Dr Sameerkumar S Shah, Consultant Radiologist, Founder, Canpic Medical and Education Foundation, Pune roots for bridging knowledge deficit and skill gap in wellness and diagnostics with the help of a centre of excellence
Growing healthcare needs followed by ever-increasing cost is a global concern. $1 of every $5 spent will be on healthcare by 2024 in the US i.e. that government is expected to focus 20 per cent of its budget on healthcare spending. This is a huge growing burden and a leading cause of poverty. More than 70 per cent of the population in India spends ‘out- of- pocket’ for healthcare. It forces the poor to use expense coping mechanisms like high-interest loans, distress selling of assets, reducing consumption of food. At times, poor people opt for death over treatment. Many countries spend less in terms of percentage of GDP spent on healthcare – e.g. in India only 1.4 per cent of its GDP. Public sector healthcare system in India is overburdened. Healthcare reforms are being attempted. Traditional solutions-to stabilise the rising cost with optimal quality in healthcare-are partially successful and hence novel approaches are necessary. Health insurance penetration is poor and cover for outpatient services is not mandatory.
“An ounce of prevention is worth a pound of cure.”
The types of prevention include primary prevention, controlling modifiable risk factors to avoid the occurrence of disease; secondary prevention, the early detection of disease before clinical symptoms are manifested; and tertiary prevention, the control of existing diseases to prevent more serious complications. It has been proved beyond any doubt that prevention reduces the cost of treatment. Clinical based preventive services need to be practised on a larger scale as much as community- or population-based services.
The health insurance sector is a major market force and could play a major role in reducing the cost of healthcare services by various means. One of them is promoting health and disease prevention. 10 per cent reduction in spending by the health insurance sector may result in them saving ~ $250 billion in the US alone. This role of the health insurance sector could further be complemented and catalysed by Centre of Excellence for Wellness And Diagnostics apart from the contribution of premier teaching institutes and hospitals offering clinical excellence.
Centre of Excellence for Wellness And Diagnostics (CEWA-D)
A centre of excellence is a place whose mission is to provide the best practices around a particular area of interest by bridging up the knowledge deficit or skill gap.
It’s objectives include:
- Providing thought leadership and direction
- Establishing and promoting best practices
- Research and development, to provide appropriate recommendations
- Support and education
CEWA-D is need of time to be started as a pilot project and will be replicated as a chain of centres in future. This centre will act as an engine to provide a solution to the problems in the healthcare sector and will provide services aiming at health promotion and disease prevention.
Centre will provide routine and specialised diagnostic services like sonography, X-ray imaging, pathology, ECG, etc. Clinical speciality, sub-speciality and super-speciality outpatient services will be added upon with utmost professional excellence e.g. diabetes and obesity clinic.
Infrastructure, equipment, human resource will be established at par with the latest technology and expertise. Ambulance services for transporting needy patients to and fro will be provided. Centre will be providing AYUSH services, gymnasium with supervised exercise programmes, restaurant for healthy and nutritious food, conference hall for academics and public lectures, library as well.
Services will be offered to patients, apparently healthy individuals and employees of any organisation focussing on routine and occupational health problems. Customised evidence-based clinical and diagnostic protocols will be a key feature.
Regular academic programmes will be undertaken for in house and other doctors, paramedics and support staff imparting highest academic excellence.
Apart from services, the centre will research in diagnostics and allied areas aiming at affordable innovations and promote novel applications. Patented products will be of immense help in scaling up the revenues enabling sustainability. Integration of services, academics and researchers will be the policy to generate revenue from each. Cross subsidisation will be attempted using revenues from innovations, easing out the burden on patients from the lower socio-economic background.
Focus on cutting-edge technology-based activities e.g. application of artificial intelligence in early detection of disorders using imaging modalities and other diagnostics creating a database.
The centre will design and undertake the clinical studies according to the loco-regional health issues. It will create and disseminate knowledge and evidence-based protocols especially on disease prevention to utilise it for target /beneficiary population. This will reduce the reliance on foreign clinical studies and data, enabling us to develop nomograms for our population.
It will promote novel applications of existing diagnostic and therapeutic modalities aiming at treatment cost reduction. Secondary prevention aims to reduce the impact of a disease or injury that has already occurred. e.g. sonographic mapping of insulin injection areas may save $3-4 billion per year in India. Screening and detection of rectocele using pelvic floor ultrasound may save the cost of long -term medical management.
Diagnosing visceral adiposity in non-obese individuals and assessing the risk of metabolic syndrome in patients who are referred for sonography for other reason. Including uncommon disorders like May Thurner Syndrome on Colour Doppler within the routine protocol to save cost, morbidity and mortality.
Such practices and protocols will be immensely beneficial to both patients and health insurance companies attracting them for a tie-up with the centre for preventive health check-ups. Centre will provide a major section dedicated to work in areas to attain the goals of public healthcare schemes. The activities of the centre will be complementary to the goals set for ‘Ayushman Bharat’ and other public healthcare programmes.
A separate section will be provided for additional activities as follows :
‘Innovation club’ will be started at the centre to promote regular multidisciplinary interactions and thereby inviting ideas and projects from innovators. It will be a support activity for innovators. This club will act as a platform to promote affordable innovations in healthcare to be catalysed by the health insurance sector. It will involve all stakeholders in healthcare by linking it to an IT platform.
Leading health insurance companies, NGOs, industry, government agencies, venture philanthropists, venture capitalists etc. stakeholders will promote lateral thinking, co-operation and interaction. Affordable innovations in healthcare will offer a major solution to many health problems, will thereby stabilise the rising cost and promote the creation of wealth on the other hand through patented products – making it self-sufficient in the allocation of funds for healthcare services. This will in turn support ‘Make in India’ scaling up the low-cost manufacturing in medical devices and related domains in India, as compared to the ‘reverse engineering’ model adopted by few countries like China.
A talent hunt programme to reach out to innovators and an idea-challenge programme to address the major health challenges by inviting innovative solutions will be the features of this club.
“Following others is easy, but providing novel solutions to meaningful problems is innovation. It endows reasons with a new capacity to enhance performance and create growth.”
To conclude, the Centre of Excellence for Wellness And Diagnostics (CEWA-D) is a need of time and will prove to be one of the best solutions to solve major challenges in the healthcare domain.
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