Healthcare challenges in the new normal and its impact on hospitals
What we have seen with Covid is that a lot of normal activities that was happening across the healthcare sector have been disrupted, so India used to get a lot of patients from many other countries, because of restrictions a lot of those international patients have stopped coming.
Beyond that, the Northeastern part of India is underdeveloped in terms of healthcare, like the seven sisters of the Northeast, West Bengal, and Odisha. Patients travel from there to places like Chennai and Hyderabad for treatment. All that has been disrupted because of Covid and travel restrictions. People are scared to come out, people are afraid to visit hospitals because they are afraid they might get Covid. So that is one factor which has impacted the hospital and the healthcare system.
Need for policy changes that an minimise cost and improve the quality of care
On a policy level, we have realised that the healthcare sector itself is not given the status of a proper industry. So if you have a look at the other industries, like IT and manufacturing, the government has made special economic zones for those industries, where they get subsidies on electricity, on land, on all the buying they do. Whereas nothing like that exists for the hospitals and the healthcare sectors. Most of the high end equipment that comes to the hospitals is actually imported from, generally from Europe like CT scan machines, MRI machines, Cath lab. All these are imported and there is a hefty import duty that has to be paid. Because, all of this is made overseas, the cost is quite significant and eventually has to be passed on to the patient.
So, I believe at a policy level the new normal should look at having various policy decisions in which it is made easier for healthcare to be delivered at a lower cost because of subsidies given by the government. This could be in terms of land, electricity, in terms of working capital financing, in terms of preventing the brain drain of doctors from India because, if you see, doctors are not paid as high as many other countries. So there is a lot of brain drain happening, a lot of very good doctors go overseas to work, typically, in the US and the UK.
Need to retain the medical talent
In order to deliver healthcare successfully, we should be able to retain the top talents of doctors in India and also reduce their expenses of getting fellowships and qualifications from overseas through subsidised loans. In addition, at a policy level, I think, wherever healthcare institutions are, they should be looked at from a special economic zone perspective, so the cost of all these institutions of operating comes down. I think that is going to impact the cost which is finally given by or handled by the patient. So these are some of the things which I feel, in the new normal we will have to look at.
People have now started understanding the importance of hygiene, the importance of hand washing, and the importance of covering your face with a mask and that is one great benefit that has come in the new normal. Adult vaccination was almost unheard of in India.
So we have seen a lot of patients who have had residual disabilities like lung fibrosis, various clots inside the body, it could be clots in the blood vessels of the legs. We have seen patients, because of Covid presenting a heart attack in the arteries of the heart. We have seen patients not being able to come out of oxygen and this has a long term impact on their productivity and life. So one of the ways that has been counted till now is by offering rehabilitation, so if somebody has lung fibrosis, they might not be able to walk. Having said that, since the disease is very recent, there may be other impacts of the disease which may be seen years later but remain to be seen.
Are we prepared for the next pandemic?
So yes and no. Yes, in terms of learning the infection control protocols, knowing how to isolate, knowing how to use personal protective equipment, knowing how to use N95 masks, the entire healthcare system in India has learnt to do all of that because of Covid. They have understood the importance of segregating areas of the hospitals with possible suspected patients. These protocols will help in future also, because irrespective of the nature of the pandemic, these pandemics are all infectious diseases and the protocols to handle them or prevent infection are standard, but what has happened is one year of treating Covid has taught us how to execute these protocols because just knowing the protocol is not enough, being able to execute it flawlessly and training people how to use it at the front level, at the grass root level is important.
Post Covid-19 health insurance
Well, if you see, a small percentage of India is covered by insurance if you exclude the government schemes, there are only about 1.4 to 1.5 crore people covered by health insurance, which is significant. 65 percent of India, even now, has out of pocket expenditure, that means they spend their savings on healthcare. Even in large hospitals, 60 percent of patient spending is actually cash, only 40 percent is insurance covered by companies. So health insurance is a way where people can actually pay a small premium every year and get coverage for themselves.
One of the other things is awareness about health. So if you see, India has seen a huge increase in the number of cancer cases, especially, young age cancer, so breast cancer is something we have seen a huge surge in women getting it. Now the screening for breast cancer, for chronic diseases in India is still at an infancy. If we have a higher screening of a population for non- communicable diseases like diabetes, hypertension, cancer, heart disease, you can reduce the impact of the total burden of healthcare by doing early intervention at an early stage.
Healthcare expenditure: to impact early screening
Screening, as well as early intervention programs like, for example if somebody has diabetes and they are diagnosed with pre-diabetes that is a very early stage of diabetes and can be even reversed, but unfortunately has no symptoms.
Cancer in the early stages starts at a very small area of tissue, a typical example being breast cancer, it can be discovered in screening mammogram which is an X-ray of the breast. A Mammogram can even detect tumors which are about 2-3 mm in size. Similarly hypertension, early stage hypertension can be treated with lifestyle interventions, like reducing salt, exercise, living the right lifestyle. Unfortunately, people are present with a stroke because they have never undergone a blood pressure check. Similarly, if we see a lot of cancers.
So if we can put more chronic disease management programs, screenings, early stage intervention, managing chronic conditions with right medication and lifestyle interventions, the total disease impact on the population will come down. 65 percent of deaths in India are now because of non-communicable diseases. Non-communicable, if you have early stage prevention programs, as well as screening programs, it can reduce the impact on the lives of the people as well as the cost of healthcare.