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Healthy India:
Imperatives for Consolidating
the Healthcare Management
Ecosystem
Health in India 1
Emerging trends and imperatives 3
Collaborate to Innovate 6
Creating and facilitating a collaborative environment 13
References 14
Contacts 16
2
Health in India –
Status and successes
India rightly brands itself as incredible. in-patient treatment, possibly making
The country’s remarkable political, quality healthcare and private sector
economic and cultural transformation facilities accessible to the poor.
over the past few decades has made
it a geopolitical force. Healthcare is However, these exciting opportunities
one of the industries that marks this often mask certain urgent predicaments.
strengthened global presence.
The healthcare sector in India is
As per industry reports, healthcare is currently at a cusp. Issues of access,
poised to grow at an estimated annual affordability, quality of care and
rate of 19 per cent to reach USD efficiency remain significant. A number
280 billion by 20201 with India being of reports have been published about
recognized as a destination for world the poor health status of India,
class healthcare. During the last decade compared to its Low and Middle
the private sector grew to become the Income Country (LMIC) peers. In terms
major provider of healthcare services. of vital statistics like infant mortality
Its share of beds increased from 49 (IMR) and maternal mortality, India has
per cent in 2002 to 63 per cent in lagged behind significantly. Even life
20102. As per NSSO 2008, the private expectancy, at 62 years, is three years
sector accounted for 60 percent of all below the LMIC average. According
in-patient admissions and 78 percent to the Global Burden of Diseases 2010
of out-patient consultations3. Private study, total Disability Adjusted Life Years
diagnostics market is growing at 20 per (DALYs) lost are 518,879,000 years for
cent and the pharmaceuticals market at the Indian population4. The economic
around 15 per cent per annum. cost of these illnesses to the country
is a staggering 600 billion dollars
The Indian government has also (approximately).
introduced several reforms. The
11th and 12th Five Year Plans and India is also facing an unprecedented
international focus on the Millennium pressure due to the poor reach of
Development Goals have led to quality healthcare to millions of its
1 Indian Healthcare :
successes, especially in the primary citizens due to issues of access and The Growth Story
health area – maternal and child health, affordability. The Indian healthcare 2 Central Bureau
and infectious diseases. The National sector has faced shortages of workforce of Health
Rural Health Mission has achieved and infrastructure. There were 1.65 Intelligence, Health
Infrastructure 2005
efficiency and health system reforms, trained allopathic doctors and nurses
and 2010
while the Rashtriya Swasthya Bima per 1000 population, compared to 3 NSSO 2008
Yojana (RSBY) - a national social health the World Health Organization (WHO) 4 Global Burden of
insurance scheme - has aimed to cover recommended guideline of 2.5 per 1000 Diseases 2010
However, this is not to imply that Given this complexity of the sector and 5 WHO World Health
progress has not been made in the last the unique situation of the country Statistics 2012
6 Ibid
decade – a significant contributor to in healthcare, it is evident that a
7 World Bank Global
which has been the private healthcare single stakeholder cannot offer all the Health Expenditure
sector. solutions and address all the challenges. Database 2011
Collaboration, thus, becomes a 8 WHO World Health
Inequity in access, affordability and pre-requisite for success. Statistics 2012
9 Employees
quality of healthcare are the major State Insurance
concerns that the country is grappling Corporation; RSBY
with on one hand; and on the other website
hand it needs a strategic approach
to leverage the growth trajectory of
healthcare to its advantage.
2
Emerging trends and
imperatives
The healthcare system consists of It increasingly seems that the tool to
multiple stakeholders including address the inequities of poverty is
the government, providers, payers, choice and not charity. A number of
pharmaceutical and medical devices innovations have taken this approach.
firms. Each plays a vital role in the Health care providers have tried to
health care system in India. However, increase access and quality of care for
interactions between various the poor.
stakeholders have remained limited.
Telemedicine and m-health initiatives
Healthcare in India has assumed a more have led to better reach and quality
dynamic form over the last few years in health management while being
– offering exciting opportunities for highly cost-effective. Various m-health
new reforms and improving stagnant initiatives across the world have led to
indicators addressing concerns of improvements in patient access through
access, affordability and quality across cost effective solutions – education
different population groups. and awareness, chronic disease
management and treatment support,
An ecosystem of innovations for world- remote monitoring, diagnostics support,
class healthcare delivery, driven by and disease surveillance.
private providers, is developing in India.
