As India advances towards a Rs 5 trillion dollar economy by 2024–25, KPMG in India has come out with a report titled ‘15 top priorities for transforming Indian healthcare: the 2024 agenda’ that highlights the certain priority areas needed for transforming the Indian healthcare industry. Dr Anna Van Poucke, Global Head of Healthcare, KPMG International in an interaction with Kalyani Sharma elaborate on the key recommendations mentioned in the report
Can you throw some light on the role of Indian healthcare sector in achieving India’s target of achieving the 5 trillion economy by 2025? What parameters from the international healthcare models can be incorporated in the Indian healthcare system for achieving the same?
India’s healthcare industry has been growing at a CAGR of around 22 per cent since 2016 (As per NITI Aayog’s report on investment opportunities in India’s healthcare sector published in 2021) and has a huge potential in being a key pillar for India’s US$5 trillion economy target by 2024. The Indian Government is undertaking deep structural and sustained reforms to strengthen the healthcare sector. This involves 100 per cent FDI being permitted in various sectors including hospital, manufacturing of medical devices as well as AYUSH. India’s health tech sector currently holds the fourth position in attracting VC funding with investments of US$4.4 billion between 2016 and 2021, with US$ 1.9 billion invested in 2021 alone (as per IBEF report on healthcare industry in India). India’s healthcare sector also has vast opportunities for R&D as well as medical tourism in wellness and traditional medicine which is efficient as well as cost effective.
As per SDGs Report 2020, It is estimated that it will cost USD3.9 trillion a year to achieve the Sustainable Development Goals (SDGs) in developing countries alone. Current levels of both public and private funding cover only USD1.4 trillion, leaving an estimated USD2.5 trillion annual gap. Filling this gap will require tapping new and greater sources of capital from the public and private sectors, including more than US$200 trillion in the capital markets, and effectively deploying these funds towards development efforts (as per the world investment report, 2020). There is however not only costs related to building up the Indian Healthcare sector. A healthcare sector that provides accessible and good quality healthcare to all involved, can help in increasing the available workforce in India. A seminal review in 2013 by a Lancet commission showed that between 2000 and 2011, about 24 percent of growth in full income in low- and middle income countries resulted from the value of additional life years gained. One element in that equation is improved labor productivity due to better health. In that sense my statement would be that ‘Health creates Wealth’.
International models such as innovative and blended financing can play an instrumental role in the way we solve society’s greatest health challenges. The healthcare sector has plentiful, immediate prospects to leverage innovative financing to bridge the financing needs for building a resilient health system. India is yet to fully explore and leverage innovative financing models. Innovative finance can be done through partnerships to pool resources from a range of public and private sources to solve problems faster, more effectively, and at a larger scale. A systematic effort led by the government along with private and other potential financing sources will be critical in creating and adopting innovative financing models in the coming times.
How crucial is the role of public-private partnerships in achieving sustainability in the Indian healthcare system?
India is taking major steps for the overall strengthening of the Indian healthcare system, however, to increase the resilience and sustainability of the system and to ensure preparedness against future pandemics, new healthcare models or ecosystem of solutions are being envisioned and implemented in India. These are increasing the accessibility of healthcare services for the citizens, allow providers to be more effective in care delivery, helping patients to take control of their health by using their data, and forcing healthcare organisations to use this data to deliver more personalised treatments. The government and the private players have taken initial steps in the right direction and they should focus on expanding the financing for ‘Healthy India’, promoting it as a mass movement, launching a healthcare sector promotion programme similar to the of Production linked incentive (PLI) scheme, bridging the last gaps in universal health coverage and strengthening the primary care system. This will help in redefining and reviving public-private partnerships and as well as prove beneficial for driving schemes like Ayushman Bharat Digital Mission (ABDM) till the last mile.
At this juncture, it’s feasible that the government explores collaboration/ partnership with private healthcare players and the investment community to take up the opportunities for much-needed augmentation of healthcare infrastructure. The need for public-private partnerships (PPPs) is further underlined considering the layout of medical infrastructure in India. According to a report by NITI Aayog, 60 percent of medical infrastructure is densely populated across metropolitan cities. Addressing this, private hospital chains are increasingly expanding beyond the metros to tier-2 and -3 cities. Private players are also seeking accreditation and developing new healthcare models at an increasing rate. PPPs will also help address the shortage of skilled workers by establishing programmes to upskill the health workforce with the ability to adapt to technological advancements.
Further, there is enormous scope to leverage ‘strategic purchasing’ as an integral approach to fast-track the achievement of larger health goals. Apart from its program to strengthen the public sector, the government can enter strategic purchasing contracts with the private sector to build primary care services, district hospitals, clinical management services and augmenting of healthcare workforce skilling.
Ayushman Bharat Digital Mission (ABDM) has been playing an important role in making healthcare accessible. What else can be done to strengthen this initiative further?
The Indian Government has always had a firm belief in the use of technology and Digital Health as a great enabler in the delivery of healthcare services and strengthening the healthcare infrastructure. Government has introduced a Unique Health ID to address the issue of patient identification. This health ID will act as a link between all the UIDs locally stored at health facilities enabling health data interoperability and unique identification of the patient. Health UID issued as virtual health cards could act like an ATM card preloaded with healthcare benefits like entitlement to health schemes, health coverage for any medical emergency, primary care benefits, certain free ‘Jan-Aushadhi’ pharmacy coupons, health checkups and other such benefits that can be availed at any public or private health facilities.
