Healthcare for all

India has seen rapid economic growth over the last two decades, with per capita income nearly doubling in 10 years. But the downside of this has been the rise of a host of lifestyle diseases such as diabetes, hypertension, cancer, and cardiovascular diseases (CVDs). As a result, the proportion of deaths due to non-communicable diseases (NCDs) rose from 37.09% in 1990 to 61.8% in 2016.[1]
This rise in NCDs, coupled with low penetration of health insurance, pushed approximately 55 million [2] Indians into poverty in a single year – 2017 – due to high out-of-pocket expenses incurred in treating cancer and cardiovascular diseases.[3]

Though much depends on how India copes with the ongoing COVID-19 pandemic, government schemes are trying to ensure that low penetration of healthcare doesn’t push more people into poverty. In September 2018, the Indian government rolled out two national programs, or schemes as they are known— Ayushman Bharat Yojana (ABY) and Pradhan Mantri Jan Arogya Yojana (PM-JAY) — that seek to provide free primary, secondary, and tertiary treatment as well as health insurance worth Rs 500,000 (7,035 US dollars) to over 100 million families every year. PM-JAY is a component of ABY.
According to Indian government statistics, 119 million PM-JAY e-cards have been issued to the country’s poorest, and by December 5, 2019 over 6.5 million patients had been provided treatment worth 1.34 billion US dollars under these schemes.

Some states, including Andhra Pradesh, Maharashtra, Gujarat, West Bengal and Rajasthan have their own health insurance schemes. In Delhi, the state government is focusing on a public-funded model of primary care, known as Mohalla Clinics. Mohalla is the Hindi word for ‘locality’. The city boasts 300 Mohalla Clinics that offer free outpatient consultation and a range of diagnostic tests to over 20,000 people a day.

These schemes are bringing about a tectonic shift in the country’s healthcare provision. ABY sponsors almost all the complex surgeries and 1,394 procedures, covering 23 specialties in both public and private hospitals.

Apart from the government schemes, private hospitals have been able to reduce the cost of surgeries by applying economies of scale. For instance, Aravind Eye Care performs half a million eye surgeries a year at a cost of 90 US dollars each, or approximately 2% of what such a procedure would cost in the US.

Aravind Eye Care utilizes its operating tables in such a way that each room has multiple sets of equipment and multiple nursing teams. As a result, before the pandemic surgeons at Aravind Eye Care could perform six to eight procedures in one hour compared to on average one procedure per hour in the US.[4]

Moreover, a number of other private hospitals, including Sankara Nethralaya, LV Prasad Eye Institute, Alexis Multispecialty hospital in Nagpur, Amrita Institute of Medical Sciences (Kochi) Surya Super Specialty Hospital (Varanasi), and LifeSpring Hospitals Private Limited are fast making up the shortfall in secondary and tertiary care institutes in cities.

Digitalization is helping healthcare providers take quality healthcare to the most remote parts of the country. In cancer care, for example, HealthCare Global Enterprises Ltd (HCG) is relying on the hub and spoke model of delivery. Dr. B.S. Ajaikumar, Chairman and CEO of HealthCare Global (HCG), is using this model to take cancer centers to the furthest away places. He has 100 oncologists at the central hub supporting the spokes through telemedicine, tele-radiology and remote consultation.[5]
 

Such approaches also play a key role in tackling the pandemic. “COVID-19 has acted as a catalyst to drive up adoption of digitalization in the Indian healthcare industry,” says Elisabeth Staudinger, President, Asia Pacific, Siemens Healthineers. In the last couple of months, several firms have ramped up their telemedicine capabilities and are recruiting more doctors. “However, we are only at the start of the journey and need to accelerate the adaptation of digital means,” she adds.

Prior to the pandemic, public schemes like ABY were facing two challenges — costs and the availability of skilled resources, for example radiologists. The reimbursements provided by the government don’t cover all the costs incurred by private hospitals.

“We are addressing both these challenges through digitalization,” says Vivek Kanade, Executive Director at Siemens Healthineers, India. The company is working on innovative technologies while also creating financial structures, such as rentals and pay-per-use models, to improve affordability for hospitals and diagnostic centers. Siemens Healthineers is also offering solutions for remote scanning services, where multiple diagnostic machines situated in remote locations can be operated by expert technologists in the metro cities. "With solutions like syngo Virtual Cockpit, technologists can assist the scanning procedure from remote," adds Kanade. “Moreover, services like container-based CT imaging solutions can be deployed to deal with the pandemic.”

In 2016, India improved its ranking in the global healthcare access and quality (HAQ) index from 153 in 1990 to 145.[6] However, the country still lagged behind neighboring Bangladesh and sub-Saharan Sudan and Equatorial Guinea. Given the technological innovations and the efforts of both government and the private sector to improve access to quality healthcare, it is likely that India will not only leverage digitalization to fight the pandemic, but also improve its ranking in the next such report.