Experts opine on how the Indian healthcare industry has evolved in the last decade and half
Alternative therapies need greater recognition and encouragement
A journalist asked the Police Commissioner of Delhi how is he going to enforce the odd-even car numbers on alternate days to combat pollution in National Capital Region since he does not have adequate force to watch every street. Smart response from the top cop was every citizen would participate and join the police in this mission! True, creating awareness against pollution is job half done. Healthcare is no exception and we have seen this in the past decades. Take the example of our country, which is considered the diabetic capital of the world. How the strong awareness created to have early detection and change in life style has almost taken away the sting of this once considered dreadful disease. People have now realised they can lead normal life despite being diabetic.
The other major challenge that has been cracked is in the area of diagnosis. Earlier doctors had to do trial and error to rule out possibilities. Technological explosion has enabled the medical world to pin point not only the disease type but also facilitate targeted therapy. It has resulted in early treatment and lesser side effects.
On the surgery front the buzzword has become non-invasive and minimal access. Open surgeries are history. Minimum blood loss, shorter hospitalisation days and quicker resumption of routines are now possible, thanks to robotics.
Moreover, the focus has shifted from illness to wellness. Annual check ups are becoming a part of life. Today, genetic studies give early warnings for change in life style!
Given the lesser number of hospital beds (one bed for every 350 in the US, 85 in Japan and 1050 in India) home care, be it palliative or otherwise, is gaining importance.
On the technology front, electronic communication has brought about sea changes. Tele radiology/ medicine is a boon to rural people. Online medicine is reducing not only the sole dependence on distribution channel but also cost per se! Web casting and mobile apps let rural doctors get their Continuous Medical Education from opinion leaders living in urban cities.
But the challenge remains on how do we democratise healthcare. With 70 per cent of the population in rural areas, major happenings of the last decade are still to penetrate these areas. Non-availability of qualified medical professionals (0.7 doctors and 1.5 nurses per 1000) and high cost of medicare are the burning problems, which need to be urgently addressed. Commendable initiatives taken in eye and cardiac care by private doctors make one believe that several other initiatives are in the realm of reality.
However, the government has a major role to play. Private – public initiatives have to mushroom. Make in India movement has to find a deep-rooted place in manufacturing low cost medical equipment and devices. Locally made cardiac stents have paved the way. All that is required now is a greater push.
Alternative therapies need greater recognition and encouragement.
Lets hope the coming decade squarely addresses all the above and make India an all-inclusive healthier nation!
– N Santhanam, CEO, Breach Candy Hospital
There has been a tremendous improvement in the quality of healthcare services in India
Over the years, India has seen tremendous improvements in its healthcare sector. Some of them are as follows:
Accreditation
The standard of healthcare services in terms of cost, diagnostic procedures and therapeutic procedures may differ between various providers. Over the last few decades, there has been a tremendous improvement in the quality of healthcare services in India. This is illustrated by the significant improvement in health indicators such as life expectancy at birth, infant mortality rates, maternal mortality rate, etc., over this period. Standardisation of protocols through accreditation could be an effective step for eliminating disparity in the quality of healthcare services being offered. Accreditation offers advantages of higher efficiency, accountability and governance. The National Accreditation Board for Hospitals and Healthcare Organisations (NABH) is a branch of Quality Council of India set up with the cooperation of Ministry of Health and Family Welfare. The first set of NABH standards for hospital accreditation were released in 2005.
The Transplantation of Human Organs (Amendment) Bill, 2009
It is meant to streamline the process of organ transplantation and curb instances of illegal dealings. This Amendment Bill provides for the regulation of the transplantation of human tissue along with the transplantation of organs. The amended bill regulates removal, storage and transplantation of human organs and seeks to strengthen provisions to curb commercial trade in human organs while facilitating organ transplantation for needy patients.
Aruna Shanbaug judgement
In a path breaking judgement, the Supreme Court of India allowed ‘passive euthanasia’ or withdrawal of life support to patients in permanent vegetative state (PVS). Simultaneously, it rejected outright active euthanasia or administration of lethal substances to end life. The court refused mercy killing for Aruna Shanbaug who lay in a vegetative state for 37 years. It did set tough guidelines for passive euthanasia ensuring its implementation under a court monitored mechanism.
