Lessons learnt in 10 Years

Can Indian healthcare's problems be solved by locally made medical devices or schemes like Ayushman Bharat? For Dr Vivek Desai, Managing Director of Hosmac India, locally made medical devices or AI is no science fiction anymore. He believes that innovation is the only way to survive in the industry. Read this article to make sense of disruptions that are not going to mould tomorrow, but also present of Indian healthcare.

There's something incredibly appealing about Dr Vivek Desai. It could be the intensity with which he talks about his company Hosmac, which he founded in 1996 or the anguish in his voice when he discusses struggles of Indian entrepreneurs. It could be his affection for his team, the members of whom he talks with pride and insists on introducing as his "colleagues". It could also be the determination with which he speaks his mind without fretting about political exactitude.

The doctor-turned-entrepreneur has more than two decades of experience in hospital planning. The firm now has offices in India and the Middle East, with 150 employees and is considered a pioneering name in the healthcare consulting arena in India.

"I am a doctor and understand hospital buildings better than any other person. Hospitals are complex buildings and need much attention. Every speciality has a specific requirement. There is a new learning every single day from issues around the world like how china built a hospital in 10 days," explains Dr Desai.

Challenges

The biggest roadblocks for the growth of the healthcare sector is the infrastructure gap between the public and private hospital, says Dr Desai. "Our country has a disparity in income levels of people and how healthcare is delivered. On the one end of the spectrum, you have rich and the other end you have poor. Similarly, you have a public healthcare system and a private health system. The volume of people they treat, the technology that they own is much different from the private healthcare sector. That's not the case in most of the western world. There is no difference between public and private hospitals in countries like Germany or the USA," explains the solution-oriented entrepreneur.

The BITS alumnus believes that India needs 1 million hospital beds by 2030. "But the disparity of distribution must go. A few states are doing well. We need other states like Chattisgarh, Jharkhand, Bihar and North East, to do well. The government's decision to allow PPP models for a district hospital is a move in the right direction because income streams are assured due to Ayushman Bharat. It's similar to the privatisation of Indian railways. Implementation will be the only challenge," he explains.

Will schemes like Ayushman Bharat bridge this gap between private and public healthcare? "It will ensure access to healthcare of superior quality to needy citizens of the country. Till then, it was not the case. Earlier whatever was free, was of inferior quality. That has changed with Ayushman Bharat, as each family is provided with a kitty of five lakh, they can access healthcare at hospitals like any other citizen. Slowly the government will bring in different sections of the population like the middle class."

Shortage of Human Resources

"Challenges are plenty and won't stop for the healthcare sector," elaborates Dr Desai. "Lack of availability of human resources is a big hurdle. We need to double the number of doctors and nurses, but it will take several years to churn out these resources. The government also understands that it needs to create more workforce in the healthcare sector. The decision to add 10,000 more PG seats this year is to improve the availability of specialist doctors in the country. Earlier, one professor was allocated one student; they have increased that to three now. The government should simplify the process of setting up medical colleges. Many countries don't insist on such a massive infrastructure. The government has started to streamline the process for setting up colleges in tier II towns, but more needs to be done. Probably, they should outsource accreditation to external agencies like how ISO 9000 certifications are done. It's a body of specialist consultants, who are licensed to accredit. That probably will help. Otherwise, red-tapism will never end," he adds.

Technology

His biggest push is for devices made-in-India. "Technology can be used to increase the outreach of healthcare and economy of scale. As we don't have enough specialists, it will be challenging to place them in remote areas. Telemedicine can be used to reach out to more patients like how radiologists sitting in India supplement care for shortage in other parts of the world like Singapore or the US."

Desai also points out that even though India has large pools of data, we have not used them and still rely on other countries for research. "The government has realised this deficit. That's why they are planning to set up a medical college inside IIT Kanpur so that there is better collaboration between the medical college and the engineering college. Many international universities already follow this model. Having a medical university will further strengthen the biomedical engineering units within the campus. This will create better solutions adapted for Indian conditions. IIT Kharagpur is also likely to roll out MBBS programmes from 2021-2022 academic sessions. Currently, hospitals import 80 per cent of their medical equipment. Further, medical equipment is going to become more expensive this year, as the government has announced health cess of 5 % on imported medical devices."

Embracing Flexibility

Ayushmanbharat has increased access to healthcare for poverty-stricken patients, who used to spend out of their pocket for healthcare expenses. Desai hopes that probably the government will include middle class also into this category. "In countries like Australia, a portion of the person's income will be cut for healthcare insurance. If they need more than the specified limit, they need to pay out-of-pocket. This is a model which can India emulate. The government should revise rates of surgeries to attract more players. Many complain that the government rate for procedures is much lesser than the usual pricing of systems. Today, hospitals are trying to compensate for the price difference by increasing the volume of operations. There is a paediatric hospital in Surat, which do more than 150 knee joint surgeries in a day. They still make profits, but marginally," he adds.

Reducing Cost is Key

Healthcare is still an attractive sector for investment, and the fact that several mergers and acquisitions are happening in the industry proves this point. But Desai points out that reducing cost is going to be key this year. "Healthcare players will have to find new ways to cut costs if they want to take advantage of Ayushman Bharat. Millions of people depend on the generic drugs produced by India, which is also known as the pharmacy of the developing world. The budget has also highlighted the significance of generic medicines."

Tailor-Made for India

According to Desai, in the decade going forward, primary healthcare is indispensable for the Indian healthcare sector."That's the reason why the government have set up wellness centres. Probably, they might outsource these centres to private players soon. Maybe, all the curbs on import might trigger a Make-in-India revolution. Currently, there are players like Allengers, who are competing with MNCs like Philips in the market. Plausibly, we will have more such players soon," he concludes.