Gautam Khanna, CEO, P.D. Hinduja Hospital & MRC

The Indian healthcare market is diverse with a multitude of factors contributing to its growth. It has become one of India's largest sectors with immense opportunities for foreign investment, growth of start-ups, and introduction of variant forms of technology such as telemedicine. The Indian healthcare market is expected to grow at a 12 percent CAGR, from around USD 70 billion in 2012 to
USD 340 billion by 2025.

This sector, however, is yet to reach its full potential. With the growing population and demand for employment, the rural sector of India comprising
70 percent is yet to be explored. With support from the government, improvement is inevitable in this sector, both in terms of reaching the masses and creating employment opportunities, thereby boosting the overall gross economy of the country.

There are several positives associated with the Indian healthcare market. The cost of treatment in India is much less as compared to other countries making India a preferred medical tourism destination. However, our healthcare workforce comprises only 0.28 percent of the total population and our hospital bed ratio is 1.3 beds for every 1000 patients, which is also very poor to meet the healthcare needs of our fast growing population. Though there is a steady increase in the number of people opting for health insurance, currently only 25 percent of our population is covered, due to which over 58 percent of total expenditure on health in India is out of pocket.

Over the last few years, India is witnessing a change in the type and percentage of disease incidence, which inadvertently is changing the demand-and-supply structure of drugs. This in itself is changing the behavior and functioning of international and national healthcare and pharma companies, thereby creating a large scope for R&D, investments, and overall growth opportunities.

On budgetary allocation in healthcare

For this year's budget, the government has barely touched the surface of the multitude of problems that our industry faces. We are a population of more than a billion people and we are expected to surpass China's population by 2022.

To see a viable difference in the current health scenario of our country, we will need unwavering attention from the government. The healthcare system in India is currently living in a vicious cycle of non-availability of essential drugs to deal with communicable and non-communicable diseases, lack and/or unavailability of basic healthcare facilities, lack of infrastructure, lack of skilled professionals, lack of funding, and lack of public and private integration. If we want a population that contributes significantly higher to the growth of the economy, we need a healthy population. To have a healthy population, they need to have access to basic sanitary and medical facilities. To access basic facilities, we need the infrastructure and measures that motivate new players to enter the field to provide these facilities, especially in the rural areas. There is no solution to the problem, until we collectively understand that everything in the healthcare sector is interrelated.

On monitoring the quality of private healthcare


Consistency of quality across both governmental and private hospitals has been long overdue. However, the important question still remains – is quality or lack thereof dependent on doctors and healthcare workers or is it determined by the resources available in a hospital? Further, the continued lack of skilled professionals affects the overall clinical outcome within a hospital, both private and public.

It is important to understand that we are in the field of patient care and, therefore, quality cannot be assessed purely by checking the infrastructure, equipment, number of beds, supplies, etc., but the inclusion of patient satisfaction and overall clinical outcome also plays a key role in the assertion of quality.

Accreditation bodies like NABH provide a formal certification with regards to quality; however, patients are the true judges as they are the final consumers. Therefore, we need the implementation of a framework that is consistent and works across both the private and the public sector, keeping in mind the growing population that goes to government hospitals.

On public-private partnership

The implementation of the public-private partnership (PPP) is extremely important to help the healthcare sector thrive and grow to its full potential. With lack of infrastructure and high out-of-pocket expenditure, the coming together of private and public entities will be beneficial to the masses. The implementation of this model will also help improve operations and enhance efficiency of public services by incorporation of private sector innovation, technology, and processes. If planned and executed in a structured manner, PPP in healthcare can be the best way to meet the nation's healthcare goals.

On making healthcare available to everyone on the go

Mobile Health/mHealth. According to the TRAI, mobile phone subscriptions have already reached the 1 billion mark in India. It is estimated that by 2018, 50 percent of more than 3.4 billion smartphone and tablet users worldwide will have downloaded mobile health apps of some kind. With numbers like these, the implementation of mobile health on a large scale will significantly bring down the cost, help reach out to the rural masses, improve the quality of primary healthcare services (PHCs), improve and better diagnose disease, etc.

Health at the doorstep. India has an elderly population of more than 130 million individuals, which is expected to grow to 378 million by 2020. A Bain report states that 60 percent of the lifetime healthcare spending in the US is incurred after age 65 years. 20 percent of all hospitalization cases in 2012 were of patients in the 60+ year's age group. This is expected to rise to
26 percent by 2025. Thus the growing geriatric group would place a greater burden on the healthcare sector with its growing demand.

With such an investment, organizations will be able to reach out to more individuals who do not have the ability to travel to the hospital. A move in this direction will also change the scenario of healthcare delivery system and lead to better patient satisfaction.

Manpower. Although the government did take a step forward in strengthening the workforce in healthcare sector by creating additional 5000 post-graduate seats, there is also a dire need to close the demand-and-supply gap of nurses, paramedics, and allied health professionals such as technicians. As the industry grows, it is these professionals who will be needed the most.

Primary Healthcare Centers. The biggest and toughest issue that rural India faces today is difficult access to basic healthcare services. The government should focus on ensuring appropriate functioning of primary healthcare centers and address the lack of professionals manning these health centers. The government should look at some kind of sops for those taking up service at a primary healthcare center and thus create better outcomes.

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