Covid As Catalyst

The rampaging coronavirus has proved to be quite revelatory. It has exposed not just the vulnerabilities of peo­ple with weak or compromised immune systems but also the gross inadequacies of India’s healthcare system — there being not enough hospitals, doctors, hospital beds, and pretty much everything else. 

At the same time, the virus has brought forth quite a few positive developments in its wake, such as the renewed focus on health and hygiene, the adoption of health tech and espe­cially telemedicine, which has somewhat reduced the burden on hospitals and doctors, freeing up their time to devote to critical cases. 

A Deloitte paper on ‘Changing consumer preferences towards healthcare services: The impact of Covid-19’ notes that 70–80 per cent of the people it surveyed responded positively towards at-home-care settings across consul­tations, diagnostics, day-care services, and in-patient care. Besides, the respondents showed significant interest in telemedicine across specialties. According to the study, the user base for telemedicine had doubled during the lockdown from 21 per cent to 44 per cent. 

Focus Areas 

Increasing expenditure on public healthcare to assure quality and access is imperative given the short­age of efficiently run, public health facilities. India’s public spend on healthcare, which stands at about 1.4 per cent of the GDP, needs to increase to ensure a better balance between public and private infra­structure, which in turn will keep a check on prices at private facilities, says Charu Sehgal, Partner and Lifesciences and Healthcare Industry Leader, Deloitte India

Further, the private healthcare sector that has been dominant in providing quality care needs to be acknowledged by the government especially, in regard to investment. “Private investment in healthcare, just as in any business, will seek a fair return and that should be allowed. Healthcare delivery is a capital-intensive business and sub­ject to continuing upgrades in tech­nology and skill. These costs need to be recovered. Government policies need to regulate unfair business practices and punish overcharging but not disallow fair returns. This will only reduce investment in pri­vate health and we cannot afford that,” says Sehgal.

Another key imperative is devel­oping the primary healthcare infra­structure and wellness centres in the country. Pankaj Sahni, CEO, Medanta points out that the primary healthcare sector needs boosting both from the private sector and the government. “At present, the entire burden of the primary and second­ary care gets shifted to the tertiary. Therefore, not only do we not have enough facilities, but also have over­burdening of the right kind of care not getting delivered in the right way,” he says.

According to Sahni, the current stressed situation the country’s healthcare system finds itself in has matured over a period of time, and is not simply a result of the outbreak of a deadly pandemic. 

“India has only 1.1 beds per 1,000 persons compared to the world aver­age of 2.7,” says Rajeev Juneja, CEO, Mankind Pharma while stressing the need to enhance primary and rural healthcare infrastructure. 

Saurabh Kochhar, the enterpris­ing entrepreneur and former Foodpanda CEO’s latest healthcare startup Meddo offers offline as well as online healthcare services through a tie-up with standalone clinics and labs. He believes that the healthcare sector is in need of over­hauling at multiple levels. “The sec­tor remains highly unorganised and fragmented which leads to health­care delivery gaps and concerns impacting all stakeholders. Despite significant efforts and reasonable penetration of schemes like Ayushmann Bharat, we are still focused on in-hospital expenses whereas, most of the treatment and expenditure happens in outpatient care (52 per cent) -- where the insur­ance penetration is less than 1 per cent. In a way, the entire system is geared towards pushing patients into the hospitals rather than keep­ing them out of it.”

He says encouraging a culture of digitisation and technology adop­tion to bridge healthcare delivery gaps is essential. Further, an over­haul of healthcare policies including insurance to offer holistic cover to patients including OPD and health­care at home services is required.

The Magic Pill: Health Tech

Coronavirus has also signalled the rise of heath tech, which has led the government to unveil the National Digital Health Mission (NDHM). The scheme would enable each indi­vidual to monitor his/her health data in a comprehensive manner. Essentially, each citizen can choose to participate though a unique health ID generated for him. PM Modi in his Independence Day address the NDHM seeks to revolu­tionise the healthcare sector with effective use of technology.

