Healthcare: Healing At Your Doorstep
There aren’t hoards of moaning patients vying for the doctor’s attention. You won’t even notice any unrelated family members huddled outside the patient’s room. In fact, nothing is like a conventional hospital scene. However, all the necessary paraphernalia including monitors, nurses, doctors and high-end medical equipment are all present — within the confines of your own home.
Welcome to the world of healthcare at home. Not only are you more comfortable, but the service is also cheaper — almost 3-5 times lesser than standard hospital charges. As healthcare services make deeper inroads into people’s houses, it looks like soon only highly specialised services such as surgeries will remain confined to the hospitals.
The concept of providing healthcare facilities at home has been around in other countries but only limited to nursing care or, at best, the presence of an attendant. A few Indian players are trying to replicate the concept in India but in a slightly more elaborate way. For instance, service providers in India are not just working with hospitals and doctors but also with pharmaceutical companies to deliver the stock of medicines, mostly high-end, at the patient’s door step. And these services are just a minuscule drop in the home healthcare ocean growing at a CAGR of 18 per cent from $3.2-billion in 2016. A CyberMedia Research, reports that the market for home healthcare in India will reach $6.2 billion by 2020.
While several governments have talked about the need to spend at least 2.5 per cent of the GDP on health, the Indian government only spends about 1.3 per cent of the GDP on the sector as per the 2015-16 figures. The public health system is dysfunctional and “personal pay” is the dominant mode. Despite having the best doctors, care outside private tertiary units is almost non-existent. This is especially disturbing in a country that has one of the lowest doctor-patient ratios — 1 physician per 1,700 persons. Of the $80 billion healthcare industry in India, $40 billion is non-tertiary care and there are no credible players in that space. Clearly it seems like healthcare services could bring relief to the existing but overburdened hospitals and fractured healthcare landscape.
Caring At Home
Sixty-one-year-old Jayanti Prakash (name changed on request), based in New Delhi, was suffering from chronic lung infection. She was admitted to a nearby hospital and was being fed through tubes. Intravenous (IV) medicines were infused and, soon, she was put on a ventilator. Doctors recommended that care should now be continued at home with the help of home care service providers. So, from a hospital, Prakash moved back to her very own room, with a view of her memorabilia, sculptures of God and photos of family members. The whole ICU set up was recreated at home. Qualified nurses and doctors were by Prakash’s side throughout to monitor her vitals and continue the treatment as prescribed by her hospital doctors. With the help of service providers, she was weaned off the ventilators in 41 days. She graduated to oral diet and soon was rid of the infection. Senior citizens, even while they are ill, prefer to be in familiar settings. And as in Prakash’s case, she was successfully able to recover at home.
Even as early as three decades ago, home visits by doctors was almost a norm. Now, it seems, the wheels of time have taken a full turn and it is back to doctor home visits again, but for a more complex diagnosis as opposed to an ordinary fever or a cold. With the advent of technology, automated healing techniques and portable equipment, there is no doubt the ecosystem of the healthcare industry is witnessing a paradigm change today. And going by industry reports, private health spending in India is more than double the government’s expenditure. A recent PwC report pegs the private health spending at 3.3 per cent of the GDP in 2014. Certainly, healthcare services at home gives more space to innovation in private healthcare delivery model. The medical equipment manufacturers too are supporting healthcare services making roads inside the houses. “The home healthcare facilities provided by Philips for chronic obstructive pulmonary disease patients range from Rs 5,000 per month to Rs 3 lakh a year, while that for iCU@Home start from Rs 8,000 per day,” says Priyank Agarwal, head of strategy and direct to patient businesses, Philips India. 
Fractured Healthcare
India’s total expenditure on health is 4.7 per cent of the GDP, which is way less of what other countries spend. For instance, while China spends 5.5 per cent of the GDP, the US spends a whopping 17 per cent of their GDP on healthcare. The global average remains around 10 per cent, according to PwC.
Moreover, though health spends by the government are rising every year in absolute terms and on a per-capita basis, there is no significant increase in the percentage of money allocated to healthcare. For instance, the per-capita spending on health by the government rose to Rs 973 in 2015 from Rs 621 in 2009 but the government’s expenditure on health as percentage of GDP did not see a significant change in the five-year period between 2009-2014, according to data from Ministry of Health and Family Welfare’s national health profile. India’s total public health spending outlay for the current financial year is expected to be Rs 1.80 lakh crore.
Aswini Kumar Mishra, assistant professor for Economics in BITS, Goa campus, writes in his essay in the book Caring for the Elderly: Social Gerontology in The Indian Context, as per the Census of India 2011, about 103.84 million of India’s population was above 60 years. The figure is expected to be 323 million (19.1 per cent of the total population) by 2050. And unlike the nuclear family in the Anglophone world, the joint family is prevalent in India, where there are significant cultural pressures to care for ageing parents. Therefore, an organised sector for caring for the elderly was hardly explored. “Geriatric care or the care of senior citizens in India was a complete white space opportunity — there was essentially no organised senior care sector in India,” says Meena Ganesh, MD & CEO, Portea Medical. “The space is at stage zero and we established Portea to allow people to heal at home bringing doctors, nurses, nursing assistants and physiotherapists to people’s doorsteps.”
