1.7 billion people. Growth of the Indian population and transition of its demography will need leapfrogging in healthcare delivery including transformation of public healthcare system. The demographic and epidemiology profile of India will witness a change. Geriatric population is expected to grow to 14% (from 4% at present) with geriatric specialised services such as dementia, nutritional services and home care services rising in demand. This shift in demographic patterns and lifestyle trends will necessitate preventive healthcare to reduce the cost of healthcare spend. Moreover, nearly 51% of India's population is expected to live in cities by 2050. It is therefore expected to accelerate the use of technology innovations such as mobile health devices, technology integration with healthcare data and telemedicine strategies which could reduce the burden from the health system while trying to boost healthier lives, reduce disabilities and increase life expectancy. This trend will continue to evolve and a future will emerge where hopefully chronic diseases are things of the past, patient dependency on public healthcare systems is minimal and more preventive care is sought for, life-threatening diseases such as tuberculosis, cancer or AIDS are cured and people lead healthy lives post treatment.

In conjunction, the private healthcare is evangelising investment in research and development in concert with the government to propel innovations in drugs and improve medical devices. A strong digital infrastructure with IoT integration across personal devices, hospitals and public healthcare databases is gaining steam to spur efficient growth. Healthcare Big Data will soon be available as healthcare systems in India will be digitised and patient data standardised and interoperable. A wide range of medical and healthcare functions, including clinical diagnosis, decision support, disease surveillance and population health management, would be possible through predictive analysis facilitating better preparedness for addressing the onset of disease burden. In private healthcare especially, the core healthcare pillars in India are expected to transition to a care delivery model which is more personalised and focused on preventive and predictive healthcare rather than the reactive and curative care as at present.

Advancement of emerging technologies is witnessed in the form of brain–computer interfaces, nanorobots, gene manipulation, robotic surgery, synthetic organs, organ cloning, individualised drugs and bionic body parts across the developed world. Many of these technology innovations are here to stay and will be adapted in India. A more equitable healthcare delivery system is expected to be established, making healthcare access faster, cheaper and better for all income levels. Explosive growth in mobile devices and rising Internet penetration will drive transformation and the healthcare sector will reap the benefits of a digitally connected India. By 2050, we can expect to see a future of connected devices, wearable both invasive and non-invasive sensors such as biomarkers, electronic tattoos, Bluetooth-enabled implants, and other sensors that track our vital signs, organ health monitoring that will change the modes of how and when the care is received. These advancements coupled with Big Data analytics and artificial intelligence (AI) will improve health and life experiences as part of a Human Operating System (Human OS) a platform for innovation. Several private players interconnecting tech with health are creating a distinct trend in transformational breakthroughs with personalised, predictive, preventative and participatory drugs, paving the way to improve care all at an affordable and manageable cost. These breakthroughs in technologies used to discover new drugs, to the processes used to clinically evaluate them, will drive the Indian pharmaceutical industry in the next few decades. Private healthcare is at the heart of this.

In the upcoming days, it is very much expected that vaccines for major infectious killers in India such as malaria and AIDS will be widely available and distributed, and human genome engineering platform will pave the way for the modification of disease-causing genes in humans, leading to the prevention of ailments translating into actionable guidelines for the use of an array of drugs that will lead to the widespread use of pre-prescription genotyping. Advancement in proactive medicines that rely on continuous stratification of 'at-risk' individuals should be seen in India, ensuring preventive action even at public healthcare systems. Low-cost bioelectronic devices that could be implanted inside the body, must be developed and programmed wirelessly to release doses of drugs at the right time, particularly focusing on chronic ailments such as diabetes, cancer, stroke and cardiovascular diseases. Regenerative medicine cuts through the ethics debate by helping everyone gain access to cloneable organs. Nanobots will be able to assess and fix us from within. On delivery of this care, medical data from wearable and other sensors will allow the doctors and health centres to interact with the patients universally, diagnose problems and offer personalised services such as customised drugs and device use for the patient and utilisation of the Human OS.

India can and will be the centre of frugal innovation to develop affordable solutions and products such as wearable organs through three-dimensional (3D) printing. Customisation in healthcare services will be delivered by 3D printing and fuelled by the insights of the data from the Human OS. Print your organ; print your medicine will drive the future of care. This sounds fantastical, but this will be a reality in a few decades. Care delivery will transition from hospital, clinic and doctor centric to self – self-diagnostics, self-monitoring and self-medication for majority of Indian cities and urban population. NDHM has paved this. The rural parts of India will be well connected digitally and point of service available within home premises for primary and secondary healthcare services.[4] The wave of future in healthcare innovations across healthcare organisations is already deploying mobile technology, mobile devices, wearable technology, remote monitoring, telemedicine and information-sharing platforms. All are transforming healthcare to solve some of the problems in the healthcare sector today. And in the foreseeable future, drones, robots and AI will breakthrough in healthcare that are performed by humans, to reduce variability, cost and error while providing 'quality' healthcare system.

The intrinsic demand for healthcare services continues to rise in India. Hence, the future of the health is a combination of technology and traditional approach – a hybrid model. With the growing demand, more and more healthcare programmes will be organised in future by the public as well as private organisations. These healthcare programmes include regular health check-ups, immunity booster programme, promotion of food supply and proper nutrition, affordable healthcare services and family planning awareness programmes. The Internet is a tool that will do justice to how well the technologies are absorbed in the healthcare overall. There is a sign of several revolutions and more and more space for innovative ideas. At the core, the doctor–patient culture must stand preserved and unharmed. I would like to see it becomes closer and knitted with the hybrid model. The human touch and technological advancement should give it a shape that blends comfort and quality. Solving and making things simpler with integrated technology, contributing share of easing out the healthcare sector challenges. This holds prospects of optimistic vision and the need for better management of chronic illnesses, medical records and prescription management and creating a continuum of care through better communication between patient and doctor. A hybrid model is the call of the hour, where the patients and doctors are able to connect better, process with quality and provide solutions to problems and challenges of the healthcare sector in the country. Private healthcare providers are already on this path.

