‘Platformisation Of Indian Healthcare’ - Urgent Policy Imperative
To serve a stratified population of over 1.2 billion people who have different affordability patterns is a challenge to any industry. While it is an opportunity for brands to serve those audience, from public-good perspective, it is a tough ask for health-care policy makers.
Context of healthcare infrastructure
Even though substantial improvements have been made in health indicators in the last 10 years, the Indian health-care system continues to contribute large proportion to the global disease burden. The Indian health-care system has a three-tier structure of the primary, secondary and tertiary care services. By the Indian Public Health standards (IPHS), the delivery of primary health care is designed to provide an integrated curative, preventive, and promotive care to the rural population, through subcenter, primary health center (PHC), and community health center (CHC); secondary care is delivered through district and subdistrict hospitals, and tertiary care at regional/central level institutions or super-specialty hospitals.
The Indian Healthcare sector has challenges of inadequate distribution of healthcare service providers and the need for low cost (& yet impactful) healthcare solutions for increasing diseases (especially chronic ones). India has a doctor-to-patient ratio of 1:10,189 - much lower than the 1:1,000 recommended by the World Health Organization. India also has a huge shortage of doctors, nurses and paramedics. The government spends just 1.1 % of GDP on healthcare.
The rural and urban populations of India have varied experiences with healthcare. Over 70% healthcare infrastructure can be found in the urban India, where only 25% of the Indian population lives! A recent KPMG report reveals that 74% of doctors practice in urban areas. This means that nearly 3/4th of the population living in rural areas lack even primary healthcare facilities !
The Covid impact on this sector has demonstrated the selfless efforts that the healthcare industry demonstrated in caring and curing. It has also shown that as a nation, we need to substantially increase our public investment into healthcare. The private sector has struggled with returns on investments (RoI) due to various reasons. However, with proliferation of technology and digital tools, especially in the field of medicine, it could prove to be a game-changer.
To a large extent, public healthcare is heavily dependent on “processes”; to this effect, the Indian healthcare system needs to “up its game” in building lean-processes that are contemporary to the current & evolving needs of the population. And it can bring wider affordability and healthcare accessibility by including digital tools in its thinking.
Make in India
Thanks to the digital framework policy of the GoI, the availability of internet access across India has been growing well and quick. This coupled with the “Whatsapp” way of communication that keypad-literate Indians have adopted with a vengeance, could help push digital-healthcare ideas forward.
The GoI’s initiatives to encourage domestic production of healthcare equipments will help lower costs of healthcare access. In addition, the adoption of online-pharmacies and secondary-digital-marketplace of healthcare service providers have been proven by their steadily increasing usage.
In September 2018, GoI launched “Ayushman Bharat Yojana”. This National Health Protection Mission was initiated to provide healthcare insurance coverage for secondary and tertiary care hospitalisation. It is expected to benefit nearly half a billion people !
Diagnosis. Doctors. Digital. (At-home healthcare) Delivery.
According to WHO, Digital health is a broad umbrella term that includes eHealth and the use of emerging and advanced technologies in the field of, among others, big data, genomics and AI. “Digital health” denotes the usage of digital technologies that help in achieving universal-healthcare access and improve the health and well-being of people.
To support the current infrastructure as well as the number of doctors available in India, the digital healthcare framework should offer theme of “affordable & universal healthcare access, with full patient-centricity”.
Digital healthcare can help with efficient delivery of preventive, curative, and rehabilitative health services to people fighting chronic diseases, irrespective of their geographical location. The policy framework should also address the concerns of patient-confidentiality and yet not slow down the digital tools adoption for healthcare - right from diagnosis to treatment. After all, digital adoption can slash costs, enable faster diagnosis and hence increase probability of better cure. Fighting Corona pandemic has taught all of us ‘how to use technology’ and to our advantage and convenience.
