Healing the Healthcare Divide
Announcement of the flagship Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY), on the Independence Day, to cover over 10 crore poor and vulnerable families with a coverage up to INR 5 lakhs per family per annum for secondary and tertiary care hospitalisation is certainly a timely and much needed trigger to reform healthcare delivery in India and to achieve the country's growth aspirations. PMJAY was formally launched on 25 September 2018.
As we move towards achieving universal health coverage for India, we would need to tackle various challenges including substantial expansion of the country's healthcare infrastructure to cover the 50 crore expected beneficiaries.
Sustainable Pricing in Healthcare
The private sector that has been providing nearly 60 per cent of in- patient care and has contributed to 70 per cent of bed capacity expansion in the last decade, will be a crucial partner in successful implementation of PMJAY.
However, there are rising concerns amongst private healthcare providers in terms of inadequate package rates for the procedures covered for hospitalisation. Conventionally, the major weaknesses of public health insurance schemes, whether Rashtriya Swasthya Bima Yojna (RSBY) or CGHS (Central Government Health Scheme), have been non-viable reimbursement rates and delays in payments to the hospitals, affecting the financial sustainability of such schemes with the empanelled hospitals.
For the government's aspirational mission to succeed in providing access to healthcare for its most vulnerable population, it is imperative to devise a reimbursement mechanism based on a scientifically developed costing framework. It is time to recognise costing from the point of view of both – affordability as well as viability and make concerted effort to understand the actual cost associated with a medical procedure including direct material (drugs and consumables) as well as indirect cost of manpower and infrastructure.
For successful implementation of PMJAY, it will be critical to ensure that package rates for procedures covered under the mission are adequate to provide quality services to the beneficiaries and do not hamper the sustainability of the healthcare providers. Different stakeholders in healthcare have a different perspective of cost. While the price controllers view the cost of care mainly as cost of consumables, patients see cost as what they pay out of pocket and hospitals work cost around departments. Because of this disconnect, the efforts of deriving rational reimbursement rates for healthcare service providers have been ineffective in the past. The only way to bring a fundamental reform is to consider the cost within the delivery system – the cost incurred by the provider.
The goal of Universal Health Coverage can be accomplished only with clear criteria for costing as well as adequate and timely reimbursement. Therefore, it is imperative to develop a proper costing approach to derive reimbursement rates that are aligned with service delivery costs at different levels of care, locations and volumes. International studies suggest the cost
crisis in healthcare can be fundamentally solved with accurate measurement of costs and their fair comparison with outcomes. With this as the genesis, FICCI undertook a study on costing of Healthcare in India, to derive the costs associated with delivery of select medical procedures across select public and private hospitals from around the country. The methodology and findings of the study were released in a paper titled ‘Demystifying Healthcare Costs: A Scientific Approach’, by Dr VK Paul – Member (Health), NITI Aayog, during the conference.
Sangita Reddy, Vice President, FICCI and Joint MD, Apollo Hospitals Enterprise Ltd. feels, 'Indian healthcare is no longer at crossroads with the announcement of Ayushman Bharat. Healthcare has entered the Universal Collective Super-highway. It is a fact that there are significant gaps in healthcare access, but we also have the wherewithal to deliver the highest quality of care available anywhere in the world at one-tenth of the prices. We want to make use of technology to make healthcare available to everybody. '
The healthcare costing is complex due to the nature of delivery of services. There are several practical issues in capturing utilisation of resources by the activities within the delivery system. The healthcare services require resources at multiple points of delivery within the system, with varying intensity of consumption of resources. FICCI, as a change agent, has been working towards developing a rational costing template since 2013, under the aegis of Ministry of Health and Family Welfare, Government of India, and was the nodal agency for the development of National Costing Guidelines.
HEAL: Focus on Balanced Healthcare
Given that healthcare in India is poised to witness a tectonic shift, FICCI organised the 12th edition of its annual healthcare event – FICCI HEAL in New Delhi on 30-31 August 2018 on the theme 'Healthcare at Crossroads', supported by NITI Aayog. Sharing his views at the inaugural of event, Union Health & Family Welfare Minister JP Nadda said that 'Ayushman Bharat is a historic program which looks at health holistically with twin pillars of Health and Wellness Centres (HWCs) for comprehensive primary healthcare and financial protection for secondary and tertiary care hospitalisation, through PMJAY. Under Ayushman Bharat 1.5 lakh sub-centres and PHCs will be converted into Health and Wellness Centres. All support should be given to HWCs to ensure promotive and preventive care, for which we are going for universal health screening at the age of 30. This is a paradigm shift as far as healthcare is concerned and this is again an area where the private sector can come in.'
Nadda opined, 'The Government of India is keen to formalise a multistakeholder forum to arrive at policy decisions and formulate implementable strategies to make healthcare affordable and accessible to all. At present, there is no formal structure for policy interaction and such synergies would be important to achieve a hepatitis-free India by 2030.'
