Calling upon private sector to come forward to compliment & supplement the efforts of Government to ensure quality affordability in healthcare, Dr A K Shiva Kumar, Member, National Advisory Committee, Government of India mentioned that India has such a huge population that one single agency cannot transform the entire healthcare in the country. Public Private Partnerships is the only way forward. He was speaking at the Conference on Transforming Healthcare in Northern Region: Agenda for Action organised by Confederation of Indian Industy (CII) here today. Dr Kumar also released the CII – Grant Thornton Report on “Bridging the Divide for a Healthy India : Agenda for Transforming Healthcare Delivery in the Northern Region”.
Dr Shiva Kumar shared that In India the average expenditure by State on healthcare is Rs 1500 per person, which is only about 1.2 percent of GDP, which is very less compared to China’s spend (around 2.7 percent of GDP). He accentuated the need to increase the GDP spend on healthcare stating that even countries like Bangladesh, Bhutan & Nepal are doing better with half or less per capita GDP as compared to India. “We need to focus on healthcare the way we have focussed on primary healthcare and make sure that the sector becomes sustainable and the private sector has a huge role to play in this. We cannot link it to the high rates of GDP growth. Even at lesser GDP growth, health agenda needs to be taken forward sustainably, he added.
Mr Pravir Kumar, Principal Secretary, Medical Health & Family Welfare, Government of Uttar Pradesh shared UP’s 2 pronged vision to upscale healthcare delivery in State. He said, “We are focussing on ‘technology’ as top–down & ‘empowerment’ as bottom-up approach to ensure that the State improves on healthcare parameters. We are working on the cloud based IT solutions to monitor the delivery of services and digitization of medical records. The other important aspect would be to empower people to demand services. For which, Gram Panchayats would focus on reviewing the service & quality of delivery. A fixed agenda would be reviewed during gram panchayat meetings, to encourage accountability.”
Sharing that UP has announced 2013 as the ‘Year of Child’, he said, “Our biggest challenge is to save the young lives in the State. Lack of physical infrastructure and inadequate human resources make it difficult to reach the 21 crore citizens of UP. There is a huge gap, which could only be bridged by the integration of public & private infrastructure. It is important that we fill the critical gap, he added.
Mr Harpal Singh, Past Chairman, CII Northern Region and Mentor & Chairman Emeritus, Fortis Healthcare Ltd mentioned that “A person who is not healthy is unable to access opportunities for learning, growth and productive work. In India, a number of rights are guaranteed to its citizens but none of these can be utilized or enforced by persons who are sick, enfeebled and spend their entire energy on treatment and medical care”. Highlighting the high variance in the quality of service available in the country, Mr Singh said, “Our medical healthcare system has to be developed to cater to medical requirements of all sections of society, both in rural and urban areas, especially for the disadvantaged section of our society. There is a need for increased investments in the healthcare sector and the integration of public & private agencies would be the key to accomplish quality & affordable healthcare”.
Mr Mahadevan Narayanamoni, Partner & Practice Leader, Healthcare and Life Sciences Advisory, Grant Thornton India LLP said, “The penetration of quality healthcare in many of the Northern States of India is still substantially low and also lower than that of several Southern States. Further, even within the Northern Region, there are significant disparities across States on key parameters such as availability of doctors and number of hospitals / beds. At the national level, rural areas are far behind on similar parameters, indicating very poor access to healthcare services”.
Mr Narayanamoni added, “Given the multitude of the issues, solutions need to be driven by leveraging existing infrastructure like district hospitals and nursing homes, technology adoption such as telemedicine and point-of-care devices, deskilling preventive care and diagnostics, using technology to reduce dependence on qualified practitioners who are in short supply and other innovative business models”.
The sessions of the conference focussed on PPP in NR States & Regulatory compliances – Creating workable models for improving quality of healthcare and Non-conventional delivery models & Partnership between Preventive & Curative Care – Is technology the right solution for accessibility and affordability. The Key takeaways included
· Higher engagement between Government and Private sector
· Models of engagement to be developed
· Clarity on expectation & deliver to encourage PPPs
· Good Regulations can help drive quality in healthcare
· Need for regulations in devices & refurbished radiology equipment
· Regulatory approvals need to be faster & cheaper
· Technology could be leveraged to ensure partnership between Preventive & Curative Care
· Non-Conventional delivery models could be made sustainable with the use of technology
Healthcare sector in India: The present scenario
Indian healthcare industry is expected to reach US$100billion by 2015 from the current ~US$65 billion in 2012, growing at a CAGR of 20% a year. The healthcare ecosystem in India is presently dominated by hospitals, which accounts for over 70% of the total revenues of the Indian healthcare sector. The Indian healthcare system comprises of:
Hospitals --> Pharmaceuticals --> Medical Equipments --> Medical Insurance --> Diagnostics
Going forward, it is expected that India will become a major base for manufacturing pharmaceutical products. This is largely due to the conducive landscape provided by the country in terms of improved facilities for production, as well as increased focus on Research & Development (R&D) spending. Further, the engineering talent of the country has started to make significant contributions towards developing affordable medical devices and equipment.
