Clairvoyance 2007

'Innovation Should Ensure that it Benefits the End-user'

The annual event of TISS just got bigger and better

The event promised to be a huge success and it turned out to be one! 'Innovation for Revolution in Healthcare'—it is under this futuristic theme that the annual event of the School of Health Systems Studies (SHSS) of the prestigious Tata Institute of Social Sciences (TISS) kicked off on December 1, 2007.

The knowledge sharing platform every year attracts healthcare professionals, academicians, social scientists and eminent leaders from various domains of the healthcare sector such as public health, hospitals, insurance, pharmaceuticals, service industry and information technology.

It witnessed an unprecedented gathering and was graced by the stalwarts of the industry. Express Healthcare was the official media partner for the event.

Dr BK Rana, Deputy Director, NABH

Dr Sushma Kapoor, Programme Director, IAVI

Day One

The event commenced with an inauguration ceremony graced by Dr S Parasuraman, Director TISS and Dr Shalini Bharat, Dean, SHSS, TISS. Dr Parasuraman shared his thoughts on the importance of targeted insurance system for the evolving healthcare market in India. "The concept of health policy is still evolving in India where only one to two per cent population get assured healthcare through insurance system whilst vast majority still depends on the public and private healthcare. These markets can be served by targeted insurance systems," said Dr Parasuraman. He further added that the challenge would be to enhance accessibility to healthcare. Talking about the agenda of the conference, Dr Bharat said that better management of health sector is an approach to increase health standards and TISS has been able to bring the best in this field to look at the challenges and draw out innovations to overcome them.

December 1 being World’s AIDS day, it was pertinent that the professionals started off with issues grappling with HIV-AIDS treatment in India. The panelists included eminent doctors, experts from WHO and NGO activists who presented their respective presentations on the topic 'Affordable Innovation for Prevention, Treatment & Research on HIV/AIDS'.

Said Dr Po-Lin Chan, Country Officer-HIV/AIDS, WHO, "The point of innovation is making sure that it is applicable to the end-user of the system. The system is currently is very doctor-focused and there need to be some strategies evolved to shift tasks from the doctor to other paramedical staff. This would particularly benefit the rural area where there is dearth of skilled doctors. Today, our system is too verticalised and nobody has a team approach. Training programmes won't help as they are all forgotten after they are over."

This session highlighted and stressed over the fact that only a few countries can afford to make it available to all who would benefit, and very few individuals can afford to purchase the drugs themselves.

When it comes to HIV infection in Indian women, Dr Alka Deshpande Professor and Head, Department of Medicine, JJ Hospital, Mumbai highlighted that a majority of women have acquired HIV after marriage. Said Dr Deshpande, "This calls in for some innovation and strategic awareness methods specially targeted to these women who have contacted HIV without any fault of theirs. I believe female condom is a possible solution, but it needs to be modified, as in its current form women are not very comfortable using it. There is also a need to aggressively campaign about avoiding mother to child HIV transmissions. The challenge is to reach the rural population and innovation is required here as to how to create awareness amongst these women." She further elaborated as to how the past few years have witnessed several attempts to find new HIV prevention methods and therapies like HIV vaccines for the treatment of HIV disease. Whilst she appreciated the fact the Government is providing free treatment for poor, she lamented that a majority of private groups have not taken any progressive steps to provide subsidised HIV treatment.

Said Dr Sushma Kapoor, Programme Director, International Aids Vaccine Initiative (IAVI), "Vaccine would be a potential tool in preventing AIDS-HIV in women."

Panelists thus discussed innovative and affordable solutions to the problems that are challenges for the Government and non-Governmental agencies, as well for bilateral and multilateral system of support.

The next interesting session that kept the audience engaged was a panel discussion on 'Strategic Innovation to enhance Market Penetration in Healthcare'. Said Daljit Singh, President-Strategy and Organisational Development, Fortis Healthcare Limited, "Public-Private-Partnership can be a good vehicle to provide healthcare delivery on a pan-India basis. Just like Gujarat and Maharashtra, other states must follow suit. Also, I believe that micro-insurance like the Yeshasvini scheme is an innovative strategy to reach to the masses and make healthcare affordable as well."