A physical visit to a doctor/hospital can be replaced through video consultation, either through whatsapp or other video applications built by various service providers. There have been countless examples of how diagnostic reports (even digital MRI films) have been reached to the specialist-doctor using digital medium and how diagnosis have been done in-time, saving precious lives and reducing time to manage the health issue. Not only does it save the consumer (patient) from the hassle of waiting in queues, it also keeps them safe from infections. From the doctor’s point of view also, it is more efficient in serving increased number of patients and can improve the quality of interaction and diagnosis. Customers can have access to experts/ specialists, irrespective of which location they live in. And as an extended value chain, these digital healthcare providers can tie up with pharmacies that can use hyper-local to deliver medicines at the patient doorstep. In the last one year, teleconsultation has witnessed an uptick of more than 500% in India with 80% first-time users and e-pharmacy concept has seen a growth of more than 140%.
Data protection
Many of us have heard stories, where in the event of sudden hospitalisation, family members had to struggle to find the relevant medical records for doctors’ analysis. Where everything is becoming digital, from signatures on documents to Driver’s license to vaccination certificates, why can’t all medical records be stored digitally for easy access?
The sensitivity is to store it with adequate data privacy protection. Data privacy is the other sensitive topic (outside of care aspect) for the healthcare sector. Healthcare data privacy is covered in the European Union by the GDPR (General Data Protection Regulation) that took effect in May 2018 and in the U.S. by the HIPAA regulations. Taking inspiration from the regulations in the EU, the PDP Bill was put forward in 2019 by the GoI, to bring about comprehensive changes to India’s current data protection rules. Currently, data is governed by the Information Technology Act, 2000 and the rules thereunder. The proposed PDP bill is still pending final discussions and subsequent legislation. With the proposed PDP Bill as reference, we could see industry-specific data-policies and data-safeguard-regulations by sectoral regulators.
A National Digital Health Mission (“NDHM”) was announced by the Central Government, and the Ministry of Health and Family Welfare (“MOHFW”) published a blueprint in late 2019, recommending the creation of a National Digital Health Ecosystem (“Ecosystem”) which allows for interoperability of digital health systems at the patient, hospital, and ancillary healthcare provider level.
On December 14, 2020 the MOHFW approved a Health Data Management Policy (“HDM Policy”), largely based on the PDP Bill to govern data in the ecosystem. The HDM Policy lays down rules for recognition of entities in the data processing space, and attempts to create a consent framework for use and processing of personal data. The HDM Policy will impact the e-medical and e-pharmacy industry once implemented, as it will not only guide the use of data collected by companies and institutions, but also increase compliance obligations. India's Telemedicine guidelines were issued in March 2020.
In summary
Non Communicable Diseases (NCDs) have emerged as one of the largest contributor of death in India, accounting for 15% of the global NCD deaths and 60% of total deaths in India. NCD prevention is most effective when it works at the origin of the problem and if the intervention starts right at its beginning. Taking timely action is important to reduce premature mortality related to NCDs by a third by 2030 - which is a sustainable development goal (SDG) that India has signed up for ! Digital healthcare could play a vital role in delivering these goals.
Increased knowledge-management protocols and knowledge-transfer between the public and private sector as well as the civil society should be actively encouraged. Technology efficiency, consumer-engagement, service delivery effectiveness in other sectors (e-commerce) can be replicated easily in Healthcare.
Putting together a common data format and setting minimum acceptable data standards and privacy norms is a must. This would allow for massive data-collation process with patient-confidentiality and data-sanctity , which would then allow usage of analytics for preventive healthcare solutions and pandemic-predictions.
With usage of digital tools such as artificial intelligence (AI)-enabled medical devices, and blockchain electronic health records, wearable medical devices, the entire healthcare industry is set for new business model adoption. A platform is a business that enables value-enhancing engagement between producers and consumers; platform provides an open ecosystem with necessary governance framework for these interactions.
Globally, the race is on to be the first successful healthcare platform. The ecosystem dynamics in healthcare is far more complex. Platformisation of healthcare is an idea that’s just a matter of time from becoming reality. It’s about how-soon can we adopt it, in totality. Sooner we get it functional, we can demonstrate another “make in India, for the world” !
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