The Indian healthcare industry is undergoing a transformation, be it on the delivery front or on the policy front. In its 12th five year plan, the Government of India has planned some significant policy changes and intends to introduce new regulations to make healthcare not only more accessible and affordable but also more transparent and ethical. How far will these regulations and policies help better healthcare access and improve healthcare delivery within our country? Express Healthcare talks to industry players on how policies can play a role in improving healthcare delivery Excerpts…
‘The healthcare delivery model of India in its current form is an excellent idea about how a system should be’
Insurance in healthcare has a bright future, as an industry it is expected to touch Rs 32,000 crores by 2016-17, public-private partnership is making it happen. Welfare schemes for employees by ESI, CGHS, ECHS etc, have made world class tertiary level healthcare accessible to poorest of patients. But there are discrepancies in the financial compensation offered by government and that of private sectors, which put pressure on patients. The healthcare delivery model of India in its current form is an excellent idea about how a system should be. The biggest challenge is translating it into providing basic healthcare to rural areas. Talent migration due to poor working conditions is at best stopped or reversed only by allowing private players to enter the arena of primary healthcare. But then who will go to rural areas without expecting good return? Political and bureaucratic hurdles make the process more painful. One solution to this problem is public private partnership creating competition which ultimately leads to improved healthcare delivery at primary care level.
No doubt that the healthcare facilities in urban areas of India are not less than anywhere in the world. We have hospitals providing best facilities, performing advanced procedures, with world class equipments. India has one of the largest clusters of Joint Commission International (JCI) approved hospitals. This enormous concentration of tertiary or quaternary care centres in the urban area makes us to ignore basic healthcare, leading to pressure on urban centres to handle high patient load.
The Government of India had recognised this problem and taken initiatives to address it through National Rural Health Mission launched in 2005 to extend healthcare to all. The Rashtriya Swasthya Bima Yojana works towards providing health insurance to the lower strata of community. However, the problem lies in implementing these policies at the grass root level. Improving the GDP allotment to healthcare by 4-5 per cent would help in providing basic facilities and better pay grades to health workers would attract more employees. Need to translate the phenomenon of globalisation of healthcare at the level of villages would require involvement of both private and public sectors.
– Dr Deep Goel, Director, Department of Minimal Access & Bariatric Surgery and Surgical Gastroenterology, BLK Super Speciality Hospital, New Delhi
‘The biggest obstacle in the healthcare sector today is lack of access to medicines’
To ensure maximum outcome, policies and regulations should be developed on the basis of the learning of all available systems, the strengths as well as lacunae in existing schemes and needs of individual states. Also, people need to be properly directed towards taking benefit of health schemes.
The best example of stringent implementation of regulations is Dubai where we are present since the last four and a half years. There the emphasis is on quality of services and safety of patients based on the local and federal laws in addition to international accreditation standards.
There are strict regulations governing licensing of any healthcare facility in Dubai. Audits are done at regular basis to ensure the quality of service in healthcare facilities. For example, it took us one year to get a license for our clinic in Jumeirah. Moreover, the license needs to be renewed regularly for ensuring proper implementation of guidelines. India should follow such discipline in implementing the guidelines set for quality in healthcare delivery.
The biggest obstacle in the healthcare sector today is lack of access to medicines. It is the common denominator in all the nations of the world, regardless of whether their healthcare systems are public or private. Healthcare regulations must begin with reform in the way in which medicines are created and, accordingly priced, which requires a series of improvements at Research & Development (R&D) level. They further need to focus on availability of these medicines to people even in remote areas.
Indian healthcare today is urban centric. It needs to be reformed through regulations that emphasise on providing good medical facilities in rural areas. They must provide impetus to lift the population, which is at the bottom of the pyramid.
Conclusively, at the core of every regulation should be the safety of patient. Everyone should have access to quality healthcare at affordable rate. Moreover, the state authorities should take the responsibility of implementing regulatory guidelines for success of policies and health schemes.
– Dr Mukesh Batra, Founder & Chairman, Dr Batra’s Healthcare
‘India needs increased penetration of insurance throughout the country’
– Zahabiya Khorakiwala, MD, Wockhardt Hospitals
‘New regulations and policies introduced would be of much larger use if well organised, improvised and facilitated’
Issues with regard to public and private health infrastructure are different and both of them need attention but in different ways. Rural public infrastructure must remain in mainstay for wider access to health care for all without imposing undue burden on them. Side by side the existing set of public hospitals at district and sub-district levels must be supported by good engagement and with adequate funding and user fees and out contracting services. This demands better routines, more accountable staff and attention to promote quality. These, attempts must persist without any wavering or policy changes or periodic denigration of their past working.
New regulations and policies introduced would be of much larger use if well organised, improvised and facilitated. These regulations would surely be beneficial for the Indian healthcare industry but the concern still remains that whether the designated body or authority utilises the opportunity justly.
In a market economy, healthcare is subject to three links, none of which should become out of balance with the other – the link between state and citizens’ entitlement for health, the link between the consumer and provider of health services and the link between the physician and patient.
– Amol Naikawadi, Joint Managing Director Indus Health Plus
‘Mere legislation doesn’t bring significant change’
Amendments to the Medical Council of India Act will empower the central government to ensure proper development of medical education, and keep corrupt practices under check. The bill to regulate medical devices is a long-due initiative which is likely to strengthen the domestic manufacturing industry and make medical equipment more accessible and affordable to the masses. It will also benefit hospitals as they will have more high-quality indigenous products to choose from.
With more than 80 per cent of the providers being in the unorganised space, there is barely any quality control over this segment at present. A regulation that can go a long way in improving quality of care delivery is the Clinical Establishments Act, which emphasises on adherence to standard practices. The utility of this Act can be further enhanced if the registered facilities are mandated to periodically share critical operational and clinical data with the state and national councils. This database can be leveraged to design performance benchmarks for Indian healthcare providers and analyse their performance on a continuous basis.
While these regulations have many positive features, it is important to not lose sight of the fact that mere legislation doesn’t bring significant change if it is not followed by effective enforcement and monitoring. We have a long history of drafting strong laws which remain mostly on paper.
Therefore, the important aspect is the speed of enactment, management of stakeholders including doctors and healthcare administrators, and monitoring of adherence. This is a mammoth task which requires an army of officials, and continuous investment in financial and technological resources. It also requires serious commitment from private healthcare players, as self-regulation is the first step.
– Vikram Anand, Head, Head, Healthcare Practice, IMS Health, India
‘It is imperative to evolve a robust long term policy for healthcare’
The core issues that need to be addressed together are:
- Who pays for the costs?
- Who provides care?
- Who regulates safety and quality of medical services?
- How do we meet the human resource need?
- How do we design medical education for future?
- How do we address the rising costs in terms drugs, devices and diagnostics? Is there a national policy to support indigenous industry to contain costs?
Hence, in conclusion, it is imperative to evolve a robust long term policy for healthcare. However, it needs to be addressed professionally taking all stakeholders into confidence and should be based on robust national data.
– Dr Krishna Reddy, CEO, Care Hospitals