Taking this issue forward, Dr N Krishna Reddy, CEO, Care Hospital Groups, reflected upon defining the market first. "Before delving into innovative strategies, the first step is to actually 'define' the market segment which you are looking out for. The market is not defined by the people or their needs, but by demand which is defined by what you can afford. You need to crystallise as to what is 'demand'.

The audience in rapt attention contemplated over the effects of increasing corporatisation and privatisation of health services that have led to the adoption of novel strategies by various players in the healthcare segment, to increase market penetration. The session thus explored various innovative strategies by hospitals and healthcare institutions across both for-profit and non-profit sectors to take pole position and establish a market reputation for quality solutions at reasonable prices. It also tried to critically analyse pioneering solutions to increase outreach and fuel revenue generation through innovative strategies like mergers and acquisitions, franchising, retail healthcare and health insurance.

The next discussion was on 'Quality Assurance in the context of contemporary India'. "There is generally a great deal of variability in how quality is defined, conceptualised and operationalised, more so in the service sector. The conceptualisation of quality, which is a multidimensional construct, is even more vague and difficult to gauge in the healthcare industry. The intricacies involved in healthcare delivery and the complex nature of the hospital industry given the diverse settings and contexts within which care is delivered along with high costs involved, is what makes application of quality standards as sacrosanct. Most often, the application of these standards to healthcare settings is an affair of great prudence," believed Dr BK Rana, Deputy Director, NABH, New Delhi.

The session primarily focused on initiatives for accreditation, the cost of quality and the development and implementation of affordable and sustainable systems for quality assurance in the context of contemporary India, keeping in mind the roadblocks that lie ahead.

After all these engaging talks, the perfect way to end the day was an interesting quiz that witnessed active student participation.

Dr Shalini Bharat, Dean, TISS

Ravi Duggal, Healthcare Activist

Day 2

The second day kick started with a presentation on 'Improving Access to Care' by Dr Denis Broun, Country Co-ordinator for UNAIDS. He explained the definitions of a franchise, franchisee, franchisor and master franchisee. Dr Broun also informed that a franchise is not a fractional venture, a chain, a Government organisation, a venture that expands fast in all cases, a way to sustainability and the only approach to involving the private sector in high quality delivery of health services for the poor. "Rather it is a network of privately-owned facilities, operating under a single brand, to replicate a uniform operating model, under supervision and monitoring, for a predictable high level of service and exploiting economies of scale to streamline operations," he added. Later on, he explained the problems of access faced and how can a franchise address those.

"Franchises are growing because they have quick start-up, uniformity of service, strong branding, limited initial capital for the franchisor, lower risk for the franchisee than an individual enterprise, and good combination of individual initiative and corporate discipline," informed Dr Broun. He supported his facts by citing an instance of The CFWShopsR network in Kenya.

This session was followed by a talk by Dr Vivek Desai, CEO & MD, HOSMAC, on 'Changing Scenario of Healthcare in India'. "Right now, we have in our country a lot of diversity in healthcare service providers. Corporate hospitals co-exist with public health centres," said Dr Desai. He further added, “India has to deal with the entire gamut of services and hence the innovations must cater to all the sections.”

This talk was succeeded by the Symposium on 'Innovative Methods of Healthcare Financing in Developing Countries' by Dr Ramesh Bhat, Professor, IIM Ahmedabad; Ravi Duggal, Healthcare Activist; Jeena Zohar, Senior Research Manager, ICICI Technologies for Public Health; and Dr Rajeev Ahuja, Health Financing Specialist, World Bank.

Dr Bhat shed light on the concept of mother NGOs (MNGOs) and cited few instances like the Chiranjeevi Scheme, Gujarat to prove the importance of such organisations. He said that for such kind of schemes, the Government has devised two kinds of payment services: salary and fee for service. Another upcoming trend is of full capitation system, which is essentially based on 'per person served'. "From all the above three, the most difficult system to maintain from the administration side is that of fee for service and the least maintenance is in full capitation system. Where one needs to define outputs very clearly, the capitation system is the best. It can be used in child delivery, cataract surgeries, removal of stones etc," said Dr Bhat.