Medical tourism
India has emerged as one of the top three destinations for medical tourism in Asia. Within Asia, India, Thailand and Singapore are the three countries that receive maximum medical tourists owing to low cost of treatment, quality healthcare infrastructure, and availability of highly-skilled doctors. Estimates suggest that India’s medical tourism market is expected to more than double in size from $3 billion at present to around $8 billion by 2020.
Yeshasvini Co-operative Healthcare Insurance
Yeshasvini Cooperative Farmers HealthCare Scheme (Yeshasvini Scheme) was introduced by the state government to the co-operative farmers of Karnataka. It was designed for the farming community to undergo hospitalisation when required at a medical centre of their choice.
This particular healthcare model involves:
- A small monetary contribution
- Minimised administrative costs
- Successfully ‘packaged’ hospital prices at pre-agreed, reasonable levels.
Presently, Yeshasvini is one of the largest self funded healthcare scheme in the country.
– Dr Bishnu Panigrahi, Group Head, Medical Operations, Fortis Healthcare
There is a growing consciousness about health related issues among people
India has taken some landmark initiatives over the years to better its healthcare system. On April 12, 2005, the Ministry of Health and Family Welfare launched the National Rural Health Mission (NRHM) to address the problems of healthcare in rural areas. Under the mission, healthcare funding had increased from Rs 27,700 crores in 2004-05 to Rs 39,000 crores in 2005-06 (from 0.95 per cent of GDP to 1.05 per cent). At the national level, infant mortality rate reduced to 30/ 1000 live birth and maternal mortality ratio reduced to 100/100,000. Malaria mortality reduction rate 50 per cent up to 2010, additional 10 per cent by 2012. Leprosy prevalence rate reduced from 1.8/10,000 in 2005 to less than 1/10,000 thereafter. In the same year, the tuberculosis DOTS programme maintained an 85 per cent cure rate.
In 2006, the government announced to build new AIIMS or AIIMS like institutions in Jodhpur, Patna, Raipur, Bhopal, Rishikesh and Bhubaneswar to bring down the cost of treatment.
Since 2006–15, 16 new AIIMS and AIIMS like institutions, were announced in the Union Budget, however, the construction for 2006 AIIMS like institutions started in 2009 and 2010 with 60 per cent of work completed. In Bhopal AIIMS, the cost of construction is said to have doubled from its 2009 estimate of Rs 682 crore. The main challenges for these institutions are shortage of doctors, nurses and trained staff. Most institutes are outsourcing nursing staff to external agencies, for instance. AIIMS Raipur has only 64 faculty members for the 24 non-clinical and clinical departments out of the required 41. There is no doubt that these facilities are required to create better health outcomes. Currently the need is to strengthen the primary and secondary care network.
Apart from this, the National Programme for Prevention and Control of Diabetes, CVD and Stroke (NPDCS) was launched in January 2008. The objective of the pilot phase was risk reduction for prevention of NCDs (Diabetes, CVD and Stroke) and early diagnosis and appropriate management of diabetes, cardiovascular diseases and stroke.
The impact was great as there awareness was generated on healthy lifestyle, health promotion at school, community and work places and decrease in the incidence of non–communicable diseases.
A tax benefit of Rs 5000 was implemented on preventive healthcare check-ups. In the Union Budget, the Government of India announced tax benefits by widening the scope of Section 80D (IT Act). A complete tax waiver was given on payment made on account of preventive health check-up of upto Rs 5000 within the overall deduction of Rs 15,000 available with respect to premium paid towards a health insurance policy for self, spouse and children. A similar deduction is available for investments on policy for parents.
There is a growing consciousness about health related issues among people, giving a boost to preventive health check-ups in hospitals.
Annual health check-ups, which were largely the privilege of corporate executives, are now being sought after by the middle class as well. Most hospitals routinely cater to walk-in patients that avail tailor-made packages for all age groups.
We have observed a rise in the number of people who have come for check ups, especially from the corporate sectors/working population. There has been an average increase of 15-17 per cent in increase of check ups till now.
