HEALTH­CARE

DOES MONEY MAT­TER?

Rural & Marketing - - FRONT PAGE -

In­di­ais fac­ing ris­ing dual dis­eases bur­den of both com­mu­ni­ca­ble and in the form of and non­com­mu­ni­ca­ble dis­eases (NCDs). In­dus­try es­ti­mates that the grow­ing bur­den of NCDs is es­ti­mated to lead to a loss of $6.2 tril­lion by 2030—nearly three times of India’s cur­rent GDP. On one hand de­mand-sup­ply gap in health­care ser­vice de­liv­ery is ris­ing and on the other hand over­all spend­ing in the health­care sec­tor is merely 4.5 per­cent of GDP of which the gov­ern­ment con­trib­utes only 1.6 per­cent. To meet the chal­lenges at mul­ti­ple fronts in­clud­ing health­care in­fra­struc­ture and ser­vices and to achieve uni­ver­sal health cov­er­age, India needs at least 8 per­cent of over­all spend­ing in the sec­tor.

Big ques­tion is- Are we mov­ing in right di­rec­tion? An­swer is-Yes. Go­ing buy the Bud­get 2017-18 an­nounce­ments and re­cently un­veiled New Health Pol­icy (NHP) 2017, the gov­ern­ment has sent clear sig­nals that it wants to make

uni­ver­sal ac­cess to health a re­al­ity. More laud­able is the fo­cus on en­gag­ing the health­care in­dus­try in sev­eral schemes and pro­grammes with dif­fer­ent mod­els in­clud­ing Private Public Par­tic­i­pa­tion (PPP). The in­dus­try has re­sponded pos­i­tively and gears up to take the health­care sec­tor to the next level.

With new pol­icy in place the private sec­tor will go for an in­creased col­lab­o­ra­tion with the gov­ern­ment for op­er­a­tional­is­ing health and well­ness cen­tres across the coun­try. It is now the im­ple­men­ta­tion that holds the key to its suc­cess.

Im­ple­men­ta­tion of suc­cess­ful PPP Projects

A lot has been said about PPP projects and there are many suc­cess sto­ries in the coun­try. Dr Arvind Lal, Chair­man, Lal PathLabs and Pres­i­dent NATHEALTH said that to meet the chal­lenges of higher spend­ing in the health­care sec­tor, PPP projects re­quired to scaled up and im­ple­mented across the coun­try and the gov­ern­ment needs to en­cour­age suc­cess­ful projects.

"Presently, 70 per­cent pa­tients are be­ing taken care of by private sec­tor. In view of huge de­mand­sup­ply gap, India needs to spend nearly 8 per­cent of GDP in health­care sec­tor, whereas

the gov­ern­ment spends 1.6 per­cent and 3.5 is be­ing spent by private sec­tor. To in­crease over­all spend­ing, private sec­tor can play crit­i­cal role, the PPP model can be the best op­tions,” Dr Lal told R&M.

“On di­ag­nos­tic side, We have sub­mit­ted a de­tailed PPP struc­ture

On di­ag­nos­tic side, We have sub­mit­ted a de­tailed PPP struc­ture to NITI Aayog and hope­fully a roadmap would be ready soon. NITI Aayog will come out with guide­lines which would act as ad­vi­sory to the States. With this we move a step fur­ther for im­ple­men­ta­tion of ef­fec­tive PPP projects across the coun­try

Dr Arvind Lal Chair­man, Lal PathLabs

to NITI Aayog and hope­fully a roadmap would be ready soon. NITI Aayog will come out with guide­lines which would act as ad­vi­sory to the States. With this we move a step fur­ther for im­ple­men­ta­tion of ef­fec­tive PPP projects across the coun­try,” he added.

“As for as the gov­ern­ment is con­cerned, we need to sit to­gether and chart out fur­ther

course of ac­tions. All suc­cess­ful PPP projects need to be stud­ied and im­ple­mented. Tamil Nadu, Kar­nataka, Ra­jasthan and Andhra Pradesh have sev­eral suc­cess­ful projects, why can't we im­ple­ment them across the coun­try,” Dr Lal ques­tioned.

Cost of De­liv­ery

It is gen­er­ally per­ceived that private sec­tor charges ex­u­ber­antly from pa­tients. While op­pos­ing un­nec­es­sary prof­it­ing, Dr Lal said that health­care cost for private sec­tor has gone up dras­ti­cally and to­day one bed in a qual­ity hos­pi­tal nearly cost Rs 1 crore, equip­ment and de­vices cost mov­ing north­ward along with higher im­port du­ties and other taxes, hence the private hos­pi­tal or groups are op­er­at­ing at a tight mar­gins. Things can im­prove only if pro­mo­tional poli­cies are in place for the sec­tor.