What should the government do to enable private healthcare reach its full potential? Among the several things, the government should be increasingly proactive in setting up hospitals, clinics and other such healthcare facilities. It can do so by reverse auctioning land, reducing red tape. The subject of 'health' should also be moved from the State to the Concurrent List. In the urban areas, large hospitals should be set up on a Public–Private Partnership (PPP) basis. A 'Build–Own–Operate–Transfer' model would undoubtedly be beneficial to all stakeholders. In addition to this, however, the private sector players should also commit a certain, flexible percentage of their entire treatment to the Ayushman Bharat schemes and provide services at low fees to the poor.

On the whole, an enabling structure must be put in place and protected for the healthcare sector.

The government also needs to bring in greater transparency and compliance to boost the quality of healthcare. An accreditation process needs to be implemented to ratify services across all public and private nursing homes/hospitals. The government must grant greater autonomy to the private partners at all stages (planning, execution as well as assessment). Only then can an optimal outcome from the PPP initiatives be expected. Second, it is a good time to let efficient private players in the healthcare sector grow and enhance their efficiency levels. Only hospitals above a certain standard of operation can hope for accreditation by the Joint Commission International/Joint Commission for the Accreditation of Hospitals and Healthcare Organizations. These standards are based on all health-related criteria, including quality of patient care, accessibility and personal and equipment hygiene. Collaboration with foreign entities, through foreign direct investment (FDI) and other forms of collaborations, would have a crucial role in increasing much-needed healthcare infrastructure in India. This segment will cater to domestic demand on the one hand and medical service exports on the other. Third, increased instances of medical tourism and lack of portability of medical insurance for foreign patients have forced Indian private players either to enter into tie-ups with foreign insurance players or actively advertise in various media in India and abroad. The deepening of the health insurance schemes offered jointly by Indian and foreign players is another example of market-based solutions on this front. The insurance sector needs reform so that India can leverage its comparative advantage in medical tourism and thereby attract greater levels of FDI.

Some of the challenges of our healthcare system are lack of awareness, lack of access, workforce shortages and lack of affordability. Underfunded healthcare systems in many cases are inefficiently run. For India's total population of 130 crores, the country only has '1.9 million hospital beds, 95,000 intensive care unit beds and 48,000 ventilators'.[5] Such deep-rooted and extensive issues make India frightfully vulnerable to any healthcare crisis, like the one we are currently experiencing. While the country deals with the COVID-19 outbreak, it is also important to think about how the healthcare system can be made stronger, more resilient and reliable. The doctor deficit that India is facing has to be bridged and the economy will get a much-needed boost from an almost untapped market.

We need to further strengthen biomedical research and invest in cutting edge 'made in India' health technologies. We must make it easier for health technology start-ups by giving them tax relief. Scientific innovation is the key. The COVID-19 pandemic has presented India with an opportunity. The Indian healthcare system can go through a radical overhauling, where it can be more sustainable as well as responsive. On the whole, building healthcare infrastructure should be the ultimate goal. If the government cannot do so directly, it should create a policy environment to allow private players to participate. Building such infrastructure will also contribute to creating employment and can also be a destination for FDI. Although the pandemic has put pressure on organisations currently, it is also motivation for the healthcare industry to deep dive into the existing challenges and be aware of the available solutions, with an agility to adapt quickly.

The healthcare as a whole, not just private healthcare, in future will connect, remind, prepare, inform and empower the patient in their healthcare journey. A futuristic integrated healthcare platform weaves its way right from the start of a patient's journey when they identify and evaluate their problem, followed by diagnosis, treatment, hospitalisation, medical insurance, follow-up and chronic disease management if required. These could be signposts while developing the movement for a new kind of health system in India, which ensures universal healthcare based on health rights for all. It may be owed to ourselves, and to coming generations of Indians, to draw lessons from this once-in-a-century pandemic, and do our best to act upon hard-earned lessons as such a turning point experience may not return again in our lifetimes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
In Post-COVID-19 World, India Must Boost Healthcare by Simplifying Laws, Encouraging Private Investment. Available from: https://www.firstpost.com/health/in-post-covid-19-world-india-must-boost-healthcare-by-simplifying-laws-encouraging-private-investment-8592151.html.  Back to cited text no. 1
    
2.
Macroeconomics and Health: Investing in Health for Economic Development. Available from: http://whqlibdoc.who.int/publications/2001/924154550x.pdf.  Back to cited text no. 2
    
3.
Strengthening Public Financial Management – PwC. Available from: https://www.pwc.in/assets/pdfs/pf/strengthening-public-financial-management.pdf.  Back to cited text no. 3
    
4.
India in 2050: Future of Health. Available from: https://www.intellecap.com/india-in-2050-future-of-health/.  Back to cited text no. 4
    
5.
COVID-19 in India: State-Wise Estimates of Current Hospital Beds, Intensive Care Unit (ICU) Beds and Ventilators. Available from: https://cddep.org/wp-content/uploads/2020/04/State-wise-estimates-of-current-beds-and-ventilators_20Apr2020.pdf.  Back to cited text no. 5
    




 

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