Johar deliberated on the initiative taken up by ICICI, namely ICICI Centre for Technologies in Public Health (ICTPH). "This step of ours will take many initiatives in catering healthcare for public at a large. We are planning many schemes that will help us reach the masses and introduce them to quality healthcare services," said Johar.

The subsequent session was a panel discussion on 'Innovative Solution for Healthcare Delivery through Information Systems-Health at your Fingertips'. The panel consisted of Dr SA Kelkar, Adjunct Professor, IIT Bombay and TISS; R Balaji, Principal Consultant, Infosys; Muralidhar Reddy, VP, Syntel; and Salil Mehta, Principal Consultant, Ernst and Young.

Mehta said, "Healthcare will grow at a better pace as it hardly gets affected by the market dynamics." The point raised here was that healthcare is relatively a late entrant to join the IT wagon, so it can take lessons learnt from the banking and finance sector. However, sadly, this is not happening, opined the panel.

The next presentation was by Ravi Duggal on 'Innovations in Healthcare Financing'. He emphasised on how innovations must be introduced with existing resources to reduce the cost. "Also, creating equality in distribution is vital for managing costs. For instance: a public health centre (PHC) gets about Rs 15 lakh-Rs 20 lakh annually to manage itself, when it actually requires Rs 45 lakh-Rs 50 lakh to run properly. Government must put money is such places." Duggal also informed the audience that one-third of the Maharashtra state Government's healthcare budget comes to Mumbai, and hence it is important that the resources be utilised properly. Instead of putting in more money, improve the current set-ups, he said.

Dr Rana Mehta, Ex-TISS student and Vice President, Healthcare, Technopak Advisors Ltd spoke on 'Innovations in Healthcare Delivery'. "Till 2015, the healthcare market in the US will touch $2.6 trillion, and India will not be far behind. In the coming few years, the healthcare industry in India will easily constitute 15 per cent of GDP," Dr Mehta averred. He also cited the various stages of healthcare industry. From 1950-70 was the fundamental stage, 1970-90 was the discovery stage, 1990-2010 is a reactive stage and 2010 onwards the stage would be a sustaining one.

Dr Mehta gave an overview of the current trend in healthcare spending and how it is on its way to a drastic change. "Currently, the trend of spending is: when one is healthy, the spending is less on healthcare, and when the person is on the death bed, the spending increases. This trend will reverse soon and wellbeing and preventive care will be the frontrunners," said Dr Mehta.

In addition, more transparency will come in hospital functioning, and the results of operations etc will become accessible to a majority of people.

The next panel discussion was on 'Innovation to Address Equity Divide in Health' which was chaired by Dr CAK Yesudian, Professor and Dean, Research and Development, TISS; and other panelists were Dr Mohan Rao, Professor, CSM and CH, JNU; Dr Aditi Iyer, Research Consultant, IIM Bangalore; Sunil Nandraj from WHO India; and Dr Srijit Mishra, Professor, IGIRD. "The income distribution between the richest and poorest nations is 123:1," said Dr Rao. Referral system, cut practice and unregulated healthcare models are making healthcare cost rise, opined the panel. "After the arms and ammunition, healthcare is the biggest industry in India," said Nandraj.

Dr Iyer highlighted one key issue, "People are falling under below poverty line category because of expensive healthcare." She further informed that gender bias in remote areas of India is also causing inequalities in healthcare in households. "We need to remove the gender bias and bring equality to have a holistic view of the healthcare scenario," Dr Iyer added.

Another significant subject that was raised is that India cannot have just one model of healthcare for the whole country. The reason, the panel came up with, is that the cultures and lifestyle of all regions are different and hence the healthcare models must be customised for various pockets of India. This session explored innovative strategies to promote and promulgate equitable distribution of resources to ensure acceptable standards of health and healthcare.

The day ended with a valedictory session and later on an alumni dinner was organsied for all to have a gala time after arranging a successful two-day conference.

EH News Bureau