To strengthen this initiative the most significant aspect is enhancing digital literacy in the country, unless a well thoughtout roadmap is articulated for ABDM to provide technical and financial incentivisation to small and larger providers, the mission is unlikely to achieve great success. The capital and operational expenses could be factored in as a subsidy and/or indirect tax incentives for the providers leveraging the transformation journey. The success of this initiative will also depend on the ability to onboard a vast number of public and private health providers to adopt digital health solutions and standards to build a digital health ecosystem. Ensuring safety and security of health data effective implementation and monitoring of privacy policies like Health Data Management Policy will build trust amongst the users.
The recently launched report by KPMG talks about ‘National Health App’ for aggregating healthcare services across the value chain. Can you elaborate on this? Do you think scalability could be a challenge as far as the nationwide roll-out of such digital health initiatives is concerned?
The Indian health system, plagued by fragmentation across rural and urban areas, often limits the accessibility to healthcare services for citizens. Thus, there is an immediate need to have a one-stop gateway in the form of a ‘National Health App’ for citizens of India to understand and manage their health requirements in an automated way. A National Health application will connect all required services offered by public and private health providers in India with a single window to navigate healthcare needs required by every citizen. The ‘National Health App’ will complement the existing applications and integrate them to improve access to quality healthcare services and enhance citizen experiences.
The increasing adoption of personal technologies has opened the gateway to the convergence of patient’s medical data with a deluge of non-medical, lifestyle-related data, much of which is generated by the patient. Patients are more informed, conscious, demand privacy and security and custodian of their personal data.
Self-care will be key to Indian health system in the coming decade and increasing healthcare cost, constraints of healthcare resources and changing consumer healthcare behaviour will drive most fundamental restructuring of healthcare in India. Amidst increasing awareness on health-related issues and healthcare needs in general, the ‘National health app’ will help patients to take an active part in decision-making regarding their health management, treatment regimes and outcomes, and support patients in managing their own health. Patients, governments and healthcare providers would push for self-care with electronic health records, personal health tracking devices and health applications for a remote support.
NITI Aayog’s proposed ‘Vision 2035 – Public Health Surveillance in India’ is important in the management of future pandemics. The report talks about stepping up the national surveillance system and the need for institutional strengthening. Can you elaborate on the same?
Surveillance is an important public health function which is important for disease detection, prevention, and control. The NITI Aayog’s document envisions a citizen-friendly public health system integrated with India’s three-tiered health system which is responsive and predictive.
To further step up the surveillance system in the country, different methodologies can be adopted which are further elaborated in the document.
Institutional strengthening needs to be done including key Institutes such as ICMR, NCDC and private sector labs to augment human resources, leverage digital technology and advanced data analytics, establish a one-health platform. Interlinking of such institutes needs to be done for timely and seamless integration of disease surveillance and research data.
An integrated national surveillance and pandemic management system encompassing various verticals of public health and health emergencies and other critical aspects of disease surveillance and pandemic management can be developed.
At present, Ministry of Health and Family Welfare (MoHFW) is in the process of establishing a National Public Health Observatory (NPHO) and a network of Health Emergency Operation Centres (HEOCs) across India for coordinated and cohesive public health management. The network of such NPHOs and HEOCs will form the backbone of a robust monitoring system for Indian public health.
Population health information system (PHIS) could be developed with real-time dashboards to merge geography, demographics and clinical characteristics of patients vulnerable to health crisis to better understand disease incidence, drive service delivery decisions and identify ‘hot spots’ among vulnerable communities.
What are your views on the reliability and cost-effectiveness of using technology in the healthcare system? Although the uptake and utilisation of technology in the system is on a rise, do you think there are gaps that still need to be filled?
The challenges of increasing cost of services, shortage of skilled healthcare professionals, etc. are pushing healthcare providers towards the use of new healthcare models based on innovative and cutting-edge information and communication technology (ICT) utilisation.
The COVID-19 pandemic has highlighted a huge opportunity to bridge existing gaps in our healthcare system using emerging technologies to provide on-demand virtual and adequate care to the masses. There has been 3 times increase in the number of people using Telemedicine (online health consultations) between March 2020 and November 2020 (as per Practo-TSI report). Non-metros witnessed a 7 times growth in online consultations compared to 2019, while physical health appointments went down by 32 percent (As per Rise of Telemedicine report 2020). The National Telemedicine Service of MoHFW, eSanjeevani, has completed 90 lakh teleconsultations in the country.
The use of the Metaverse in healthcare can be revolutionary which can help remotely located patients get the right care, right diagnosis, receive medical treatment, or assistance in medical procedures from experts sitting in different geographies in real-time. Some key aspects where metaverse can improve the future of the healthcare system include:
- Solve problems more efficiently by remote assisting using virtual and augmented reality by collaborating from different locations providing treatment to the patient.
- Leveraging Gestures Controlled Diagnostics to scan through the patients’ medical records during mid-surgery by using hand gestures
- Visualising 3D medical images in real 3D using augmented realities instead of getting different views on flat screens.
- Using virtual reality, movement-based interaction and mixed reality and its usage with metaverse can help trainees learn from experts while sitting at home and performing assignments and learning.
Although technology has the potential of lowering treatment delivery costs and significantly improving patient outcomes, gaps which need to be addressed include accessibility of health records which can be hacked. Digital divide – the gap between those who have full access to digital technologies and those who don’t – presents a barrier towards usage of technology in India.