The growth trajectory of the Indian healthcare sector is obstructed by enormous challenges and bottlenecks. Further, as the growth momentum of the sector accelerates with the deployment of sustainable mechanisms for improving the quality of services while undertaking initiatives to meet the growing needs and desires of a population that will increasingly want, expect, and ultimately demand affordable quality healthcare, the challenges facing healthcare delivery will become even more elaborate.
India presently faces infrastructural challenges to healthcare delivery. According to a study, the bed-to-population ratio in India is 1:1000, way below the WHO norm of 1:300. India also has a serious shortage of doctors and nurses. The public healthcare spending in India is also among the lowest in the world. A major barrier to bridging the social gradient in healthcare delivery is the fact that most advanced medical technology and hospitals are located in the country’s urban areas. This impedes the access to basic diagnostics and healthcare delivery for rural areas.
Nationally, the overall funding allocated for healthcare is a mere 4.1% of GDP. Further, the Government’s funding is <1% of GDP, which is far lower than the national average of other emerging nations. The present healthcare delivery ecosystem in India is dominated by the private sector, which accounts for almost 70% of the total healthcare delivery in the country. Delivering high quality healthcare to the rural India is further impeded by the focus of private players on major cities and Tier 1 cities. This gives rise to an urgent need to improve the penetration of high-quality healthcare systems in the Tier 2 cities and rural regions of India. A key to improving the healthcare provision is to address the market-specific challenges and regulatory bottlenecks such as the long gestation period for hospital infrastructure, availability of trained doctors and nurses, availability of affordable medical equipment and consumables, and better diagnostic facilities.
Healthcare sector in North India: The present scenario
The healthcare sector in North India is on a robust growth curve, growing in accordance with the overall growth of the sector in India. With the increased inflow of investment form private healthcare service providers in the northern states of Delhi, Punjab, Haryana, Uttar Pradesh, the region, on a whole, has been witnessing a surge in the number of new hospitals and diagnostic centres, as well as expansion of existing healthcare centres. Further, the region has also actively promoted investment in establishing pharmaceutical manufacturing infrastructure and medical equipment manufacturing units.
Still the region continues to lag behind other regions of India in terms of healthcare parameters. The number of hospitals as well as the number of inpatient beds available relative to the total population of the region is far lower than the national average. The states continue to battle the high rates of infant mortality as well as the incidence of deaths due to dengue, cholera, diarrhoea and other respiratory ailments. Also, the region is witnessing increased incidences of lifestyle related diseases, which continue to impact its standing on the overall healthcare barometer of the country.
The lack of requisite quality healthcare infrastructure in the semi-rural and rural area of this region in terms of the availability of doctors, proper monitoring mechanism and affordable treatment methods is one of the chief barriers to the delivery of basic healthcare services in the region. In order to address these issues, the Government of India has identified states such as Bihar, Himachal Pradesh, Jammu & Kashmir, Madhya Pradesh, Rajasthan, Uttar Pradesh and Uttarakhand for rolling out its ambitious National Rural Health Mission. Through this Mission, the Government aims to target the rural areas, provide better healthcare facility and also constantly monitor the health parameters in these regions.
Besides, the Central Government has also proposed the National Urban Health Mission (NUHM) scheme to improve the affordability and accessibility of healthcare services for the urban poor with a focus on slum dwellers and other vulnerable groups. Several central sponsored as well as state sponsored health insurance schemes have also been introduced for the economically backward sections of the states.
In order to supplement its commitment to improve the access of the increasing patient population to qualitative diagnosis and treatment at affordable prices, the various State Governments have also launched various innovative initiatives to attract Public Private Partnership (PPP) investments into the healthcare space. Hence, the prevailing healthcare scenario in North India provides an opportunity for the private sector to bring in significant change and impact in the way the healthcare services are being delivered in this region.
The key areas wherein the agenda has to be set for action would be:
· improving access to affordable real estate for setting up new healthcare and diagnostic centres
· using technology as an effective tool to monitor health parameters and deliver treatments
· leveraging existing infrastructure for providing effective and quality treatment
· adopting the PPP model to lessen the burden on the government and bring in efficiencies of the private sector
· improving access to indigenous medical devices by providing active support for local entrepreneurs for setting up infrastructure to manufacture indigenous medical devices and offer them at affordable prices
· addressing the skill gap through better education and training methods
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