With an in­vest­ment of Rs 250 crore, Aakash Health­care has set up a su­per Spe­cial­ity Hos­pi­tal in New Delhi which will cater not only NCR but whole North in­clud­ing Pun­jab, Haryana and

Hi­machal Pradesh. The Aakash Group fo­cuses on pro­vid­ing af­ford­able and qual­ity health­care ser­vices and for that it prefers ‘Spoke and Hub’ and ‘OpEx’ mod­els to ex­pand its reach in North India.

Elab­o­rat­ing the mod­els, Dr Aashish Choudhry, Direc­tor, Aakash Health­care said, “For cost ef­fec­tive, we would not open ma­jor cen­tres in dif­fer­ent lo­ca­tions in North, but go for sub-cen­tres in Tier II and III towns. Pa­tients will be treated there and if needed they will be shifted to main Cen­tre in New Delhi. This is our ‘Spoke and Hub’ model.”

“Cost of health­care ser­vice is very ex­pen­sive for the private sec­tor. Land, elec­tric­ity and equip­ment are very high which raises the cost of de­liv­ery. Once foot­print in­creases, there is scope for cost re­duc­tion. For cost­ef­fec­tive, we are opt­ing op­er­a­tional model (Opex) by ac­quir­ing sick or smaller units in var­i­ous places to cut down the over­all op­er­a­tional cost,” he added.

“With these two mod­els, Aakash Group aims to bring down cost of a bed in its chain to Rs 30 lakh from an av­er­age of Rs 1 crore in a spe­cial­ity hos­pi­tal. We are com­mit­ted to pro­vide af­ford­able and qual­ity health­care,” Dr Choudhary em­pha­sised.

Pre­ven­tion is the key

New Health Pol­icy fo­cuses on preven­tive care. Mil­lions of peo­ple go be­low the poverty be­cause of cat­a­strophic out-of-pocket ex­pen­di­ture (OOPE) on health­care. The in­dus­try es­ti­mates OOPE at nearly 60 per­cent. Sev­eral Re­ports pointed out that pre­ven­tion of dis­eases, par­tic­u­larly non­com­mu­ni­ca­ble dis­eases ( life­style dis­eases) that are ex­pen­sive to treat, is the most cost-ef­fec­tive strat­egy for a coun­try scarce re­sources.

“Data re­veals that one out of 10 per­son in India is now di­a­betic. With ris­ing NCDs bur­den, pre­ven­tion is the most ef­fec­tive strat­egy and it is promis­ing to note that the new pol­icy fo­cuses on preven­tive and pro­mo­tive heath­care. We, at In­dus Health Plus, are de­ter­mined to make qual­ity health­care af­ford­able, ac­ces­si­ble and af­ford­able,” said Har­ish Pil­lai, Chief Op­er­at­ing Of­fi­cer, In­dus Health Plus.

In­dus Health Plus, a lead­ing com­pany in preven­tive health­care sec­tor, has in­tro­duced com­pre­hen­sive pack­age for preven­tive check-ups and it is op­er­at­ing in 17 states to reach over 80 lakh peo­ple.

“We have tie-ups with state-of-the-art hospi­tals and di­ag­nos­tic cen­tres to en­sure the best of health­care fa­cil­i­ties for our clients acrors the coun­try. Apart from com­pre­hen­sively designed preven­tive health checkup pack­ages with high de­liv­er­ables, the com­pany pro­vides ‘Health Friend’ cards to take care of the medical and hos­pi­tal­i­sa­tion ex­penses,” Pil­lai ex­plained.

He said that with the gov­ern­ment’s thrust on pre­ven­tion & pro­mo­tional poli­cies and with a large num­ber of In­sti­tutes of Ex­cel­lence in both private and public sec­tors, India can emerge as global Pre­ven­tion and Well­ness hub. Well­ness seg­ment is grow­ing at a rate of 23 per­cent an­nu­ally which re­flects the po­ten­tial of the sec­tor.

Lever­ag­ing Tech­nol­ogy

“Dig­i­tal Health can trans­form the way we look at health­care ecosys­tem in the coun­try. It can hugely impact pa­tients, doc­tors and sup­ply chain. A data can be chipped in a sim­card. Ac­cess to medical records would be easy. Telemedicine, e Pharma and on­line con­sul­tancy can be over­come many hur­dles,” Amit Mookim, Manag­ing Direc­tor, ims health said.

