India can be the global ‘healthcare guru’ in 5 years

India can be the global ‘healthcare guru’ in five years

Dr. Girdhar Gyani, Director General, Association of Healthcare Providers (India), proposes an integrated approach to healthcare, and greater incentivisation for private sector investments.

Apivotal phase for Indian healthcare came in 2017, when the Government came out with a revised health policy and laid the focus on universal health coverage, which has four components – ensuring that health care is available, accessible, affordable & accountable/ acceptable (quality). In 2018, the government launched Ayushman Bharath, under which 50 crore Indians from underprivileged sections are being provided coverage of Rs 5 lakh per annum. To overcome the shortage of infrastructure, the government has brought in National Digital Health Mission in 2019 (now redefined as Ayushman Bharath Digital Health Mission), as technology can put healthcare delivery on the fast track.

From 2019 onwards, the government has increased MBBS seats on the fast track, from 50,000 seats in 2014 to nearly 100,000 MBBS seats today. The state of UP has announced to establish a medical college in each district. In the private sector, the number of hospitals may not have increased, but number of beds has increased, thanks to liberal regulation during COVID-19.

Amidst the trials & tribulations of COVID-19, a level of emergency got created, which left us with a lot of learnings. In terms of availability, we realized that we have a huge shortage of beds, even in Tier-I and Metros. Similarly, we witnessed huge shortage of doctors, equipment, medicines, safety kits, etc.

The future now is, obviously to bridge the gaps. The government is coming forward to take support of the private health sector in very open and transparent manner.

No government would like to deprive the community from good health and overall wellness. But at the same time, it will depend upon availability of resources. The average spend globally on health care by various governments is around 9.5% of GDP. A country like the US spends 18% of its GDP on health care, compared to 1.3% for India.

Luckily, from 1980s onwards, the private sector came up in a big way. As per a rough estimate, around 3.6% of GDP was being spent by the private sector till last year. In India, around 65% of primary health care and 85-90% of tertiary care is provided by the private sector. So, it would make more sense to consider healthcare as a unified ecosystem, rather than classify it into public and private healthcare services.

Before the pandemic, we had 1.3 beds per 1,000 population, while the minimum WHO requirement is 3.5 beds per 1,000 population for developing countries. During COVID, all state governments allowed hospitals to increase beds by 30%. Even if we presume that we are at 2 beds per 1000, we have to go up to 3.5 beds, implying potential for investment.

However, bulk of the investments in the past five years are coming from overseas. If we make a slight correction in the policies, even Indian investors can come in a big way. In India, we can list around 500 hospitals, which are absolutely and truly world class. If we project these as India Healthcare Hub and not individual entities, we can be a leading nation for medical tourism.

The government has started working on broadening the definition of doctors beyond MBBS. If you aggregate Ayush and allopathic doctors, we will surpass the limit provided by WHO. Work on integrating them is going on.

Moreover, we need many more specialists or postgraduate doctors. We have asked the government to increase PG seats on a drastic basis and recognize fellowships. If you do not have specialists, no investment will come for tier 2/3 hospitals.

The second policy intervention is to incentivize the private sector for opening up satellite hospitals in the close vicinity of, say 100 km radius. Doctors from the main hospital can travel to the satellite hospital in emergency, and handle routine treatments through telemedicine.

Hospitals are given electricity at commercial rates like for cinema halls and shopping malls. This needs to be brought down to industry or domestic rates. There is also a need for single window clearance. A hospital has to approach over 37 departments for clearances, which takes over a year at times before starting operations.

Yet another incentive could be to provide soft loans. International Financial Corporation could be approached to provide loan at 6.57%. With this, the private sector will be able to set up greenfield hospitals in tier 2/3 towns. The central government needs to also make a push to state governments, which can facilitate land acquisition. If these factors are addressed, the private sector is ready to invest in a big way and India could become Global Health Guru in five years.