Dr. Prem Nair, Medical Director, Amrita Institute of Medical Sciences

• What are your views on the Healthcare market in India vis-à-vis the global market?

Public health scenario is a major challenge. The lack of clean water, adequate nutrition, sanitation, and access to primary care are still major problems in India.

Two-tier system of healthcare (Public and private) where Private has better facilities but not affordable unlike in the west where access is not a problem due to third party pay or ship.

OOP (out of pocket) cash payment is close to 80 percent in India, virtually non-existent in the west.

There is mandatory comprehensive health insurance with universal coverage in the west, virtually none in India for the unorganized sector. Only 2 percent of doctors live in rural India were 70 percent of the population lives.

There is far more equitable distribution of doctors globally. Shortage of doctors, particularly specialists have results in high maternal/high mortality which is among the highest in the world.

• Your thoughts on budgetary allocation in healthcare?

There is a need to immediately increase GDP allocated by the Government at the State and the Central levels to at least 5 percent through a contributory universal health coverage for all.

The healthcare market is growing at a tremendous pace. During 2008 to 2020 it is expected to record a CARG of 16.5 percent. The industry is expected to touch USD 280 billion  by 2020.

• What is your vision for Health and Family Welfare? What were the challenges you faced while implementing health services?

Ensuring accessible, affordable and sustainable primary and secondary healthcare in rural and semi-rural areas and for the urban poor

- Strengthen healthcare for the vulnerable groups

- Progressive implementation of a system of universal health insurance coverage for the masses through a contributory plan

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• What is your perspective on monitoring the quality of private healthcare?

Quality Assurance through NABH is one of the established goals of all major private providers, in all areas of franchise operations, including, recruitment, training, monitoring of clinical outcomes, patient experience, cost-effectiveness and the provision of feedback, and incorporation of an organizational culture of quality.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. 

• How important is Public Private Partnership in making healthcare a success?

-Effective PPP in making Healthcare a Success

Government needs to make a choice of being the dominant provider of payer―whether it wants to contribute in building infrastructure and manager operations of hospitals or diagnostics―or it wants to the principal payer for healthcare services provided by the private sector. Adopting a provider role will slow down the development of public beds, but it can help solved by adopting PPP models because private provisions in predicted to show strong growth.

The country needs to increase bed strength by 100 percent, for which the private sector has to pay the provider and industry with NGOs and insurers will have to come up with innovative business models on investments, project planning and optimum deployment of capital at all income levels, especially the rural and urban poor sectors.

However, before embarking on the PPP Model, there are some key steps to be taken. A framework has to be set up with clarity in choices, opportunities, procedural details and sustainable studies, and only then work PPP model work.

• What according to you are the areas where government should invest to make healthcare available to everyone on the go?

Investment in a Universal Health Plan with regulatory controls, for the poor and a contributory plan for the middle class will ensure access, equality and poverty alleviation due to hospital related expenses. Coverage should provide primary, secondary and tertiary care through a PPP model. This will allow rapid scaling up of healthcare services, competition between private and public hospitals with the improvement in quality and affordability of healthcare for all.

Areas that Government needs to focus immediately are maternal and child health, affordable quality medicines, universal immunization and free vaccines, research and development of low cost quality medical equipment and consumables and facilitation of Human Resource development in Healthcare.

• 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?

The State remains the primary responsibility for health and the center plays a facilitatory role as well as active provider role to some extent.

The state monitors the burden of disease and injury; they provide a broad array of preventive and curative services. They ensure quality and safety. The state needs to provide comprehensive reports in the form of registers to the center whose role is policy making, financing, collecting and dissemination of healthcare information and setting standards and inspection of healthcare facilities.

It is important for states to be in sync with central policies so as to ensure effective healthcare implementation that is data driven.


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