Prof T Sundararaman, Dean, School of Health System Studies, TISS, speak about healthcare trends in 2018 and how these developments will impact the overall Indian healthcare scenario, in a conversation with Raelene Kambli
What are the new trends that you anticipate for the healthcare sector this year? And what changes will these trends bring in?
The most hopeful trend that we see in the healthcare sector is the proposed development of the health and wellness centres. These centres are giving huge impetus to comprehensive primary healthcare in the recent times which wasn’t there earlier. It was mentioned in the budget speech, but it did not get picked up in the subsequent dialogue. This trend can be a big driver for change within the sector. A change in perspective for healthcare delivery- a more focussed one on providing value-based care to patients.
Can you spell out what health and wellness truly mean in healthcare delivery?
Health and wellness centres if they play out well, it would be going beyond the traditional boundaries of providing care. For example, primary healthcare which was largely looked at as women and child health restricted to immunisation and a little aid to women pre and post pregnancy; today, this has transitioned to become more focussed on a wider range of preventive and promotive care – inclusive of both communicable and non-communicable diseases. So we are talking a lot of prevention — and that too what is called secondary prevention. We are talking about detecting hypertension, diabetes and many more lifestyle related diseases and trying to curb their rise as well as complications and deaths due to these diseases. Moreover, providing effective screening mechanisms and diagnostic services to patients so that they are assured of early and appropriate treatment which would ensure that their life expectancy is normal. Premature mortality due to these diseases can be averted.
How will these trends bring in profitability to healthcare organisations who offer these services?
Managing health and wellness centres is not a profitable venture unless we look at it as a vehicle for creating social capital and public good. This type of healthcare is better characterised as a merit good. That is why in this area even the only form of private participation sought by the government in the budget speech is through CSR and philanthropies. At the societal level though investing in health and wellness centres is profitable- it usually takes around 10-15 years to get returns. Moreover, investment in healthcare is more likely to ensure a demographic dividend to the country. Demographic dividend refers to the growth in an economy that is the resultant effect of a change in the age structure of a country’s population. The change in age structure is typically brought on by a large cohort of young and productive population that goes along with a subsequent decline in fertility and mortality rates.
So how can investment in healthcare provide demographic dividend?
Well, investing in health, has an advantage for India. Since, our country has a huge young population, investing in their health will increase economic ability leading to a phenomenal growth in GDP. Currently, the US and the UK are a having a GDP growth rate of 2-3 per cent and we are at around seven per cent. At the time of their demographic dividend they too had such high growth rates. But if we look at improving our health and wellness system, we can boost our GDP further and sustain these growth rates for longer.
Tell us about the innovations that can propel growth for Indian healthcare.
There is a world of possibilities with respect to medical devices. We (government and researchers) are looking at a non-invasive haemoglobin measurement device, which can measure haemoglobin level without a prick. Technologies which can identify neonatal deafness and thereby eliminate muteness, microbial cultures that can identify bacterial infections within a short span of time, and a hundred other such technologies are emerging that can have a far reaching positive effect. Point-of-care technologies is another innovative area that has a great scope. There is also a scope in improved systems of health services delivery.
You are talking about diagnostic tools and innovations. Do you think this will give impetus to the diagnostic sector?
Yes. Especially, diagnostic innovations that are frugal and suits the needs of the Indian population. Such innovations and companies providing such services will have a huge potential to grow in the near future.
What is your opinion on genomics then?
Well, genomics does have a great potential in India. It will have a lot of relevance in the diagnosis and treatment of cancer and it may be relevant even in all chronic diseases. Yet, it is still at a nascent stage.
Will genomics add to healthcare cost? What should companies do to make these services cost effective and affordable to all?
At present, yes it will add to cost. But if effective cost strategies are put in place, especially in the public health domain, volumes would be driving costs down thus, bringing the values that people are looking for.
What role can behaviour science play in improving healthcare cost burden in India?
Behavioural sciences have a tremendous role to play in improving the effectiveness of healthcare delivery. But I am not sure of its contributions to driving down costs. In healthcare, typically outcomes are very uncertain and choice of care is complex. Healthcare markets do not work in the way other industries work for commodities and services. Paying for healthcare at the time of need does not give much room for choice. If you are ill, you will have to pay as there is no choice involved. Behavioural sciences have been used by health management organisations to shape markets for greater consumption of healthcare services. It can play a role in shaping markets for better health practices and more rational use of therapies- which together should be able to reduce societal costs on healthcare.
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