The irony is that despite an estimated 100 million elderly in India, the home healthcare industry is still at its nascent stage. According to industry experts, families could save over 60 per cent on the medical costs and reduce the chances of acquiring hospital borne infections such as staphylococcus aureus or even pneumonia, if they opt for professional care giving at home. Already, non-communicable diseases, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and cancer cause one in two deaths in India. By 2050, 200 million people (of the 323 million over-60) are likely to be suffering from chronic ailments underscoring the multi-pronged nature of the problem confronting the country.
Services at Home
Apart from creating ICU facilities at home, the service providers offer post-surgical care such as stitch removal, IV antibiotic therapy, cancer care such as chemotherapy, cardiac care such as continuous remote ECG monitoring for high risk patients, pulmonology care including oxygen therapy. Apart from this, services such as invasive home ventilation, injection administration, catheter insertion, blood transfusion and dialysis are also done at home. Medwell Ventures, a Bengaluru-based home healthcare service operator, raised around Rs 135 crore in April from a cluster of investors including Mahindra Partners and their existing investor Eight Road Ventures and F-Prime Capital Partners (part of Fidelity International). Medwell, which operates Nightingales specialty home healthcare services, claims it was the first to introduce home dentistry in India. Nightingales has grown exponentially since its launch in 2014 across four cities, 14 branches and 1,500 people.
Working Models
Home care is a service that has been around for more than a century in the US and some parts of Europe. However, Indian companies make use of three different home care approaches: Bengaluru’s Medwell’s branch and sub-branch driven model; another Bengaluru-based firm Portea follows the call centre-styled model and is now turning to be a marketplace for mature services. More companies in this space are being noticed, especially by the investors. Noida-headquartered HealthCare At Home India (HCAH India) has raised Rs 250 crore from Singapore-headquartered Quadria Capital, which primarily invests in companies dealing with healthcare and pharma. HCAI India, a joint venture between the Burmans, promoters of FMCG major Dabur India, and the founders of UK-based Health Care At Home, run local offices for back-end operations with centralised quality and offers high-end home health services such as chemotherapy, post-operative care, ICU at home.
In the West, the idea gained traction due to the prevalence of insurance-led model. Hence, with increasing penetration of insurance as well as awareness, the healthcare experts believe that the market of healthcare inside home could capture half of the healthcare industry business.
“We are in advanced discussions to raise $25 million. The funding will be used to strengthen our technology and broaden our services spread in each of the 16 cities where we are present,” says Portea’s Ganesh. The company also undertook funding of $9 million in late 2013, $37.5 million in September 2015.
Medwell says the company is not looking at the next round of funding anytime soon. “However, we are quite bullish on expansions. We are planning to increase our branches from 15 to 60 in the next couple of years,” says Vishal Bali, chairman, Medwell Ventures. HCAH India CEO and co-founder Vivek Srivastava says, “We are looking at touching revenue of Rs 1,000 crore by 2020.” Clearly care services at home is gaining attention from both startups and investors.
Towards Better Strategies
While the numbers speak volumes of the popularity of the sector, the biggest challenge for the industry is to ensure adequate oversight of healthcare delivery model since it is outside the confines of a medical facility. “While it is a welcome disruption, such services are prescribed mostly to patients where hope of recovery is slightly less. Where chances of recovery are high, the idea will be to keep them under monitor,” says Dr J.S. Arora, member, advisory group, Patients for Patient Safety (PFPS), a WHO initiative.
Still, several players continue to enter the home healthcare business in India. For instance, Philips India entered the sector by floating a new entity Philips Home Care Services (PHCS). The wholly owned subsidiary of Philips India will focus on delivering both devices and medical services at the consumers’ household. According to Philips India’s disclosure to the Registrar of Companies (RoC), the company carried out a pilot study under ‘Project Vijay’ for operating the home healthcare business for over a year. Philips will provide home healthcare treatment, diagnosis and care for ailments such as heart failure, respiratory disease, post-surgical treatment, sleep disorder, kidney and cancer care. PHCS says the company has grown 10 times in the last 10 months. “We are targeting a growth of 20 per cent over the next two years,” says Philips India’s Agarwal.
New players are entering the healthcare sector with a model that stresses on patient’s well being as opposed to looking at it as business model. For example, the Rs 50,000-crore diversified conglomerate ITC, which has interests in FMCG, tobacco and hospitality, has decided to set up a multi-speciality hospital to mark its foray into the healthcare sector. And the company is set to make a difference in the healthcare sector. Chairman Y.C. Deveshwar announced at the company’s annual general meeting held recently that the proposed hospital will provide incentives to doctors based on how well they serve patients and not for bringing in business for the establishment. Now, that’s another giant step towards promoting healthcare as a social cause.
