BackMint Conclave: Better medical technology, PPP could reduce disease burden
While considerable work is being done, India's healthcare sector is falling behind the curve, experts feel
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India, home to a fifth of the world’s population, spends about 1% of its gross domestic product on healthcare. It also shoulders a major share of the world’s disease burden— something which modern technology could help ease. The first expert panel of the Mint Healthcare Conclave held in Mumbai, moderated by Mint’s Vidya Krishnan, discussed technology in healthcare and how it could to be put to best use.
The government needs affordable medical technologies which can be scaled up to diagnose diseases in a better way.
“Medical technology and health devices can be serious force multipliers to bring healthcare to the larger section of the population. We do have certain criteria that these medical devices need to fulfil," said Meeta Rajivlochan, public health secretary of Maharashtra. Devices must be sturdy, easy to use and affordable. Companies, she said, must keep these aspects in mind while designing them.
“Healthcare in India is at a crossroads. Polio is defeated; medical tourism is on the rise. All good stuff is happening that is advantageous to the country’s healthcare system. But progress is overshadowed. Hospital-based care is of international system. But the care outside the hospital is very bad. This is a huge opportunity," said K. Ganesh, chairman and founder of Portea Medical, a healthcare service provider that treats patients at their homes.
Some emerging trends which lower cost while improving health outcome could benefit patients and hospitals alike. Ganesh feels that in this regard, the shift from hospital-based healthcare to home-based healthcare is the most important. The second trend is the reaction to proactive medicine. The third is a shift from a population-based medical scenario to a personalized one. According to Ganesh’s estimates, 80% of the care given in the hospital can be given at home with efficient technology.
Technology can boost operational efficiency as well. “Our challenge is (ensuring) affordability and accessibility of this technology to the common man. A doctor who was doing some charitable work in Uganda once called me for some medical help. He sent me images of the patient’s X-Ray over WhatsApp and on the phone, I told him what to do," said Dr Sudarshan Ballal, chairman of the medical advisory board and medical director at Manipal Healthcare Pvt. Ltd.
Experts believe that low-cost technology is an absolute necessity for business survival. “Cost in India is already very less compared with the cost of healthcare globally. An MRI (magnetic resonance imaging) here will cost you $50-60. Try getting that anywhere around the world, it will be $500-600. In perspective, India already has the lowest prices in the world, but further cost reduction must happen. But if the price needs to come down, the cost laden on it must also come down," said Dr Adheet Gogate, senior director and India head (healthcare transformation services) at Philips. There is a tax of 12.4% on importing medical equipment into India, compared with 2% in China, he adds.
However, a single-minded focus on cost could affect quality, some say.
“Unless you have world-class infrastructure, you will not have world-class prices. We cannot further lower cost for all those who are already asking to lower cost because that will affect quality. We now need to make technology for those who cannot afford it by finding alternative ways. We need a regulator that sets laws, prices, exchange mechanism and cross-subsidies," Gogate of Philips said.
At a very basic level, despite having low prices, the issue remains to be inequity. “We cannot be happy with the quality of infrastructure we have. We should aspire to be better. In Maharashtra, there is a very significant cushion in medical prices. This has a lot to do with reducing the cost of medical devices and the cost of medicines. Cost of medicines has been brought down by using generic medicines and economies of scale. Compromising on prices may not necessarily mean compromising on quality," said Rajivlochan.
While considerable work is being done, the panel felt that India’s healthcare sector was falling behind the curve. Dr Ballal said: “The government should confine itself more to primary care than to try and provide more to tertiary care. That could be left to the private sector, with the government providing insurance."
Have we been able to put technological advances to good use? Ganesh believes that significant developments in technology in the last five years and expected leaps in the next five years will help a lot. Computers will do a significant amount of the work. Technology can be put to very efficient use, driven by Internet penetration, cloud computing, broadband and falling prices of phones.
SESSION 2: Can a balanced diet and healthy nutrition lead to a better lifestyle?
Many of us spend three-fourths of our lives at the workplace. In this context, the workplace becomes very important in terms of maintaining a healthy lifestyle.
“Lifestyle by definition includes several things and not only stress, but also right nutrition, balanced diet, drug abuse, etc. All these together lead to a good or bad lifestyle, which in turn, lead to medical repercussions," said Dr Vishakha Shivdasani, who has a fellowship in nutrition and specializes in controlling diabetes, cholesterol and obesity.
Besides Shivdasani, the panel moderated by Mint’s Neha Sethi, included Madhuri Ruia, a diet and nutrition specialist and a Pilates expert; Dr Ramen Goel, bariatric surgeon, and Mint’s C.H. Unnikrishnan.
“Diet in itself can play a big role in controlling stress at the workplace. We can’t change tough deadlines, tougher bosses, and economic upheavals but how you eat is up to you," said Shivdasani.
“Exercise is as important as nutrition is. It’s the food on your plate, combined with the exercise you do that gives the kind of invincible health that you need and gives you profit for your organization," said Ruia.
“Workplace dynamics don’t suit the human body at all, because we are not designed to sit in front of the computer and work. You must learn to keep active throughout the day," Ruia adds.
There are ways to stay fit while working and it is important that employees are aware of it.
“The working environment has changed a lot. In metros, the lifestyle, the work timings are totally different from what many people have followed in the past. We still do not have enough awareness of a healthy lifestyle neither in the corporate world or otherwise," said Unnikrishnan.
When diet and exercise fail, people resort to surgery.
Many people suffer from lifestyle problems, feels Dr Goel. “The workplace is not related to office any more. With iPads and Blackberrys, the office has literally reached the home. We are working around the clock. To break this cycle, some very small changes are needed. CEOs should lead by example," said Dr Goel.
