With rapidly changing dynamics in healthcare space, the demand for India’s home health sector is only set to rise. By Sanjiv Das
India, home to one of the largest young population in the world, also has a growing number of geriatric population. According to data from Deloitte, the global elderly population is expected to grow more than double to two billion by 2050 from 840 million in 2013 and India will have 340 million elderly by 2050. Coupled with changes in the traditional family system and rise of nuclear families as well as diseases triggered by lifestyle changes, the geriatric population needs healthcare by their side. This, in turn, is where the concept of home healthcare comes to play.
The convenience of receiving healthcare services at home is the highest level of access that a patient can hope to get. And this service is not only being accessed by the elderly, the young generation is also looking for the convenience and effectiveness of ongoing therapy. Though at a nascent stage in India, the home healthcare market is going to witness a phenomenal growth in years to come. Providing accessible, affordable and high quality treatment will be the motto of the home healthcare providers.
Today, the country is witnessing a dearth of doctors and paramedics. Hence, patients travel far and wide to get quality treatment as there is a disparity between metropolitan cities and tier II and III cities when it comes to quality healthcare. Also, cost factors force many to forgo treatment mid-course. Home healthcare, if properly implemented, can play a pivotal role and get rid of these issues.
According to a report by Zion Market Research, the global home healthcare market was valued at $228.90 billion in 2015 and is expected to generate revenue of $391.41 billion by 2021, growing at a CAGR of 9.4 per cent between 2016 and 2021.
Home healthcare also referred as home medical care or formal care, includes occupational and physical therapy and skilled nursing. Sometimes, it involves helping older adults with activities of daily living, such as bathing, dressing, and eating.
According to the report, Asia Pacific is expected to be the fastest region for the home healthcare service market. In the Asia Pacific, emerging countries such as India, China, Singapore, and Malaysia is anticipated to drive the home healthcare market due to improving healthcare standards.
Dr Gaurav Thukral, COO, HealthCare at HOME, says, “Though the concept is yet to reach its potential, there are plenty of opportunities for all players. The key challenge comes from the unorganised sector, small time players who do not follow standards of care or maids or manservants hired as attendants for providing home care. Standardisation and accreditation practises have already begun to regulate home healthcare industry – which is the key to eliminating wrong practises.”
According to Narasimha Jayakumar, CEO, Nightingales Home Health Services, “The home healthcare sector is still in its early years and is making the shift from an unorganised sector to a professionally-driven organised healthcare delivery system. The market is evolving fast with a few players having established a wider pan India presence and others remaining focussed to individual cities.”
“Some contributing factors for this growth include affordability, need for personalised care for chronic and lifestyle-based diseases, changes in the traditional family system, and rise in nuclear families,” says Meena Ganesh, MD and CEO, Portea Medical.
Challenges to conquer
A majority of the population has a general perception where they think that home healthcare is all about having nurses or an attendant at home. The segment has witnessed an increase in the demand for home healthcare services in categories other than the elderly and those needing post-operative care. There are endless opportunities in this segment provided certain things are in place. Besides opportunities, the sector also has a lot of challenges which if overcomed will be a game changer for the society.
Says Jayakumar of Nightangles, “The key opportunity of this segment is the rise in chronic diseases in the country and ageing population. Patients with chronic conditions go through expensive recurrent hospitalisation and a clinically driven home healthcare service can reduce the incidence of hospitalisation for these patients thus providing a cost effective healthcare delivery solution. Traditionally, home healthcare and the responsibilities associated with it were entrusted to a stay-at-home member of the household. The challenge of most sectors which transition from unorganised to organised approach is the price value proposition for the consumers. The second is the workforce transition.”
According to Ganesh of Portea Medical, lack of regulation, zero insurance for healthcare services availed at home, and the fact that there is very low government spend on this sector are some of the hurdles. She says, “With enhanced customer experience, this segment is poised to be a huge asset to influence others to adopt home healthcare and return to home healthcare providers as and when healthcare needs arise in their lives.”