'Patient journey will now be delivered in parts'

Pankaj Sahni, CEO, Medanta  talks to  Jyotsna Shama about  the emerging trends in the healthcare sector, Covid management and overall learnings from the pandemic. Excerpts Covid-19 management at Medanta When the hospital was built, it was designed in such a way that every ward had its own air handling unit, an isolated space where doctors and nurses could wear their PPEs etc. A lot of infection practices are inbuilt -we have been quite lucky in this regard. As the cases are surging, doctors and nurses are now more familiar with the treatment options and the over-all management. We have a fairly aggressive Medanta home-care program where we have treated hundreds of patients by monitoring them remotely. We have also tied up with a hotel to save the hospital capacity for the really sick patients. Our doctors look after the patients in the hotel but the food and other amenities are provided by the hotel itself.   Upcoming trends in the healthcare sector One of the biggest trends to have emerged is that the patient journey will be delivered in parts rather than in one comprehensive unit. For an instance, earlier the patient would come in to the hospital, get admit-ted, get the entire range of  treatment and then get discharged. However, in present times, we can expect to see the treatment given in segregated parts. Some elements can be delivered at the primary care clinic, investigations can be done while being virtually con-nected to the doctor and the patient can come in only when actual treatment is needed. The second trend that’s being anticipated is to de-velop programs to empower patients, essentially to give patients more power during the course of their care journey. This is moving towards proactive health monitoring, which will shift to real health monitoring rather than the disease management. Lessons learnt from Covid-19 People have become conscious about hygiene includ-ing washing hands and wearing masks. Also, people have started to realize that there is no magic pill for health, they will start giving importance to the kind of food they eat and the kind of air they breathe. They are not only going to demand better healthcare delivery but also better health experiences.

A pilot launch has taken place in the Union Territories of Chandigarh, Ladakh, Dadra and Nagar Haveli and Daman and Diu, Puducherry, Andaman & Nicobar Islands and Lakshadweep. “Based on the initial learnings in the UTs, we will gradu­ally work in partnership with the states to launch the NDHM. I seek the whole-hearted support, inputs and cooperation of doctors, health­care facilities, citizens and state gov­ernments to adopt this game-chang­ing scheme,” Harsh Vardhan, Minister of Health & Family Welfare, said on the occasion.

Covid-19 management at Medanta 

When the hospital was built, it was designed in such a way that every ward had its own air handling unit, an isolated space where doctors and nurses could wear their PPEs etc. A lot of infection practices are inbuilt -we have been quite lucky in this regard. 

As the cases are surging, doctors and nurses are now more familiar with the treatment options and the overall management. We have a fairly aggressive Me­danta home-care programme where we have treated hundreds of patients by monitoring them remotely. We have also tied up with a hotel to save the hospital capacity for the really sick patients. Our doctors look after the patients in the hotel but the food and other amenities are provided by the hotel itself. 

Upcoming trends in the healthcare sector 

One of the biggest trends to have emerged is that the patient journey will be delivered in parts rather than in one comprehensive unit. For instance, earlier the patient would come in to the hospital, get admitted, get the entire range of treatment and then get dis­charged. However, in present times, we can expect to see the treatment given in segregated parts. Some elements can be delivered at the primary care clinic, investigations can be done while being virtually con­nected to the doctor and the patient can come in only when actual treatment is needed. 

The second trend that’s being anticipated is to de­velop programs to empower patients, essentially to give patients more power during the course of their care journey. This is moving towards proactive health monitoring, which will shift to real health monitoring rather than the disease management. 

Lessons learnt from Covid-19

People have become conscious about hygiene includ­ing washing hands and wearing masks. Also, people have started to realize that there is no magic pill for health, they will start giving importance to the kind of food they eat and the kind of air they breathe. They are not only going to demand better healthcare delivery but also better health experiences.

