It’s business, not public service

It’s business, not public service
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First Published: Tue, Jul 15 2008. 11 54 PM IST

Updated: Tue, Jul 15 2008. 11 54 PM IST
Amid cutting ribbons at a Navi Mumbai hospital and blocking traffic last week, President Pratibha Patil implored India’s 31,000 medical graduates who finish up every year from 271 colleges to “contribute” to a less urban India. Most of them won’t. You, I and our President already know that. There are easier ways to make a living. 
Let’s first bust some expectations. Some of us believe that health care must be provided universally free by our governments. Nice, but no thanks. Another related assumption: Increasing health care access (especially in rural areas) equals a public service project (i.e., no money). We also seem to believe that increasing health care access means spending more money and not making more money. Somehow, we don’t feel the same about mobile access (imagine a Sampoorna Grameen Mobile Yojana...tsk, tsk).  
Our 34-year-old office attendant Parashuram is from a sugar cane- growing village in Kolhapur. When not serving tea, he reads Lokmat on the Internet and maintains our “petty cash” accounts on Excel. He left his family and moved to Mumbai 15 years ago, but hasn’t yet made the money to move back.  He recently rushed home after an SOS and called to tell me that his wife was nearly dead.  
Last year, she underwent two unsuccessful gastrointestinal procedures. Currently, her organs are so bad that fluid oozes out of her abdominal sutures. Being a diabetic doesn’t help. We emailed her reports to a kind physician friend in South Carolina. It’s too late for even a specialist to help. Today, she’s left to her body’s own might to get well. Parashuram has spent his savings and is wondering what to do next.
Most patient-gone-bad stories are rooted in bad or delayed diagnosis. Whether it’s Mrs Parashuram or President Patil, everyone wants one thing when they go to see a doctor: to get out OK, quickly. They will pay within their best means to access trusted, good quality health care.  
Let’s examine how three types of businesses can greatly benefit by increasing health care access in India.
Telemedicine has done the rounds for several years but hasn’t really taken off because the tele part needed to be in place. With inescapable mobile connectivity, that got covered. But how do you use this to diagnose a patient? There are clues. Welcome to CellScope, a device that attaches itself to a cellphone and converts it into a microscope. Developed in University of California, CellScope can peer into blood and identify a strain of malaria or even count cancer cells. It’s exciting because it capitalizes on a global trend that has everyone from cowherd to CEO connected. More applications are bound to follow.
Mobile operators in India will do well by sparing their advertising budgets to create newer channels of mobile usage in partnership with device manufacturers (such as building health care applications). The more reasons for Parashuram’s family to use the cellphone, the more these businesses benefit.
Retail health clinics are nearing 1,000 in the US. Consider MinuteClinic. Started in 1999 and acquired by integrated pharmacy services provider CVS in 2006, the firm operates 516 clinics in 25 states. They offer top quality, affordable treatments and deploy trained nurses (not expensive doctors) at retail locations. One of America’s largest insurers is quietly experimenting with Cisco Systems to make this model more virtual. The outcome of its project is to keep employees of clients healthy through the Internet (a physician “sees” you through a computer).
The virtual retail clinic model fits easily with the expansion plans of Indian retailers seeking new channels of growth and differentiation. We all know of a certain bazaar that’s big and expanding to tier IV locations such as Udipi or Asansol, or a megamart that’ll explode to 500 hypermarkets soon. There are Choupal Saagars, the rural hypermarkets expected to expand to 700 within the decade. These retailers can incorporate a hub-and-spoke model coupled with virtual access to exponentially increase outreach.
Last October, Microsoft launched Health Vault, a website to help patients maintain their medical records. Google followed this May with Google Health. I signed on a few days back. The site lets me add profile details, medications, allergies, tests, immunizations and even shows drug interactions dynamically. And, if my records are with MinuteClinic or Walgreens, I can simply import those. I’m wary of Google reading my health records, but I’m still impressed. The advantages outweigh the worry. Microsoft and Google also got major endorsements from Kaiser Permanante and Cleveland Clinic, respectively.
There’s an obvious trend here. If I were Google, I’d be eager to partner Indian retailers and quickly get a major boost in volumes for my health care solution.
Let’s imagine Parashuram’s situation a bit differently. His wife has a problem in her abdomen and goes to the nearest retail outlet. She scans a pre-purchased health card, a medical technician examines her, pulls up her record, reviews her history and uploads the new findings. Pathology tests are sent to a central location. Depending on the level of complexity, specialist physicians at a hub review cases. If the doctor needs to speak to the patient or “see” her, she can do so virtually.  
A retail clinic’s medical diagnosis is likely to be more trusted than that of a local practitioner. Patients as consumers already trust the ever widening retail platform. Retailers need to actively build partnerships and create a responsible health ecosystem for their consumers. This isn’t just about saving someone’s wife. There’s money here. President Patil, please try this model and our medicos might just show up more often outside the city.  
Praveen Suthrum is president, NextServices, a health care solutions firm based in Ann Arbor, Michigan, and Mumbai. He blogs at Comment at
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First Published: Tue, Jul 15 2008. 11 54 PM IST
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