The country is establishing new global To leverage the healthcare growth
standards for cost, quality and delivery, story, the industry is now reshaping
through its breakthrough innovations and redefining the very concept of
in healthcare. The other end of the “healthcare”. It has moved far beyond
spectrum is witnessing a number of curative clinical practice (focused on
innovations to increase access and episodic care), to embrace prevention,
improve quality of health services for wellness and the concept of the “holistic
the poor and unreached at affordable care” through the pervasive health
costs. The last couple of years have continuum.
seen a rapid increase of private equity
and venture capital funds available for
entrepreneurs in healthcare, which
has enabled scale up of some of these
new interesting models of providing
healthcare.
Community/ Health
As we have observed from the Insurers
Employers
examples, there are countless new
developments cropping up regularly.
Emerging trends and innovations in the Academia
sector have the potential to change
the healthcare landscape significantly.
But these developments are often small
innovations. They need to leverage the
incomparable scale that India offers. In
other words, the healthcare ecosystem
needs excellent management and
collaborations that are strategic, cutting-
edge and forward-looking. While
interactions between and amongst
these stakeholders are taking place at
a smaller scale in a case-by-case basis,
these relationships and inter-linkages
4
need to be developed and sustained.
The diffusion of innovation still remains
an issue in the Indian scenario. Majority
of innovations do not percolate down
and remain limited to urban affluent
areas. Eventually, process innovation
will have to leapfrog product and
business model innovation and provide
affordable healthcare, with efficiency
and quality. These need to be the
mainstream and not exceptions.
Collaboration Innovation
Collaborate to Innovate
Stakeholders need to synergize to bring
about innovative models in service delivery
and technology
6
Collaborations between different collaborate. Experiences from different
providers across the healthcare models, like the Colston Health Centre
continuum in Birmingham for mental illness, show
Different providers across the healthcare that employee motivation at the primary
continuum – preventive, primary, level and employee efficiency at the
secondary, tertiary and rehabilitators secondary level go up significantly with
all need to collaborate in order to form minimal investments in integration.
a seamless and efficient chain. Both
vertical and horizontal integration can Besides this, collaborations between
be implemented in streamlining business diagnostic chains, primary care facilities
processes, reaching right clients and and hospitals can be leveraged to
maximizing effectiveness. achieve these benefits.
Given the increasing competitive To better manage primary care for patients with
intensity, rising real estate costs and a mental health problems, the Colston Health Centre
tough operating environment, large in Birmingham, UK, developed a model of interaction
numbers of healthcare providers are between primary and secondary care. A consultation-
exploring new and innovative business liaison model was undertaken with the consultant
models to tap larger number of psychiatrist visiting the health centre – who would support
patient segments, lesser penetrated and give advice to the General Practitioners (GP) on how
geographies, and enhance service to manage patients with mental health issues and on
offering levels. Various unconventional potential referrals to specialist mental health care. The
formats are being tried out by some collaboration was taken further by using mobile phones
of the new entrants which have also for quick consultations, liaisons for undergraduate and
increased willingness of existing players postgraduate trainings. At a later stage, mental health
to collaborate. professionals became attached to the Colston Health
Centre to work along with the GPs to provide primary care
Investments in collaboration between and integrated therapies to patients.
primary and curative care not
only contribute to prevention of
complications in chronic diseases, but
Metropolis Health Services (a diagnostic chain) has tied
also reduce secondary and tertiary
up with the social franchising model of MerryGold Health
overcrowding by managing simpler
Network in Uttar Pradesh to provide quality diagnostic
health problems at the primary level,
facilities to patients. Patient samples are sent directly to
thereby allowing them to focus on
the Metropolis Health Services laboratories and patients
high-end treatments and in turn
can collect reports from the MerryGold hospital.
improve processes and cost efficiencies.
Referral processes also become
more efficient, timely and effective
when primary and curative providers
8
Another area where technology is used
increasingly is in healthcare and hospital • Private providers like Max Super Specialty Hospital,
management to improve efficiency. Apollo Hospitals, Medanta and Escorts are collaborating
Healthcare technology companies, with public payers/insurers like the Central Government
such as GE, are offering a wide range Health Scheme (CGHS).
of clinical and financial information • AstraZeneca (a pharmaceuticals company) has partnered
technology solutions that enable with insurance and health benefits provider WellPoint
better decisions and outcomes for in the United States to gain more insight into patients.
both businesses and patients, improve Once equipped with the medical history of patients
revenue cycle, drive quality outcomes and their families, insurers can make better-informed
and accelerate image management and decisions on the coverage they provide.
workflow.
wellness. With greater awareness
Collaborations between providers among consumers and patients, health
and payers/insurers seeking behaviour increases and
The coming decade is going to there is willingness and acceptance of
mark rising demands on and costs healthcare directed towards preventing
of healthcare provision, changing illness and promoting good health.
demographics with an increasing aging Wellness players involved in the
population, and an epidemiological collaboration can contribute in this
transition towards non-communicable entire process, especially in areas of
diseases. Due to this, healthcare is better nutrition, stress management,
moving towards a preventive and lifestyle diseases and mental health.
wellness approach. Addressing Insurance companies can incentivize
these demands of chronic disease wellness programmes through
management and of prevention innovative products that have reduced
and wellness promotion requires insurance premiums for clients who
collaborations amongst providers, maintain certain health standards, and
insurers, other payers (like employers) cover out-patient treatment and annual
and wellness players. health check-ups.
