Healthcare spending by the government
With respect to healthcare spending by the government, it has been observed that this sector is low priority for policy makers. To begin with, government spending should increase in this area and healthcare should be brought to the forefront with a significant shift from curative to preventive care.
Taxation policy for hospitals and other healthcare providers
The healthcare sector should receive similar incentives to those provided to companies in an SEZ i.e. benefits such as tax exemption for 10 years and a favorable policy framework for primary healthcare providers (not only to hospitals/secondary or tertiary).
I would also recommend increased tax benefits for preventive health checks, OPD services and OPD insurance products.
Insurance
The Union and state governments should encourage initiatives by insurance players which will encourage them to cover primary healthcare, thus reducing traffic to secondary and tertiary healthcare providers, which in turn will reduce their claims ratio and cost. Traditionally, private healthcare players have shied away from the primary healthcare space, as this sector is considered to be a “loss-making sector”. However, this is changing, and in last couple of years, several start-ups have been launched in this sector in various cities, which has also attracted high quality foreign institutional investors (FII), thus making it a more attractive sector to insurance companies.
Public health policies
The government should take steps to promote Universal Health Coverage (UHC) through a primary care set-up. In India, an effective healthcare model to develop is one which is financed by the government, but delivery is through family physicians. These will not be employed by, but provide contracted services for the government. More importantly, remuneration and monetary incentives should be based on population level health outcomes, such as vaccination coverage, better control of chronic diseases, patient satisfaction and cost reduction.
Public private participation
The world’s largest PPP in healthcare is the NHS GP model in the UK and it is one of the best examples of a successful PPP. A similar model should be replicated in India. We in India, currently follow a system which is incentivised towards transactions and volumes. As a result of this, the doctors and healthcare providers (hospitals and clinics) only focus on a higher volume of consultations and procedures without giving too much attention to quality, clinical outcome or patient satisfaction. In the UK, health authorities outsource the care of a given population to GP clinics (who are private players), but their payment depends on multiple parameters such as patient satisfaction, clinical outcome, achieving public health targets (such as 100 per cent immunisation), standards of care, as well as volume and reduction of cost. We too need follow a similar structure in India, which will result in the provision of high quality care at a lower cost.
Disease focused policies
Management of chronic illnesses (diabetes, heart disease, etc) is important for the prevention and delay of future ill-health through advice, immunisation and screening programmes. A focus on non-communicable diseases can improve overall health outcomes for the population.
These illnesses can be addressed at a primary level, making it imperative to bring primary healthcare to the forefront.
Medical education and training
In order to build a healthy medical workforce for the country, it is essential to invest in continued medical training and education. This should not only cater to the secondary and tertiary sectors but the primary healthcare sector as well. Currently, GPs are at a grave disadvantage due to the lack of options for education and specialisation in family medicine.
Healthcare manpower resource
In medicine, we can consider two types of specialisations. The first is a ‘vertical specialisation’, where the doctor has in-depth knowledge of a particular area and focuses solely on it, such as cardiologists or neurosurgeons. The second is a ‘horizontal specialisation’, where the professionals are generalists, dealing with a broad range of health related issues, such as treating a pneumonia patient, managing a child birth, as well as doing minor surgeries. GPs and General Duty Medical Officers in a rural PHC are good examples of such “Horizontal specialists”
In order to make healthcare more accessible and affordable, we need more doctors with a wide base of skills and knowledge rather than specialists in a single field. The government, Medical Council of India and private players must work together to solve this anomaly. Most medical graduates in India want to move into ‘vertical specialisation’ roles because the Indian healthcare system does not provide any career growth for GPs, making it an unattractive choice. If this problem is addressed, the issue of manpower resources in healthcare will automatically correct itself.
The above recommendations aim at reducing cost, improving quality, and increasing accessibility to healthcare services in the country.
– Dr Santanu Chattopadhyay, Founder & CEO, NationWide Primary Healthcare Services