‘The government should focus more on primary and secondary healthcare’

India is like multiple countries within a country. We have the affluent India and the middle class India whose numbers are anywhere between 300-350 million people. This population is equivalent to the population of the US alone or Europe alone. This population is educated and highly motivated. They are demanding high-end healthcare equivalent to any advanced country. There is an insurance system which is increasing but still the majority opt to pay in cash.

Private healthcare in India covers nearly 70 per cent of the population and majority of the middle class and affluent people get service by private enterprise. It is a very competitive market and in fields such as oncology and cardiology, the private enterprise is able to provide healthcare equal to that of advanced countries, sometimes even better, at a fraction of the cost. India is one of the cheapest healthcare providers in the world, even cheaper than Africa. We are able to provide high-end healthcare at an affordable cost. Today, we are proud to say that India has become a medical destination for foreign patients and this is on the rise.

So far the private enterprise has achieved the above with minimal or no government involvement and sometimes in spite of the government. Having said that, we still have a major challenge trying to meet the demands of nearly 900 million people who are less affluent or below the poverty line. The government has made attempts in the past to address this issue but with marginal results.

The social impact has been minimal and needs lot of intervention in various areas.

I would like to summarise it as follows:

• The government should focus more on primary and secondary healthcare. In some parts of India, infant mortality, maternal mortality, malnutrition, anaemia in women of reproductive age etc are worse than in the Sub-Saharan region. So the focus should be on using our limited funds and human resources to improve the primary healthcare needs of the country.
• The government or its related bodies should stay away from tertiary care and encourage private enterprise to penetrate tier II and III cities. This can be done through simple measures like expansion of the Arogyasri programme which exist in several states. A case in point is how HCG in the last six years has bought about a paradigm shift in cancer care in the country by establishing high-end centres using hub-and-spoke models, not only in tier-1 cities such as Delhi, Bombay, Bangalore and Chennai, but also in tier II and III cities such as Cuttack, Trichi, Ranchi and Shimoga to name a few. People now do not have to travel long distances and spend money on travel and lodging expenses for several months, they can get high-end therapy near their home. All this has a huge cost saving effect on the family which has not been recognised so far. An organisation like HCG has made this model viable and affordable. It is able to treat even the below poverty line people with or without the available schemes. Prestiges institutions such as Harvard Business School have appreciated the model and written case studies on them. Why is it that our own government has not recognised and encouraged such models? Their positive social impact is enormous and greatly beneficial to the society.
• Based on these models, the government should stop setting up centres such as AIIMS and other tertiary care set ups. Instead, they should encourage private enterprise to perform the same functions at a lower cost and better service. This model will be highly sustainable as compared to the government models that exist today.
• In regard to tertiary healthcare, the government should provide subsidy to below poverty people so that they can go to recognised tertiary care centres and get the same care as affluent people get. The motto should be ‘equal care to all, irrespective of their socio-economic status’. The government alone will not be able to delivery such care and only through private enterprise can this be done.
• The government should be a monitoring agency making sure that high quality healthcare is delivered and proper outcomes are measured.
• I do not believe more money needs to be spent to achieve these goals. Entrepreneurs like us have helped through innovations to bring about these changes. There are large groups of dedicated and highly trained doctors as well as entrepreneurs who are willing to join hands with the government to bring about this change.

– Dr. B S Ajaikumar, Founder & Chairman, HCG Enterprise