Says, Thukral from HealthCare atHOME, “One of the major challenges in this segment is that people find it hard to believe that high-end home healthcare services are possible. They feel that they can get good services only though admittance in hospitals.”
In need of government’s support
Indians still pay a fat amount from their own pocket to meet their health expenses as compared to countries like the US and the Middle East. Though the government is trying to bring in health schemes for the masses, a majority of the population remains underserved and is dependent on the under-financed and overcrowded public healthcare system. Unless basic healthcare needs reach the masses, the road ahead seems bumpy for the home healthcare sector. It needs to be seen on how government’s initiative can actually help the sector in the long run.
Jayakumar says, “The government should strengthen the training of paramedical personnel who want to make a career in home healthcare and include this course in the vocational training institutes like ITI. The growth of this sector is closely linked to insurance reimbursement, so the government must include home healthcare cost reimbursement in all its health insurance coverage schemes which will also provide the impetus to private health insurance schemes to include home healthcare in their products.”
Ganesh of Portea Medical says, “The home healthcare sector also currently has the lowest government spend. There is a need to put in place norms and incentives for regulation of this sector taking a cue from countries such as United Arab Emirates. Insurance companies do not cover home healthcare services under their ambit, something that needs urgent attention.”
With the Ayushman Bharat Scheme in place, there will be an increased burden on hospitals as more patients will seek treatment and the segment has the potential to relieve the ever increasing burden on hospitals and doctors.
Thukral says, “The government can support the growth of the home healthcare industry by introducing standardisation and regulation practices, mandating its inclusion in government-led health insurance policies and formulating policies to reduce burden on hospital infrastructure through home healthcare partnerships. We are hopeful that moving forward, the government will also understand the value that home healthcare solutions provide bring to the healthcare industry.”
Health insurance in India is in a dismal state as not many people opt for it due to various reasons. Since not many opt for health insurance, going ahead to get quality treatment, is a distant dream for many. Though many insurance providers aptly provide insurance covers, a few of them are providing their services in the home healthcare segment and in days to come more are likely to venture into this segment. Can the insurance sector be a game changer for the segment?
Says Thukral from HealthCare atHome, “Standardisation and regulation of home healthcare industry is sure to extend health insurance cover to home healthcare soon. Inclusion of insurance of home healthcare service is beneficial for both the patients and for the insurance company as well. Insurance companies can increase their market and coverage by covering home healthcare as one of the cashless or reimbursable service.”
One of the advantages which the insurance sector can bring in this segment is significant reduction in fraudulent cases. The home healthcare sector rely on the most current technology to deliver their services efficiently and economically.
According to him, “All the activities related to patient care are recorded in the system, leaving a trail and can be audited at any point of time. Hence, there is always backup data available to check for fraudulent claims. In addition there will be a significant reduction in claim amounts as home healthcare service is much cheaper.”
Jayakumar mentions, “Although home healthcare services are gaining considerable traction in India, currently, they are not comprehensively covered by health insurance companies. Across the globe, home healthcare is covered under insurance and has been a key enabler for healthcare insurance companies — to reduce the overall cost of care and thus help consumers by restricting the rise in insurance premium on a yearly basis. We are hopeful that healthcare insurance products will soon cover the cost of home healthcare.”
Ganesh from Portea opines that insurance companies do not cover home healthcare services under their ambit, something that needs urgent attention. She says, “Insurance plans do not cover home healthcare as a separate category. However, some services are covered only if prescribed by doctors or if the expenses incurred are an extension of hospitalisation.”
Technology, a key enabler
Home healthcare services with the help of appropriate technology can cover a wide base of population in the country. The space is dotted with healthcare aggregators, doctor discovery platforms and start-ups offering home healthcare services. The sector is already on a fast track with digital technology in place where it is easier these days to detect fails and missed medication. Also, mobile devices, along with AI and algorithm-based analytics, will enable care givers provide real time consultation in remote areas.
Jayakumar opines that integration of information technology with medical electronics is enabling the sector to provide high quality medical care at home at affordable prices. He says, “Patient-centric approach enabled by technology convergence consisting of connected devices and digital health are reportedly more accurate in early adoption of preventive measures and facilitates quicker intervention, as and when required.”
