Future of Healthcare in India

India has given birth to sages, Charaka and Shushruta, who have given the world the gifts of Ayurveda (Medicine) and Surgery, the basic foundation of modern-day healthcare. But today the same land ranks nowhere amongst the developed countries when it comes to healthcare. It is not because of medical technology or know-how but because of a lack of infrastructure.

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The fact that the number of doctors in the rural health care public system is less than the annual graduation of MBBS doctors in this country is reason enough to explore partnerships to provide service guarantees. Partnerships with professionals outside the public system are needed, based on trust and transparency, even to make the public system deliver quality services. It is increasingly recognized that public-private partnerships can play a significant role in the healthcare sector in India. Public-private partnership (PPP) as a vehicle to deliver healthcare services is being incorporated as a component in the policy landscape. The government of India's think tank, the National Institution for Transforming India (NITI) Aayog, has also flagged the need to launch small-scale studies in PPP mode to enhance the availability and quality of healthcare services. For the past several decades, the private sector has incrementally expanded its scope and terrain in the health sector and now contributes >70%.?According to the National Health Policy of India (2017), ～2.5 per cent of the Gross Domestic Product (GDP) must be spent on the health sector by 2025. The expenditure on health was ～1.8% of GDP in 2020-21 and rose to ～2.1% in 2021-22.

?The pandemic prompted collaborations in the healthcare

?During the Covid-19 pandemic, something rare happened. The pandemic catalysed both the public and private sectors leading to collaborations like never before in diagnostics, technology and treatment. The synergies that were seen in the management of Covid-19 are unprecedented, the CoWin portal being the best example. The pandemic has shown us strong evidence that by working together, the public and the private sectors can take quality healthcare to the last mile a lot faster and a lot more affordable. It would be a massive failure on the part of the healthcare fraternity if we do not further explore the feasibility of such public-private partnerships (PPPs) in the management of other deadly diseases. The private sector now has a rare opportunity to fundamentally redefine its relationships with health systems, healthcare providers and patients. ?

In 2021 alone, India received US$7.7 billion of committed investments across 25 projects, the largest in the South Asia Region. Whereas most countries in South Asia Region saw a sharp drop in PPI compared to 2020, India saw a 49% increase in private investment commitments. The two biggest challenges affecting healthcare in India are affordability and accessibility, with urban and rural experiences varying greatly. Here are three ways that PPP projects can help address the problems of accessibility and affordability in rural Indian healthcare:

?Expertise: The quality of medical aid and excellence of service are the primary differentiators that have driven a competitive advantage private healthcare institutions are thriving on. When spending out-of-pocket, 70% of Indians would choose private healthcare services over public institutions. Despite private healthcare being four times more expensive, 72% of rural residents and 79% of urban residents would not trust a public healthcare facility. Making the private sector services and expertise available in these public health facilities could be a game changer.

?Technology: Technology is the primary driver for ensuring accessibility and affordability in many cases. There is a reason why specialist resources are urban-centric, and we cannot afford to wait till this distribution goes on to become universal. Technology is the tool to be harnessed to take urban expertise to rural settings with minimum physical movement of the patient or of the specialist. Telemedicine initiatives are a strong case in point, the national teleconsultation service eSanjeevani being an apt example.

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Efficiency: The PPP model can ensure that the existing medical infrastructure and resources be leveraged through optimum utilization, at an affordable cost to the end user.

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1.???Partnerships in Medical and Nursing Education:- It recognized the emerging need for partnerships in Medical and Nursing Education. The efforts of the Government of West Bengal to seek partnerships with the Non-Governmental Sector in the training of ANMs was seen as an innovative effort to improve the capacity-building challenges in the short run. Some States have also issued advertisements asking for the Expression of Interest from the private sector, to set up Medical Colleges with the Government providing District Hospitals for caseloads and mandatory requirements of 300 bedded hospitals for Medical Colleges.

2.???Hospital Committees:- Every government health facility becoming a legal entity allows partnerships for services at those levels. The Indian Public Health Standards for each such Hospital allow the pursuit of basic service guarantees with the flexibility to hire locally. Human resources have been the greatest constraint in the past and these legal entities can help government hospitals to engage professionals on per case/per day basis. There is perhaps a space for HR agencies that can make available health professionals where they are needed. With a large number of private practitioners, it is possible to have a panel of private Specialist Doctors’ panels in CHCs/District Hospitals, who can be called in provide services in public sector health facilities on a payment basis. The Human Resource partnership holds the key to service guarantees.

3.???Outsourcing basic services:- The need for outsourcing simple arrangements like electricity provision, ambulance, cleanliness, laundry, diet, diagnostics, etc. in hospitals is well established. There are many experiments in the country where nongovernmental provision improves access to such facilities if these are monitored effectively

4.???System of incentives:-It may cost far more to keep a resident Gynecologist or a Surgeon in a remote rural area than in an easy urban location. This flexibility has to be exercised for a system to deliver and provide service guarantees. These specially crafted public institutions which are institution specific must have a mandate and the financial resources to provide incentives wherever required. The performance of these institutions can be monitored by independent research and evaluation institutions to see the extent to which service guarantees are provided. Non-governmental organizations can facilitate this process of innovations in human resource engagement.

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5.???Financing health care:- The total expenditure on health in India is estimated to be anywhere between 4.5 to 5.5% of the GDP. Of this, the current level of public expenditure is less than 1% of GDP. One also has to acknowledge that even though 30,000 MBBS Graduates pass out every year in our country, the entire rural health system up to the block level does not have more than 27,000 Doctors at any given point in time. The case of Specialists is worse with the vacancies in Government being extremely high. Specialists are largely available in the Non-Governmental sector and if we want people to have Specialist health services, we have to have mechanisms to enter into partnerships with them.

Examples of such models

Yeshasvini Cooperative Farmer’s Health Insurance Scheme, which was initiated by Narayana Hrudayalaya, Bangalore’s super speciality hospital and the Karnataka government, is a landmark initiative that has come as a great boon to the farmers in the state. Members can avail themselves of free surgery costing up to 125,000 ($1,545) and 200,000 for multiple surgeries and in urban Yeshasvini, the maximum limit of treatment per person for single admission is INR175,000 and for multiple admission is 250,000 in the same year.

The Arogya Raksha scheme in Andhra Pradesh is another insurance scheme initiated by the state government, in collaboration with New India Assurance Company and private clinics wherein. End-to-end cashless services for 1,059 diseases under secondary and tertiary care are being provided through 400 government and corporate network hospitals.

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