Relative to treatment procedures, preventive health interventions are cost-effective, both from the prospective of health service payers and public funded health systems. Early diagnosis and prevention of disease and its symptoms reduce burden on inpatient/outpatient care, ambulatory services, medications and rehabilitation.
In October 2015, a new ayurvedic medicine for type-II diabetes, BGR-34, was launched. The Lucknow-based Council of Scientific and Industrial Research (CSIR) laboratories prepared new and effective Ayurveda drug made from four plant extracts to treat diabetes. The drug, introduced in tablet form, may cost Rs 500 for 100 tablets. If taken for a longer period, it may also reduce dependence on insulin. The tests carried on animals and related scientific study found it to be safe and effective with clinical trials showing 67 per cent success.
The development of ‘BGR-34’ will help to eradicate diabetes in India, which is also known as the ‘Diabetes Capital.’ It is an innovation for the masses developed within the resources available with the institutions and has the potential to cut through the market.
– Amol Naikawadi, Joint Managing Director, Indus Health Plus
Increased awareness about importance of quality in healthcare is a welcome development
The last 15 years of the new millennium have been both exciting and challenging for the healthcare sector in India. There have been great strides in medical equipment technology. The diagnostic armamentarium has become very accurate, fast and less painful. Similarly, automated highly sensitive laboratories are providing fast and accurate results for the clinicians to make early diagnosis. There is equally impressive progress in the therapeutic areas. Cardiac angioplasties, Carotid block removals, minimal access surgeries, most accurate and blood less robotic surgical procedures are some examples. There are also advances in radiotherapy, chemotherapy in cancer patients and heart, lung and pancreas, transplants in addition to kidney and liver transplants.
The real fascinating development is in healthcare IT sector. It has revolutionised the delivery of healthcare. Use of computers and transmission of prescription through them have not only reduced the waiting period but errors are also minimised. The real time information about the patients to the doctors and nurses on their smart phones and tabs has made it possible for the doctors to constantly monitor the patients’ health status and to give timely advice even when he is away from the patient.
Telemedicine is another remarkable progress. The patients in remote areas can seek expert advise from far off places.
It is satisfying to note that several communicable and infectious diseases are controlled and some like polio and guinea worm infections have almost been eradicated. However, some diseases like dengue and malaria have shown a disturbing trend. There is increasing focus on infection control and environmental hygiene. But unfortunately antibiotic abuse has resulted in many organisms becoming resistant to antibiotics and appearance of superbugs, which are a great threat. Similarly cases of drug resistant tuberculosis poses a real challenge. Maternal and infant mortality rates have come down, though our country still lags behind in comparison with developed countries. Similarly, high pollution in large cities is causing many serious illnesses.
Lifestyle diseases like diabetics, cancer have considerably increased. It is observed that 50 per cent of the hospital beds are occupied by illnesses related to life style diseases.
Increased awareness about importance of quality in healthcare is a welcome development. Several hospitals are seeking accreditation from NABH, NABL and JCI. However, a large number of hospitals do not focus on quality. The major deficiency being poor documentation sketchy training of the staff and inadequate infrastructure.
The shortage of trained doctors, nurses and technicians is another major challenge which needs to be addressed immediately.
Some of the healthcare legislations like Drugs and Cosmetic Act, especially in relation to blood banking, biomedical waste rules, PCPNDT, Clinical Establishment Act and Human Transplant Act have played effective role in improving the standards. However, implementation of PCPNDT to some ridiculous level, and some objectionable provisions in Clinical Establishment Act need to be addressed immediately.
Health insurance is another that needs attention. There are several drawbacks in the present system and the sector needs to mature.
Optimism for the future of health care is well founded where the entire population will have a healthier life. For that, all stakeholders especially the government should take appropriate measures.