The sector is able to provide high quality medical care at home with developments in information technology (IT) and integration with medical electronics.
“Though healthcare IT has been in use for long to bridge gaps in expert care, it is now being increasingly used in home healthcare systems to deliver health at home, largely due to advancement in user friendly medical devices. Home healthcare medical devices can be broadly divided into two types, active or passive. Both types of technology can be used interchangeably and serve varied functions in home health care. The information recorded in them can be read later on by an expert or can even be actively transmitted to a hospital or health centre,” says Thukral from HealthCare at Home.
Ganesh from Portea Medical says, “With enhanced customer experience, this segment can be a huge asset to influence others to adopt home healthcare and return to home healthcare providers as and when healthcare needs arise in their lives. “
He futher adds, “The key to quality home healthcare lies in accessing the right and latest technology at affordable rates. This will not only help hospitals offload their burden of occupancy but also bring down cost of medical care depending on the facilities and services availed for the home patients.”
Manpower training and logistics
Proper manpower is needed for any organisation to function properly to sustain and the same goes for this sector too. Home healthcare companies are investing a lot in this sector though the sector is still unrecognised. A perception still exists where many believe in hiring a healthcare assistant (a manservant or maid) who have no medical experience.
Jayakumar says, “At Nightingales we have an extensive training schedule for all staff whether they are clinicians, nurses, physiotherapists, speech therapists or bedside care givers. All our staff is full time on the payroll of the company and we follow all statutory and regulatory processes around their employment. The logistics are all tech enabled and GPS monitored so we know at any given time where our staff is stationed or in transit.”
Thukral says, “Leaders of the home healthcare industry in India are investing in world class training for their staff along with quality set ups for home care. This focus on trained home healthcare staff combined with advanced technology for diagnosis, treatment and patient monitoring ensures that the patient continues to receive quality care, as received in the hospital, with the additional benefit of comfort of familiar atmosphere, proximity of loved ones and economic viability.”
He also mentions that there is a great need to ensure that clinical staff is effectively trained to be able to manage patient complication at home through an exhaustive induction programme, recurring on job trainings, refresher trainings and audits.
Ganesh from Portea says, “One area that needs serious attention is skill development for nursing attendants and general assistants. Home care is not part of any nursing curriculum and people are unaware of such a concept. There is a need to include home care as a key component of nursing and create awareness on how this additional skillset is required. The sector must be made lucrative for youngsters to be seen as a potential and alternative career path.”
An evolving sphere
Even though hospitals are venturing into this model, they are jittery about the fact that it is not their core competency. Hospitals with in-house resources sometimes limit their services to a certain distance due to internal capacity of medical manpower and medical infrastructure.
According to Jayakumar continuing expansion of home healthcare services either by hospitals or standalone home healthcare cos: will accelerate the growth of this emerging healthcare ecosystem and give patients and their families the confidence of receiving high quality clinically led healthcare services in the comfort of their home.
Says Ganesh from Portea Medical, “While this is definitely a welcome change, hospitals only provide assistance for people with chronic diseases and the elderly patients. While hospitals want to provide this as a continuum of care, they understand that this is not their core competency and that it is prudent to align with specialist players for services in this segment.”
Thukral from Healthcare at Home opines that with hospitals offering home healthcare solutions, they are able to admit more number of new patients as patients requiring step down care can be referred to home healthcare solution providers. A symbiotic relationship between hospitals and home healthcare solution providers is shaping the future of Indian healthcare.
The way forward
The need of the hour is to ensure that home healthcare, like the other segments, is better regulated and recognised as an industry. This will help in extending the reach to remote corners of the country as well. Moreover, a symbiotic relationship between hospitals and home healthcare solution providers will help shape the future of the sector. Provided its nurtured properly, the home healthcare segment can be a good option for cost effective treatment under the comfort of one’s home.
Government’s effort with the private sector and people’s changed mindset will be a game changer for the sector in the coming times.