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NATHEALTH submits recommendations to Centre to manage next COVID wave

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The recommendations urge government to initiate urgent action on granting flexibility to hospitals to give adequate attention to non-COVID care

NATHEALTH has submitted a set of recommendations to the Prime Minister’s Office (PMO), Department of Pharmaceuticals (DoP), Central Drugs Standard Control Organisation (CDSCO), Ministry of Health and Family Welfare (MoH&FW) and NITI Aayog for bolstering the existing healthcare infrastructure to be well-prepared for the third wave of COVID-19.

The representation highlights that while first two waves of the COVID-19 pandemic have already overburdened the health system of India, there are countless non-COVID patients who are suffering prolonged agony and are at a risk of worsening physical and mental health in the absence of adequate medical attention.

The submission also included findings from a recent patient study conducted by NATHEALTH with IQVIA in 2021 on the impact of COVID-19 and delay in treatment and on patient behaviour due to restrictions in accessing healthcare facilities. The recommendations urge the Centre to initiate urgent action on granting flexibility to hospitals to give adequate attention to non-COVID care, alongside catalysing new medical infrastructure creation, unlocking working capital for the MedTech and broader healthcare sector, expanding health financing and public spend, developing resilience in the rural and peri-urban areas and scaling up healthcare service access beyond metro cities through technology.

  • Catalysing new medical infra creation: Incentivise incremental quality medtech infra creation backed by commensurate investments to expand CC/ICU infra in hospitals and ambulatory/home care infra outside hospitals. This should be done by creating a level-playing field between local and global manufacturers, creating a roadmap for quality innovative medical infrastructure by raising investment (both public and private) in the GDP from current 1.7 per cent to between four-to-five per cent over the next five years. The time to do this will be now when this investment can have a multiplier network event in restoring the economic health of the nation past the pandemic while laying the healthcare foundation of a $5 trillion modern economy.

    While we try to find tax financing to fund this programme, we may also make it mandatory for a portion of company CSR to be spent on healthcare infra funding. Between 2014 and 2018, CSR spending in India grew 47 per cent, but gaps in the system continue to be a cause of concern. These funds can be channelised (by making it mandatory for a portion of company CSR to be spent on healthcare infra funding for the next three years), to increase the much-needed capacity in the healthcare segment. In addition, the health sector will greatly benefit from a composite tax (direct and indirect) rationalisation with long-term infrastructure lending at competitive interest rate, incentivising capacity and employment generation. NATHEALTH can partner with the government to set up the contours of a broad plan to this effect.

  • Boost short-term health infra availability and productivity: Use technology and automation for productivity gains and augment surge capacity and draw cross funding from PM Care, PMJAY/insurance flexi funds and CSR spend to fund AMC for all medical equipment, get spares and equipment up and running, develop e-ICU mandate in hospitals above minimum beds, training for frontline equipment technicians and remote monitoring.

    Create a programme to audit and get every medical equipment and allied COVID infrastructure to be up and running within 30-60 days. In addition, global innovation around COVID is moving at a rapid pace. We need an accelerated approval process for market-ready innovations like vaccines.

  • Unlock working capital: Release medtech payment dues, receivables and arrears to free up working capital to invest in inventory of critical spare and life-saving equipment. The duty and CESS announced in previous budgets on medtech equipment is adding costs to providers and a waiver of this tariff will be a reasonable step benefitting the citizens, at a time when global supply chains are tight and escalating input costs, freight and other logistics costs are an ever-increasing burden.
  • Health financing: Increased coverage of insurance, particularly in tier-II and III towns, will drive capacity growth as high-quality providers will have confidence in the paying capacity of the patients. Forty eight per cent of the population travels 100 Km to access healthcare, there are opportunities to build asset light models powered by digital technologies improving access and affordability with appropriate reimbursement and financing models.
  • Building rural/peri-urban pandemic resilience: Invest in emergency ambulances and medical/testing infra for rural India where the pandemic is gaining grip – community testing, referral emergency and non-emergency transport and vaccination. Accelerated capex spends under 108/104/NHM/NDMA programmes for the next two years to FY 2021-22. Explore asset light PPP models for peri-urban/rural infrastructure building and services delivery.
  • Ease of Doing Business: Develop a transparent predictable regulatory environment, particularly around pricing. Create mechanisms where these decisions are not unilateral, linked to quality/standards and arrived at after due deliberations at central and state levels with appropriate input from industry. An unstable pricing regulatory environment has deep disincentives for investments and access to financing, which are critically needed now. A consultative process with checks and balances needs to be created as we need to develop a framework that ensures that quality and patient safety are never compromised, and this will require adopting value-based procurement norms which rewards the best quality/patient safety per unit of cost (not cost alone).

Speaking on the recommendations, Dr Shravan Subramanyam, Senior Vice President, NATHEALTH said, “The pandemic has exposed the missing links in the Indian healthcare system – shortage of skilled staff, beds and infrastructure has taken the limelight. It is heartening to see how private players from across industries have joined hands with the government to close these gaps and to help healthcare providers navigate strongly during these times. Example of this has emerged everywhere, remote monitoring solution has brought added ICU capacity to rural and urban areas, AI chest x-ray applications help doctors diagnose faster, unique CT solutions help keep staff safe from the virus, the skilling initiative is also helping to upskill and train professionals for better healthcare delivery. Along with customers and partners such as NATHEALTH, we are also looking beyond the pandemic to ensure cardiology, oncology and trauma patients are empowered with timely and adequate attention to ensure their health does not deteriorate further. The pandemic has shown that when industries come together, we can positively impact more lives.”

The Patient Confidence Study Report, submitted along with the recommendations, highlights that 57 per cent of the surveyed patients, cancelled/postponed/rescheduled their treatment plans between March-December 2020, almost 100 per cent of patients cancelled/postponed/rescheduled their surgeries due to lockdown, 34 per cent of OPD patients cancelled or rescheduled their visits to hospitals, 82 per cent patients wished to reschedule/return to their treatment plan by June 2021, and 62 per cent patients believed that their health condition has been negatively impacted.

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