– PM Bhujang, President, Association of Hospitals
Advanced techniques in dental services are coming to India
Many states are appointing dental surgeons as the DME. Many universities are appointing dental surgeons as vice chancellors. The army is elevating the rank of Dental Dir Gen to Lt Gen, equal to director of medical services. All-India level entrance exam for the PG, equalisation of pay amongst medical and dental professionals. Some of the achievements include advancements in dental services. Implants have become the most predictable prognosis rehabilitation tool and nano materials are the latest restorative materials. Digital radiography provides adjunct to all dental treatment, at the same time reduces radiation hazard. CBCT allows dentist to plan and execute most rehab procedures with accuracy.
Less than adequate sterilisation protocols are followed by most practitioners in India which is a drawback to the image of the healthcare sector. Also, there is a rise in improper display of educational degrees and limited options for advanced studies in dentistry. One can see a lack of awareness amongst the public regarding specialities of dentistry.
Nevertheless some policy changes have certainly benefitted the sector. Formulation of Oral Health Care Policy by the government and inclusion of oral diseases in the main list have helped in improving dental services in India. Dental Council of India (DCI) banning the opening of new colleges without the medical college is an eye opener for defaulters. Also, opening of imports in dental fields is another development in this field.
– Lt Gen (Dr) Vimal Arora (Retd) Chief Clinical Officer, Clove Dental
Creating healthcare ‘Affordability’ through financial inclusion is slowly taking off
India is home to 1.2 billion people with a $2 trillion economy and a $100 billion healthcare industry. However, when it comes to healthcare, there are major challenges. Only 17 per cent of the population has some form of health insurance. A recent study has shown that 95 per cent of even those who are insured do not have adequate insurance. Of the healthcare spend of five per cent of the GDP, public spend is only one per cent of the GDP, leaving 75 per cent to be spend out of pocket by private individuals, resulting in 40 million people falling off into poverty every year, due to the burden of out of the pocket medical spent. Healthcare expenses have emerged as the number one reason for people falling off into poverty. Public spent on healthcare must rise to 2.5 per cent of the GDP if it has to make any dent on healthcare’s contribution to poverty.
In this bleak scenario, a welcome trend is emerging. Creating healthcare ‘Affordability’ through financial inclusion is slowly taking off. NBFCs and main line banks have started offering EMI options to patients to meet hospitalisation expenses, benefitting those with good credit history or those with corporate jobs.
– Jose Peter, CEO, Arogya Finance
Medical breakthroughs that have changed the way medicine is practised in India
Personalised medicine is the major breakthrough in cancer care. With the rapid development in next generation sequencing techniques we are now able to detect defective genes that can be targeted for therapeutic response. Our ability to predict responses to chemotherapeutic drugs and targeted treatment agents using ex vivo platforms is truly revolutionary as it will improve response rates and avoid unnecessary toxic and expensive treatment. With the integration of genomics and the ability to predict responses to therapy for any individual we can now deliver a truly effective personalised treatment designed around the specific person as we know that no two tumours and no two individuals are the same.
In terms of technological development, focused technology like radio surgery is another major breakthrough.
Additionally, analytics is another breakthrough, where analysing patients’ profiles on a massive way will help us get better outcomes.
Some of the progressive devices that we have developed include:
Aum voice prosthesis
The device helps throat cancer patients whose voice box is removed to speak again. We have named it Aum voice prosthesis, signifying the first sound for a patient who regains his voice to communicate again after he loses his voice box. The Western makes cost upto Rs 35,000. The Aum voice prosthesis is designed to reach out to the Indian patients, especially for the needy, at Rs 50. This prosthesis is unique in the aspect, that it combines uncompromised quality and good functionality. We have filed patents for this.
X Pointer
A new surgical landmark in neck dissection to help identify and preserve the spinal accessory nerve during modified neck dissections.
Intex Technique for dissection of carotid body tumours
This technique helps conserve time by dealing with more vital branch – internal carotid artery in the initial steps itself, defines the need to involve the vascular surgeon in the initial stages and plan and pre-empt interventions early in surgical steps.
Lastly, in the area of preventive oncology, we have taken a major step to assist and participate with government towards tobacco control. Gutkha ban was one such significant landmark decision. In addition, HCG has played an active role in implantation of COTPA Act for tobacco control at the grass route level and participating in government committee to advance the role of cancer prevention.
– Dr BS Ajaikumar, Chairman and CEO – Healthcare Global Enterprises
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