(Hony) Brig. Dr Arvind Lal, Chair, FICCI Health Services Committee and CMD, Dr Lal PathLabs said 'It is important to derive rational and sustainable package rates for Indian healthcare is no longer at crossroads with the announcement of Ayushman Bharat. Healthcare has entered the Universal Collective Superhighway. It is a fact that there are significant gaps in healthcare access, but we also have the wherewithal to deliver the highest quality of care available anywhere in the world at one-tenth of the prices. We want to make use of technology to make healthcare available to everybody.
procedures covered under the Pradhan Mantri Jan Arogya Yojana, to ensure quality care can be provided and the costs incurred within the healthcare delivery system are covered. For this, there is a strong need to understand costs from the perspective of all relevant stakeholders – the government, the providers and the consumer.'
Even after 70 years of independence, public provisions for healthcare remain largely inadequate and India's healthcare model is shaped mostly by private healthcare. Globally, India has been recognised for availability of high quality secondary and tertiary care at the fraction of price as compared to developed countries. But it fails to provide even basic healthcare beyond the urban limits, putting about 70 per cent of its population dwelling in the rural areas at risk of suffering from preventable and curable diseases and conditions.
Dr VK Paul, Member (Health), NITI Aayog, Government of India, said that as course correction in healthcare takes place, quality and ethics will be the guiding force. He urged the private sector to engage
It is important to derive rational and sustainable package rates for procedures covered under the Pradhan Mantri Jan Arogya Yojana, to ensure quality care can be provided and the costs incurred within the healthcare delivery system are covered. For this, there is a strong need to understand costs from the perspective of all relevant stakeholders – the government, the providers and the consumer. (Hony) Brig. Dr Arvind Lal, Chair, FICCI Health Services Committee and CMD, Dr Lal PathLabs
with the government in providing quality care at reasonable rates, monitored by the government. He said, 'PMJAY is not possible without the engagement of the private sector. We also need to create a pipeline of specialists and private sector can help in filling that gap.'
Dr Alok Roy, Co-chair, FICCI Health Services Committee and Chairman, Medica Group of Hospitals, highlighted, 'Developing and maintaining hospitals is a capital-intensive affair and therefore, managing costs, achieving profitability and justifiable growth are very important for any hospital venture to be successful. Hospitals face number of challenges as they are exposed to greater risk as compared to other industries, owing to complexity of operations, ensuring appropriate quality of care and humanitarian and ethical issues in providing healthcare.'
Varun Khanna, Co-chair, FICCI Health Services Committee and Executive VP, Fortis Healthcare, feels, 'We have less than 1 bed to a 1000 people as opposed to global average of 6 beds to 1000. And what we fundamentally need in this country is capital for healthcare.'
Sharing his experiences from practicing in UK, Prof (Dr) Dinesh Bhugra, CBE, President, British Medical Association, recommended, 'There is a need to shift the focus from secondary healthcare and hospitals to primary care. There is also a need to change the way we train the next generation of doctors and medical students.’
FICCI Healthcare Excellence Awards: 16 Healthcare Professionals & Institutions Felicitated
The Lieutenant Governor of Delhi, Anil Baijal, along with the Minister of State for Health and Family Welfare, Anupriya Patel and Chairperson, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai, Tina Ambani,
gave away the 10th FICCI Healthcare Excellence Awards to 16 healthcare professionals and institutions in New Delhi on 30 August 2018.
Speaking on the occasion, Baijal urged to remove paradoxical situations present on the ground in providing quality healthcare to all. He said, 'Development of a country is predicted on the basis of the healthcare situation in the country. We need right policy and regulatory framework to achieve remarkable growth.' Emphasising on the importance of start-ups, he said that they are redefining the healthcare sector and urged the private sector to come forward and work in collaboration with the government to take healthcare to the next level.
Minister of State, Anupriya Patel reiterated the benefits of Ayushman Bharat and said that government is working towards strengthening Public Private Partnership (PPP) and creating workable and viable PPP model which can be implemented in next two-three years.
Tina Ambani mentioned the five 'As' are important for the healthcare sector and emphasized, 'Accessibility, affordability, awareness, aspiration and association are the five pillars that will help to bridge the gap in providing quality healthcare to the common man.'
Code of Ethics for Health Services Industry
Recognising the need for transparency and accountability in the functioning of all healthcare establishments, FICCI developed the Code of Ethics for Health Services Industry through extensive consultation with stakeholders from the Government as well as the private sector.
The code, which is applicable to healthcare professionals, healthcare providers, diagnostic centres and other healthcare institutions operating in India, covers several aspects of ethical conduct including patient centricity, privacy and confidentiality, fair trade practices and grievance redressal.
Already 7 other associations, with more than 30,000 institutional and individual members; and more than 15 healthcare organisations from across India, have endorsed the code. However, this is just the beginning of a journey to propagate the code to a large number of healthcare service providers across the country.
This voluntary code can be used as a yardstick by the health service providers for their day to day conduct and interactions with patients as well as within the healthcare community.
Union Health & Family Welfare Minister JP Nadda with industry leaders.
L to R: Chairperson, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai, Tina Ambani; Minister of State for Health and Family Welfare, Anupriya Patel and Lieutenant Governor of Delhi, Anil Baijal, at the 10th FICCI Healthcare Excellence Awards.