A CURE FOR HEALTHCARE

India Today - - UPFRONT - by Naresh Tre­han In­dia’s lead­ing car­diac sur­geon is also the founder of Medanta, The Medic­ity

In­dia’s healthcare in­dus­try is ex­pected to be worth $400 bil­lion by 2025, fu­elled by mul­ti­ple de­mand driv­ers—an ad­di­tional 500 mil­lion-plus in the mid­dle class by 2025, 130 mil­lion-plus se­nior citizens by 2020, 300 mil­lion-plus at risk of dy­ing due to non­com­mu­ni­ca­ble dis­eases (NCDs) by 2020, 45 per cent pen­e­tra­tion of in­surance by 2020 and the re­quire­ment of 2 mil­lion-plus beds by 2025.

The sec­tor is ex­pected to gen­er­ate 5.4 mil­lion jobs by 2025. To­day, In­dia pro­vides qual­ity care rel­a­tively cheap. If we build on this, the sec­tor can dou­ble forex earn­ings by 2020 to $8 bil­lion. Be­sides, the growth of the sec­tor im­pacts other in­dus­tries with its mul­ti­plier ef­fect, as over­all GDP growth strongly cor­re­lates with healthcare spend­ing. How­ever, there are many chal­lenges in re­al­is­ing this po­ten­tial. In­con­sis­tent healthcare de­liv­ery, poor hy­giene and san­i­ta­tion, a trust deficit, fund­ing chal­lenges, reg­u­la­tory un­cer­tainty and lim­ited man­power have re­sulted in Sus­tain­able De­vel­op­ment Goals (SDGs) not be­ing met.

With this as a back­drop, the Na­tional Health Pol­icy, NHP 2017, is a wel­come move. The de­ci­sion to sig­nif­i­cantly in­crease public health ex­pen­di­ture, to 2.5 per cent of GDP, in a time-bound man­ner was long over­due. NHP’s pre­dom­i­nant fo­cus on pre­ven­tive and pro­mo­tive health, a sig­nif­i­cant de­par­ture from the fo­cus on acute care in the past, and the re­solve to strengthen public healthcare de­liv­ery will make the im­pact sus­tain­able. In ad­di­tion, the de­ci­sion to pro­mote in­te­grated care—via co­ex­is­tence of AYUSH and mod­ern medicine—is a wel­come move, which will help balance the short­com­ings of a highly spe­cialised de­liv­ery struc­ture and pro­mote In­dia’s well-known ad­van­tage of a ro­bust sys­tem of tra­di­tional medicine.

His­tor­i­cally, the pri­vate sec­tor has played a lead­ing role in the growth of the In­dian healthcare sec­tor as ev­i­dent from the fact that it ac­counts for 80 per cent mar­ket share, 60 per cent beds, 60 per cent in-pa­tients, 80 per cent out­pa­tients and 80 per cent doc­tors in the de­liv­ery of sec­ondary, ter­tiary and qua­ter­nary care ser­vices.

Nei­ther the govern­ment nor the pri­vate sec­tor alone has the ca­pac­ity and re­sources to re­spond to the agenda of uni­ver­sal health cov­er­age. In this con­text, the govern­ment’s recog­ni­tion, in NHP 2017, of the need to align the growth of the pri­vate sec­tor with public goals is com­mend­able. The key is to fos­ter a long-term part­ner­ship be­tween the two. As the govern­ment sets about trans­lat­ing the pol­icy into an im­ple­men­ta­tion frame­work, we be­lieve the fol­low­ing are im­per­a­tive to an ef­fec­tive part­ner­ship:

De­velop ef­fec­tive PPP mod­els for the pri­vate sec­tor to par­tic­i­pate in govern­ment schemes, and broad­base ac­cess to best in class care;

Di­a­logue be­tween govern­ment and pri­vate play­ers to de­velop a com­mon un­der­stand­ing of the eco­nom­ics of de­liv­er­ing qual­ity care af­ford­ably. The fi­nan­cial health of pri­vate play­ers is not great. Even ter­tiary hospi­tals in met­ros as well as Tier-2 cities on an av­er­age are earn­ing low sin­gle-digit PAT (profit af­ter tax) mar­gins and the RoCE (re­turn on cap­i­tal em­ployed) is less than the cost of cap­i­tal. It’s im­per­a­tive to assess and holis­ti­cally un­der­stand the eco­nom­ics;

Form an in­de­pen­dent body like Mon­i­tor (NHS), UK, to de­velop a frame­work to assess the fi­nan­cial health of both public and pri­vate providers, align on ac­cept­able returns for pri­vate providers, de­ter­mine rates for pur­chase of pri­vate pro­vi­sion by public on a true-cost ba­sis and mon­i­tor ap­pro­pri­ate­ness of health out­comes;

Lib­er­alise pri­vate sec­tor par­tic­i­pa­tion in med­i­cal ed­u­ca­tion such that it is at­trac­tive for pri­vate play­ers to in­vest;

In­dus­try and govern­ment should col­lab­o­ra­tively set up a process of puni­tive ac­tions to curb un­eth­i­cal prac­tices;

The NHP missed out­lin­ing the need to pro­tect med­i­cal pro­fes­sion­als, the most im­por­tant part of the healthcare de­liv­ery ecosys­tem. Re­cent events of grow­ing mis­trust and vi­o­lence against med­i­cal pro­fes­sion­als will halt the growth of the sec­tor.

The time is right for the public and pri­vate sec­tors to re­it­er­ate their com­mit­ment to part­ner each other to achieve In­dia’s dream of uni­ver­sal health cov­er­age and di­a­logue on build­ing a last­ing sus­tain­able part­ner­ship.

The healthcare sec­tor is seen gen­er­at­ing 5.4 mil­lion jobs by 2025 and po­ten­tially $8 bil­lion in forex by 2020

Newspapers in English

Newspapers from India

© PressReader. All rights reserved.