10
with the latest developments in this
constantly changing sector. Besides this, Apps like Bant, developed by the University Health
updating teaching methods and syllabi Network in Toronto, allow Type 1 diabetes patients
to be relevant to the current sectorial monitor their blood sugar levels to help manage their
developments is essential. condition.
Collaborations for an empowered “Sleep as Android” is an app for insomnia patients to track
patient their sleep cycle and analyze insomnia conditions to help
Increasing use of technology is also improve sleep patterns.
resulting in evolution of interactive
patient care by educating and UChek by Biosense is a urine analyzer that uses the
empowering patients to be active iOS platform and iPhone camera to automatically read
participants in their care management. commercially available urine dipsticks to diagnose upto 25
Models such as interactive technology medical conditions.
platform, online patient self-help
groups, and increased involvement of continuum, and the government have
patients in care pathways – right from also been undertaken.
before admission to post discharge,
mobile health, social media platforms The involvement of the government
and patient remote monitoring among in a cross-sectorial convergence
others are increasingly being accepted. cannot be emphasized enough.
These models play a dual role – provide Although India has experimented in
patients with multitude benefits limited scale with multi-stakeholder
including convenience and choosing collaborations for healthcare, other
a healthcare delivery model/ provider countries like Indonesia, Mexico,
based on informed access, and help and Bangladesh have had successful
healthcare providers increase service experiences. Facilitative regulations by
levels and at the same time reduce costs the government (such as the preventive
owing to higher efficiencies. healthcare in the Finance Bill 2012 in
India mentioned above), allocation of
Multi-stakeholder collaborations adequate resources (such as allocations
While there are models of two or three and preferences for Public-Private-
categories of stakeholders coming Partnerships in the 12th Five Year Plan),
together for specific goals of healthcare empowering key stakeholder groups
(as seen in the above sections), multi- for policy action, and political will are
stakeholder collaborations involving crucial for creating and managing large
players across the value chain and care scale collaborations.
12
Creating and facilitating a
collaborative environment
Stakeholders
Technology
Government
Equitable Increased
Talent Access Coverage
Provider
Sustainability
Healthy
India
Payer/Insurance
Affordable Improved
Financing Care health
Pharmaceuticals outcomes
Medical Devices
Innovation
The striking feature of the sector is like the ones listed in the previous
that it has the potential to grow at section need a conducive environment.
an exponential rate in the foreseeable The ecosystem has to be facilitative
future and to present new opportunities of such partnerships. All stakeholders,
within itself, which will emerge as including industry, government, and
growth drivers. In order to realize the investors need to step up to make
immense potential for each to invest coordinated and concerted efforts
in and grow with the sector, there is a towards creating such an environment.
need for a cohesive and collaborative
approach, where all stakeholders Some of the key questions that need to
work synergistically and leverage the be resolved to achieve these desirable
opportunities to create a lasting impact. collaborations are:
• What role can the government play
Collaborative innovations not only and what are the policy action points
increase value for all players, it also needed to create such collaborations?
reduces cost for the end user and • While collaborations between
improves health outcomes. But government and industry is
sustained and meaningful collaborations common through public-private
14
References
1. Indian Healthcare: The Growth Story
2. Indian Health: The Path from Crisis to Progress, Richard Horton and Pam Das,
Lancet 2011
3. Cardiovascular Diseases in India: Challenges and Way Ahead; Deloitte Paper,
2011
4. India’s Health Care Hurdles, ISB Insight, Vol 9, Issue 2
5. Guest Editorial Introduction to the Special Section on Pervasive Healthcare, Ilkka
Korhonen and Jakob Bardram; IEEE Transactions on Information Technology in
Biomedicine, Vol. 8, No. 3; September 2004
6. Welcome to Welness, Sonal Vij, Express Healthcare, September 2009
7. Five Health Information Technology Trends for 2012, Physicians Practice
8. India Pre-Visited: New Frontiers in Healthcare Innovation, Indo-Swedish Health
Week 2010, Information package for the Leading Health Care Program
16
Sustainable Strategies for a Healthy India 17
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