Small steps can help corporates promote healthy lives. “One thing is that one needs to start the day on the right note. People say they are busiest in the morning, but you need to start correct. Secondly, you need to eat every couple of hours. Move from white sugar to brown sugar. Serve whole wheat snacks. Serve good fats, good protein. Choose your food properly. You don’t need to count your calories, there is no such thing as counting calories," said Shivdasani.
“We should not feel ashamed of eating our meals, even if we are in a meeting. You won’t get the cravings when you eat right. Eating right is the best way to reduce stress. Thinking clarity improves greatly," Ruia said.
Dr Goel feels it’s a question of setting role models. The only way to motivate people is for senior executives to set an example. “If the prime minister starts walking on the roads tomorrow, then the ministers will also start walking and the whole bureaucracy will start walking. It’s a role model thing," he said.
Contrary to popular belief, obesity is not something that affects the rich alone. “We know that maids that work in our homes, their kids are getting fat. Even pets are getting fat. There is an aspirational value attached to fast food. If you tell a lower middle class person to not go to a McDonalds, they are not going to listen to you. I think a certain kind of regulation is needed, like in New York they have stipulated the maximum size of the cola that can be served," said Dr Goel.
“Obesity is the one disease that can bankrupt this country. When you see the statistics of deaths in this country, you will never find obesity, but it is what leads to most of the conditions. Where do you get healthy food in this country? Even in hospitals where nutritionists manage food, the food is unhealthy," Goel adds.
It is not only hospitals and fast food chains that provide unhealthy food. The problem starts at a younger age and experts believe we should start dealing with the problem early enough. Prohibiting sales of unhealthy food at schools could be a good beginning.
“A lot of the affluent schools in Mumbai... you look at the meals that they are serving to children, it’s appalling," said Shivdasani. “They have everything refined, white flour, desserts in every meal. So, when the child comes home, he is going to want to eat the same kind of food at home. And that is why it is the parents who play an important part. They need to educate their children about it," he said.
SESSION 3: Public-private partnership model for
healthcare
India needs to create infrastructure and groom talent for its future, but there is a big gap between demand and supply. In order to improve delivery of healthcare services, we have to combine our forces in infrastructure, finance and talent. Together, they will provide better healthcare services. Could public-private partnerships (PPP) show the way?
The expert panel on the PPP model for healthcare was chaired by Mint’s deputy managing editor Anil Padmanabhan and included Meeta Rajivlochan, public health secretary of Maharashtra; G. Srinivasan, chairman and managing director, New India Insurance Co. Ltd; Muralidharan Nair, partner, healthcare advisory at Ernst and Young and senior member in Central Committee for Universal Healthcare Project; D.G. Shah, secretary-general at the Indian Pharmaceutical Alliance; Vishal Bali, Asia head for healthcare at TPG Growth, and Dr R. Panda, vice chairman and managing director, Asian Heart Institute.
“As a country, we contribute 21% to the global disease burden. We have 0.9 beds per thousand people as against WHO recommendation of three beds per thousand to provide for baseline health services. We are among the last five countries in the world in terms of public spending on healthcare. We have an acute shortage of 1.4 million doctors and 6.8 million nurses to meet even the basic WHO requirements," said Bali.
Shah agrees. “I am not a pessimist. We will be able to overcome the challenges. In any healthcare PPP model, medicine is a part of the model. What the pharmaceutical industry needs to do is to provide abundant availability of safe and affordable medicines and provide access to as many as possible," he said.
Nair sees PPP as some kind of a promised land discussed for long but not delivered. He feels the business case for PPPs is very strong. The kind of challenge in finding funds to meet even the basic needs often makes healthcare a luxury, he said.
“The only way to solve this is for public and private sector to work together. We have 65% of capacity in public sector and 75% of human resources in private," Nair said.
Trust deficit seems to be the most important problem with PPP in healthcare, especially in the context of health being a social subject.
“The question is not much about availability of funds but how these funds are being utilized. The most important issues were regarding the quality of service provided, whether it was in a public hospital or in a private hospital. Issues like lack of transparency in the treatment procedure, unnecessary treatments and administering expensive drugs came up. But the biggest problem was lack of standard operating protocols in both public and private hospitals," said Rajivlochan.
Healthcare for all still remains a distant dream. “Hardly 25% of people are covered under health insurance. In India, we have a peculiar situation where people below poverty line have a health insurance and those above it don’t. The solution for healthcare for all is to have health insurance for all. But at present, health insurance covers only hospitalization; so we need to move to covers which provide for even outpatient expenses," said Srinivasan.
Panda explains that healthcare in US is fully private while that in the UK is public-funded. India cannot adopt either of these system fully, since it will have to massively increase spending for that. The best model for us, he says, is the PPP model.
There are clearly worries on managing PPPs in India, in the absence of a national framework. Rajivlochan believes there hasn’t been much debate about such a national framework either. Few people outside the insurance industry want to talk about regulation, she said. All experts, though, agree on the need for a healthcare regulator.
The PPP model has been a success in some sectors. “We have better airports, roads and ports because of PPP. So, the question then is, how do you translate some of the good earnings of PPP in other areas like infrastructure to healthcare," said Bali.
The country has not addressed the need for a healthcare regulator. “No industry wants regulation. But the insurers have lost a lot because of the lack of regulation in healthcare. We have been paying left, right and centre and it is going to prevent the growth of health insurance in this country. So, regulation is very important," said Srinivasan.
Bali says that “the word that we should use is ‘responsible regulation’, because very often in this country, when we start regulating, we destroy value and healthcare cannot go down that path".
Regulation means to have standards and enforce those standards. “We don’t need to go through a number of licences. What we need are standards, which should be mandatory," said Panda.
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