• What are your views on the Healthcare market in India vis-à-vis the global market?
Indian Healthcare industry is booming and will grow at a CAGR of around 20 percent in next 5 years, due to high level of social awareness and increasing expenditure undertaken by public / private players in the segment. The size of Indian Healthcare industry is expected to touch USD 160 billion by the end of this year, reaching around USD 280 billion by 2020. The global scenario too has been moving well aligned with these figures, with a steep rise in health care spending, ranging from 2.5 percent to 7.5 percent between 2015 and 2020 in major countries around the world. The global health care sector has been trending around, on rising demand and associated spending, fueled by an aging population. The growing prevalence of chronic diseases has led to development of costly clinical innovations; increasing patient awareness and knowledge, ultimately leading towards never ending expectations.
Though private sector has been playing a major role in India's healthcare industry, that accounts for almost 75 percent of the country’s total healthcare expenditure, public sector too has been picking up its pace in the segment, whereby Government of India has created the National Health Mission (NHM) for providing effective healthcare to both the urban and rural population.
Telemedicine and IOT integration with M2M is a fast-emerging trend worldwide and India is gearing up to maintain its pace in this domain; with major hospitals adopting telemedicine services and public-private partnerships (PPP).
Presence of world-class hospitals and skilled medical professionals has strengthened India’s position as a preferred destination for medical tourism and Government of India aims to develop India as a global healthcare hub. The Government is also providing policy support in the form of reduced excise and customs duty, and exemption in service tax, to support growth in healthcare.
• Your thoughts on budgetary allocation in healthcare?
Budget 2017 has laid emphasis on developing the in-house human assets for the healthcare segment, whereby two new AIIMS hospitals will be set up in Jharkhand and Gujarat, along with creation of additional 25,000 medical post graduate seats under DNB (Diplomate National Board) courses in many of the hospitals across the country.
Government has also introduced Aadhar cards embedded with health data for senior citizens in order to record their health conditions that will be linked up with couple of upcoming LIC programs.
Furthermore, FM has outlined an action plan to eliminate kala-azar and filariasis diseases by 2017-18, leprosy by 2018, and measles by 2020 and tuberculosis by 2025, under the National Vector Borne Disease Control Programme (NVBDCP).
Government will be coming up with new set of rules, regarding medical devices that will be internationally harmonized, which will attract investment into this sector. This will reduce the cost of such devices and more employment will be generated domestically. International harmonization of the medical device market will help Indian medical device companies compete with global players as our products will be harmonized with European and American standards. This will definitely help Indian products find new export markets.
• What is your vision for Health and Family Welfare? What were the challenges you faced while implementing health services?
Increased life expectancy and improved physical quality of life of people are the key health parameters for any country. Attaining the highest level of physical, mental and spiritual health for our people, so that they effectively contribute towards the development of our nation, is my vision. The challenges what we face today includes the provision of quality health care services, supported by preventive and curative mechanisms. Improving maternal and child health has been taken up on priority by the present government, with special focus on reducing the IMR and MMR.
While the private sector in the healthcare industry is a better provider of quality medical help, it is also expensive and restricted to the urban well off population areas. The major challenge lies in bridging the gap between the “rich-poor” and the “rural-urban” divide, so that majority of our people do have access to quality healthcare.
• Today, there are over 20 international healthcare brands in India with several corporate hospitals. However, a large section of the ‘private healthcare delivery segment’ is scattered and quality of medical care continues to remain a matter of concern. What is your perspective on monitoring the quality of private healthcare?
Non-availability of effective diagnostic tools and increasing reluctance of qualified and experienced healthcare professionals to practice in under-equipped and financially less lucrative public healthcare system is becoming a big challenge. Furthermore, absence of doctors and dissatisfaction with quality standards at state-run / public hospitals is a major cause of shift towards private healthcare centers, which has gained a majority stake in the Indian healthcare system.
Most healthcare expenses are paid out of pocket by patients and their families, rather than through insurance. Penetration of health insurance in India is too low by international standards. Also private health insurance schemes, which constitute the bulk of insurance schemes, availed by the population, do not cover costs of consultation or medication. Only hospitalization and associated expenses are covered. Malpractices like inflated hospital bills, providing sub-standard medical care and a crass commercial market-oriented model substituting an empathetic outlook towards patient’s problems have lowered the standards and image of the private healthcare sector in the country.
The Clinical Establishments (Registration and Regulation) Act 2010 (CEA), the law in existence to regulate private healthcare establishments, has prescribed minimum standards for personnel conduct and suggested standard operating protocols. However, an emphasis on compliance rather than enforcing punitive action has led to the Act failing to check the large-scale proliferation of corrupt practices by private medical players.
• How important is Public Private Partnership in making healthcare a success?
There are couple of major thrust areas, where a Public-Private Partnership could be evolved as a synergistic model to combine both the social objectives of universal healthcare access and the business objective of running a profitable healthcare facility.