Mi­lan Rao, CEO, India &

For cost ef­fec­tive, we would not open ma­jor cen­tres in dif­fer­ent lo­ca­tions in North, but go for sub-cen­tres in Tier II and III towns. Pa­tients will treated there and if needed they will be shifted to main Cen­tre in New Delhi. This is our ‘Spoke and Hub’ model

Dr Aashish Choudhry Direc­tor, Aakash Health­care

South Asia, GE Health­care said that cost-ef­fec­tive­ness, ac­cess and quest for qual­ity can be achieved with ex­ten­sive use of dig­i­tal health. As we scale, cost will cer­tainly go down and tech­nolo­gies will mul­ti­ply dis­rup­tions as well. He said from a cen­tralised care cen­tre of a city, with the help of dig­i­tal tech­nolo­gies, 100 beds in Tier III hospi­tals can be man­aged.

Fur­ther the NHP pro­poses set­ting up of a Na­tional Dig­i­tal Health Au­thor­ity (NDHA) and health in­for­ma­tion ex­change plat­form. These mea­sures will cer­tainly cre­ate the much needed dig­i­tal back­bone of health in­fra­struc­ture and will be­come a game-changer in con­tin­uum of care. De­ploy­ing tech­nol­ogy through So­cial En­deavor for Health and Telemedicine (SE­HAT), a telemedicine health ini­tia­tive with public -private part­ner­ship, has shown how tech­nol­ogy can be lever­aged across ru­ral and re­mote ar­eas to de­liver pa­tient-centric health care.

NATHEALTH-PwC Re­port : The Way For­ward

To bridge the huge in­fra­struc­ture gap, India will need much more par­tic­i­pa­tion from the private sec­tor and for these con­ven­tional modes of health­care fund­ing will need to be aided by in­no­va­tive modes fund­ing to im­prove health­care in­vest­ments in India, re­veals a Re­port which was re­leased at NATEv2017, an an­nual c con­fer­ence re­cently or­gan­ised by t the Health­care Fed­er­a­tion of India ( (NATHEALTH). NATHEALTH).

The Re­port rec­om­mends f four scal­ing in­no­va­tive modes w which should be in­tro­duced for f fund­ing In­dian health­care. These in­clude Fund of funds such as Pen­sion funds, In­vest­ment route through PPP and long – term debt. Re­port bats for fi­nanc­ing through pen­sion funds which may pro­vide ac­cess to a large pool of money. It also sug­gested fund­ing through busi­ness trust en­tity like Real Estate In­vest­ment Trusts along with bi­lat­eral in­vest­ment treaties.

While un­der­lin­ing the need of huge fund­ing re­quire­ments, the Re­port says the FDI in the sec­tor has sig­nif­i­cantly been in­creased in the last three years. How­ever, health­care public ex­pen­di­ture’s share in GDP re­mains around 1.6 per­cent in FY 16 and in­no­va­tive fund­ing would sup­port the tar­get of tak­ing it to 2.5 per­cent by 2030.

An­jan Bose, Sec­re­tary Gen­eral, NATHEALTH said that, “While the op­por­tu­nity for im­prove­ment of health ser­vices in India as well as glob­ally is huge, for it to fall into the right place the gov­ern­ment and the en­tire health­care ecosys­tem will have to work to­gether even as they com­pete on other fronts so that the ben­e­fits per­co­late to the seg­ment which most re­quires it.”

Ac­cess to cap­i­tal has been one of the big­gest road­blocks to the growth of health­care sec­tor. To­day, the In­dian gov­ern­ment spends only about 1.6 per­cent of its GDP on health­care, which is among the low­est glob­ally for any coun­try. There is a need to fo­cus on the health­care needs.

With new pol­icy in place the private sec­tor will go for an in­creased col­lab­o­ra­tion with the gov­ern­ment for op­er­a­tional­is­ing health and well­ness cen­tres across the coun­try. It is now the im­ple­men­ta­tion that holds the key While the op­por­tu­nity for im­prove­ment of health ser­vices in India as well as glob­ally is huge, for it to fall into the right place the gov­ern­ment and the en­tire health­care ecosys­tem will have to work to­gether even as they com­pete on other fronts so that the ben­e­fits per­co­late to the seg­ment which most re­quires it

An­jan Bose Sec­re­tary Gen­eral, NATHEALTH With the gov­ern­ment’s thrust on pre­ven­tion & pro­mo­tional poli­cies and with a large num­ber of In­sti­tutes of Ex­cel­lence in both private and public sec­tors, India can emerge as global Pre­ven­tion and Well­ness hub. Well­ness seg­ment is grow­ing at a rate of 23 per­cent an­nu­ally which re­flects the po­ten­tial of the sec­tor

Har­ish Pil­lai Chief Op­er­at­ing Of­fi­cer, In­dus Health Plus

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