’The geriatric services market is estimated to be worth about $250 million in India’
KPMG International recently released a new global report, ‘An uncertain age: Reimagining long term care in the 21st century’, commissioned by The Lien Foundation. Amit Mookim – Partner and Head of Healthcare, KPMG in India compares the results of the report with the realities of India
What is the status of healthcare for the elderly in India?
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| Amit Mookim |
By 2050, India’s population of those aged 60 and above is expected to total 323 million, a number far greater than the entire US population in 2012.It has been reported that a majority of India’s elderly – about 80 per cent – live in rural areas, of which 40 per cent live below the poverty line. A major portion of the elderly population has no social security such as Provident Fund, Pension scheme, Gratuity and healthcare. Most major hospitals in India have no separate geriatric care specialties and most of the elderly patients are treated in common wards. Geriatric care comprises special components such as emphasis on orthopaedics, CVS, visual and auditory impairment etc and the treatment perspective varies considerably. It is important to treat geriatric care as a different field to do complete justice to the treatment and care of the elderly. So far in India, only a minor affluent portion of the population has access to geriatric focused wellness centres and other elder care modalities.
What is the projected impact of healthcare for the elderly in India, in terms of demographic profile and burden on healthcare spends, both on a personal as well as national level?
The elderly face an array of health conditions including co-morbid complexities and in many cases find only insufficient treatment options. Given the rising demand for social care services from an ageing population, governments are increasingly keen to share their responsibility for meeting this need. Even in the UK, where healthcare is overwhelmingly state-funded, the private sector is now the main provider of nursing home beds. The overall geriatric disease burden in India is massive. In the US, geriatric patients utilise close to 28 per cent of health resources, while their utilisation through similar estimates would be close 15-17 per cent in India.
What kinds of options are available and where are the gaps?
The geriatric services market is estimated to be worth about $250 million in India and expected to grow to over $1 billion by 2013 and $2 billion by 2017. However, the segment is extremely niche and few players have explored the market. Apollo Hospital in Chennai is amongst the few hospitals that has a department of geriatrics along with Heritage Hospitals (Hyderabad) and Max in Delhi. These departments aim to focus specifically on the needs of the elderly and have treatment and management programmes designed especially for ailments afflicting this genre of patients.
Most of these players offer medical check-up services for the elderly and health monitoring options. Some also offer diet help and wellness routines. Geriatric care is an emerging healthcare model – ideally an integrated unit where the elderly can receive end-to end healthcare support: from health management to monitoring and diagnosis. A different kind of model is Association of Senior Living India (ASLI) which is a voluntary membership association for developers/service providers/corporate that operate in the senior living industry. While not focused on healthcare, ASLI is a great platform for providers to realise and address the needs of the elderly in India.
However the number of such facilities is very less and a major portion of the population doesn’t have access to these. The issue is compounded by the fact that a larger portion of the elderly cannot afford these services. A major gap lies in the current medical education system which doesn’t have any specialisation for geriatrics. This leads to a gaping deficit in the number of qualified personnel trained to treat and manage healthcare for elderly in India.
What are the global trends as per the KPMG report, ‘An uncertain age: Reimagining long term care in the 21st century’?
Some of the trends highlighted in the KPMG report –
In terms of demographics the report enunciates the rise of the elderly population globally along with the narrowing longevity gap. The report illustrates these trends with examples of countries like Singapore and China which are forecasted to have relatively higher ratios of elderly people in the coming years.
The need for elderly care is further highlighted owing to the increasing pressure on traditional family based care. With the rise in number of divorce rates, single parent households, nuclear families etc – the elderly are far less likely to receive adequate care.
From a business model perspective the report highlights two major trends. Firstly, the integrated model for elderly care – which brings together varied areas of healthcare and offers end to end services to a patient. The geriatrician, community nurse, pharmacist, dietician etc all work as an integrated unit to serve all needs of the elderly patient. And secondly, the integrated model also pushes for a patient centric approach which highlights the focus on patient rather than ailment – consequently quality of life (QOL) over treatment of a disorder.
What are the new models of integrated care mentioned in the report?
Most models based around integrated care mentioned in the report have the following characteristics: they bring together personnel with different capabilities and expertise in different areas of geriatric care, provide all round care not restricted to healthcare needs and focus on QOL rather than disease conditions or impairments
A noteworthy example is the Geriatric Flying Squad, a rapid-response, multidisciplinary nursing service for sub-acute care recipients living at home. Developed in 2010 by a hospital in New South Wales, Australia, it includes a clinical nurse specialist, a doctor specialising in geriatric care, a social worker, occupational therapist, physiotherapist and clinical psychologist. Another example is Programme of All-Inclusive Care for the Elderly (PACE). Developed in San Francisco in 1973, it’s a publicly funded system of integrated care for eligible frail and disabled adults living in the community. Enrollees attend a day care centre where they receive most services from a multi disciplinary team.
What should be the new approach to medicine in long term care?
The approach in long term care should be patient centric over institution centric. The management of health should be a priority rather than the mere treatment of the disorder. Since elderly patients may not necessarily need medical treatment but activities to occupy their mind and companionship – players in this domain should consider these factors.
Wellness centres, diet regimens and mind activities are recommended to most geriatric patients – an institution which caters to geriatric patients should have these facilities that foster the QOL of a patient. Needs of each patient should be assessed and solutions provided should be custom made to genuinely ensure the well being of the patient. These social models of care are better equipped to take care of the elderly than medical models.
According to the report, where does India and other emerging countries stand in comparison with developed countries on these parameters?
Countries like France, Germany, Finland, Japan, Norway, UK etc have a publicly funded insurance system in place which takes care of the healthcare needs of the elderly. In some countries this funding is shared by the government as is in Singapore and Australia, whereas China and India do not have a structured programme for geriatric care.
What should be the road map to reach these levels in India?
India has a long way to go in terms of geriatric care. Although home care as a segment is emerging in India the domain is fairly niche.
The traditional healthcare providers are currently not prepared for the coming challenges of the increasing elderly population because of the sheer size and diverse needs of this aging generation. These challenges include both physical and mental health care needs – with the latter issue even more largely neglected than the former.
The Indian system of care is not patient centric and care is still a reactive approach rather pro-active – with emphasis on treatment rather than management. Further, geriatrics as a subject is not considered widely in India’s medical education system.
As mentioned before there a few players that have entered the segment, however these players are far and few and their offerings are not comprehensive.
Geriatric care as a segment has a large addressable market size and immense potential. Further the business is relatively less capital intensive and hence scalable. Also, few players in the market make the competitive structure friendly. Health care providers should look at investing in this space. Focus on patient centric geriatric care in an integrated set-up is what Indian healthcare providers should look at in the near future to tap the potential.
Also, geriatrics as a topic should be given its due importance in the medical education system in India. More training institutions and specialisations in the field could partially resolve the huge manpower deficit in the domain.
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