What’s health tech? According to the WHO (World Health Organisation), it is the application of organized knowledge and skills in the form of devices, medicines, vac­cines, procedures and systems developed to solve a health problem and improve quality of lives. 

According to Sahni, it takes more than a tele-consultation to think about care. Whether it’s remote connectivity, wearable devices, arti­ficial intelligence algorithms or even simple things like navigating hospitals via apps and payment mechanisms etc. -- the entire con­cept around patient awareness and empowerment is what tech helps with.

“I caution that just looking at tech in isolation is not the right way to think about it. So, just telemedi­cine or tele-consultation is not how we bring in care. The real value will be how we link the digital and online world with offline care,” says Sahni.

While that is true, telemedicine does remain an important aspect of the bouquet. SeekMed, a global tel­emedicine platform, witnessed multi-fold growth during the pan­demic. As per data gathered by SeekMed (April-June 20), super specialities like cardiology (150 per cent), orthopaedics (167 per cent), psychiatry (400 per cent) and gas­troenterology (344 per cent) saw a significant increase in tele-consults during the April-June quarter this year compared to the same period last year. 

“Our revenue model is based on a fixed commission for each consulta­tion. We don’t charge any annual subscription fee from our doctors or patients and have a meticulous met­rics of evaluation for clinician list­ings. Our operating model gives us flexibility to scale up without incur­ring high cost,” says Alok Awasthi, Founder, SeekMed. 

In addition to India, SeekMed has a significant presence in Bangladesh and Nigeria, “In the last one year of our operations, we have received patient requests from thirty coun­tries ranging from Australia in the east to the United States. Majority of our consultations happen for patients from outside India who seek a second opinion from our top doctors with many exploring treat­ment options in India,” adds Awasthi. 

In fact, drug maker Mankind Pharma recently partnered with DrOnA, a tele-consultation plat­form. “By collaborating with DrOnA, we want to bring a change by enabling every practitioner to create his own virtual clinic and pro­vide access to patients anytime any­where,” says Mankind Pharma’s CEO Rajeev Juneja, adding that the demand for telemedicine is largely in metros and larger cities. “The penetration in smaller and rural areas still remains low due to lack of affordability, accessibility, awareness and availability,” he says. 

For Care Health Insurance that was previously Religare Health insurance, Covid-19 has only has­tened the move towards digital. “This move towards digital has meant that we have been able to work from home effectively and engage with consumers, health­care providers and hospitals. Claim management and cashless transac­tions at Care Health Insurance have been smooth and efficient,” says Anuj Gulati, CEO & MD. 

It is not just insurance but even pharmacies and wellness related services have embraced digital in a big way and this is a welcome move benefitting all stakeholders. 

The Way Forward

The pandemic has made institu­tions and governments across the world realise the importance of a robust healthcare system. “One of the lessons learnt from the pan­demic for us here in India is the need for supply chain resilience in case of our medical devices and drugs. We cannot afford to rely unduly on one country for our sup­plies. For example, 70 per cent of our API for our pharma manufac­turers was imported from China and the Covid-19 situation caused serious disruptions in these sup­plies in the beginning of the year and impacted our pharma produc­tion. The good news is that the gov­ernment responded very quickly and had set in motion several initi­atives and incentives to encourage manufacturing of APIs as well as, medical devices within India,” says Deloitte India’s Sehgal. 

For us in India, this realisation that a solid healthcare system is the backbone of the country, and if not tended to properly, can cripple the country has come at a huge eco­nomic and humanitarian cost. Both the government and private players have responded to the recent ongo­ing crisis appropriately and done a commendable job but there is still a long way to go. 

Going forward, the government needs to invest in improving public health infrastructure, strengthen primary care facilities, invest in research and development and also develop world-class medical schools. Private entities need to be fair and balanced, looking at their work in the sector beyond mone­tary benefits.