Development and strengthening of healthcare infrastructure that is evenly distributed geographically and at all levels of healthcare will provide a strong foundation, followed by its proper management with respect to its technical efficiency, operational economy and quality.
Gradually, we can focus on capacity building for formal, informal and continuing education of professional, para-professional and ancillary staff engaged in the delivery of healthcare, which will provide a continual support in strengthening the macro healthcare system in the country. Finance being the lifeline for any major project, creation of voluntary as well as mandated third-party financing mechanisms will ensure the proper smooth flow of processes across the system. Development of an efficient supply chain for medical supplies and sundries at the point of care units, will restore confidence in the minds of general public at large.
A fruitful partnership between private players and government enterprises can improve healthcare service delivery capabilities and ensure wider access to affordable healthcare for weak sections of the population. While the public sector can provide benefits of scale and large-scale funding, the private sector can bring to the table innovative clinical practices, private investment and an efficient business model. It has normally been seen that the public private participation (PPP) model has been targeted largely towards providing medical services in the metros. The model needs to be extended to Tier II and III cities to make healthcare easily accessible and affordable.
• What according to you are the areas where government should invest to make healthcare available to everyone on the go?
Government will be taking steps for widening the availability of essential drugs across India and reducing the cost of life saving drugs.
Citing the example of coronary stents, government has already brought the same under price control and asked the National Pharmaceutical Pricing Authority to fix its ceiling price. On similar lines, the government will amend the Drugs and Cosmetics Rules to ensure availability of medicines at reasonable prices and to ensure use of generic medicines. The Medical Council had recently amended its guidelines to encourage doctors to prescribe generic names of medicines.
Allocating Rs.48, 853 crore to the Ministry of Health and Family Welfare (MOHFW) in Budget 2017 is a commendable reiteration of the government’s commitment to strengthening the healthcare infrastructure in the country and ensuring broader outreach of quality healthcare to deprived sections of the society. A 15 percent increase in the budgeted allocation as compared to last year is proof of the fact that the government is committed to providing “Health for All” and is making concrete efforts to ushering in a Universal Healthcare Model, preventing increasing instances of maternal mortality rates (MMR) and infant mortality rates.
Keeping Prime Minister Narendra Modi’s mantra of “Make in India” at the center of bolstering India’s healthcare competencies, the government should allocate more funds to revamp the present public health infrastructure. Emphasis should also be placed on increasing investment for creating medical centers in remote corners of the country to make healthcare easily affordable. Promoting suitable partnership models to synergize the technical expertise and funding capabilities of the private and public sector can go a long way in ushering sustainable healthcare inclusion for large sections of the population. Onus should also be placed on funding indigenous manufacturing capacities along with providing attractive incentives for research and development.
• What are the policies interventions that the healthcare sector in the state needs to align with the healthcare objectives at large at the national level?
One finds a dual mechanism prevailing in Indian Healthcare system, full of great achievements, as well as miserable failures. On one hand we have medical tourism and cutting edge equipment and on the other we have kids dying of malnourishment and people with treatable conditions. The urban-rural divide has never been higher than the one what we see today.
Health care services in India are dominated by the private sector, whereby nearly 75 percent of services, in monetary terms, are provided by the private sector, as compared to its reverse ratio in developed countries around the world. Also, the per capita spending rates are extremely low in our country, though the healthcare insurance is slowly picking up the pace, for filling the gap.
On one hand urban India is facing lifestyle based diseases like cardiovascular complaints, diabetes mellitus and cancer, whereas on the other hand rural India is seeing a sharp increase in non-communicable life style diseases like Respiratory Tract Infections. Poor in urban & rural India are faced with communicable diseases like tuberculosis, Sexually Transmitted Diseases (including HIV/AIDS), dysentery and typhoid. Access to health services is severely limited as health infrastructure proves to be grossly inadequate, especially in the rural areas where secondary and tertiary care is available with great difficulty.
We need policy interventions related to better aligned healthcare programmes that effectively respond to the demands of people, with an effective and independent monitoring mechanism. Increased investments are required in secondary and tertiary healthcare, especially in rural & urban poor areas. Opening up the medical insurance sector, for making healthcare services easily available and affordable for all, should be undertaken on a priority basis.
• Anything else you would like to tell us?
The economic, medical and societal benefits of in-vitro diagnostic tests are often overlooked, despite the fact that these tests provide a fundamental base for improving patient care and contribute towards protection of consumer health. Diagnostics have a significant impact on the quality of medical treatments, as it assists in detecting and diagnosing disease more rapidly and at an earlier stage, even before symptoms occur. Government should lay more emphasis on the IVD testing that will help in determining disease risk earlier, ultimately leading to selection of more targeted, effective, and often less invasive treatments. Introduction of Rapid testing kits into the public healthcare systems, especially in rural areas will act as a boon in providing cost effective solution, for timely diagnosis of several such diseases, whereby proper medical treatments can be imparted on time.