This week’s blog is written by our research analyst Surbhi Mehta, who is based in the Deloitte India office in Hyderabad and has been working with the UK Centre for Health Solutions team for the past six months. The inspiration for her blog came from a Deloitte report India-UK Technology Collaborations- Smart cities, digital healthcare, advanced manufacturing and women in technology, launched in November 2016 at the India-UK Technology Summit. The focus of this blog is on how digital technology is transforming access to and the quality of healthcare in India.
How Healthcare in India is Evolving
India, like the UK, has a strong need to improve the value for money of healthcare in order to address the challenges of increasing demand, escalating costs and the equity and quality of care delivered. As a result, both nations are increasingly looking towards digital innovation to address these issues. Within India, the incentive to seek innovative, cost-effective, healthcare solutions stems from poorly managed public healthcare coverage and a lack of insurance penetration for its large rural population (70 per cent of the county’s population is non-urban).1 This has led to high out-of-pocket medical expenses and disparate levels of care across India’s numerous regions.
In recent years, improving economic prosperity and social mobility within India has resulted in increasing demand for affordable high quality healthcare. Consequently, India is enjoying a technology and digital boost to meet the healthcare needs of its growing, consumer savvy, population, including:
- higher quality healthcare for all citizens
- better planning and delivery of services for the increasing number of older people
- the adoption of innovative services to tackle increasing prevalence of non-communicable diseases, namely diabetes, respiratory conditions, cancer and dementia.
The expectations of the role technology can play is underpinned by recent projections that suggest the Indian healthcare and healthcare IT markets will grow by CAGRs of 23 and 11 per cent respectively, from 2016-2020.2, 3
Tackling the Issues
Established providers and emerging start-ups in the healthcare space are tapping into areas such as the digitisation of patient records, mobile health, e-pharmacy, remote consultations, wearables and remote patient monitoring to tackle the country’s cost and healthcare delivery challenges:
Digitisation of patient records: With a rapidly growing population of over 1.3 billion people (more than 17 per cent of the global population), the Indian Government is seeking to empower its citizens by its “Digital India” programme. Digitisation of health records is expected to play a significant role in providing better access to quality healthcare services, especially in rural areas.4 India is currently at the initial phase of this development, and is planning to roll out the National Health Data Scheme (NHDS) and innovative e-hospitals programme, which are aimed at providing doctors with better information on their patients’ medical history.
Virtual consultations: According to the WHO, India has 0.7 doctors per 1,000 population, which is below the recommended average of 1 per 1,000 people.5 India also has a shortage of hospital beds (0.9 hospital beds per 1000 people compared to the WHO recommended 1.9 beds per 1000 people).6 Given these staffing and infrastructural constraints, virtual-doctor consultations are becoming a key route for patients to gain access to timely healthcare. Indeed, India has established a number of new home healthcare companies providing technology enabled clinical consultations, physiotherapy, and post-natal care services. The potential for health app development in India is increasing substantially thanks to growing internet penetration and increased smartphone usage. For example:
- A Gurgaon based start-up, formed in 2014, aims to bridge the access gap between the doctor and patient through innovative mobile applications (apps). One such app allows users to book lab tests, enable sample collection and receive laboratory reports, all without needing to leave the home. The app also shows health tips from doctors on 400 topics.7
Affordable healthcare delivery to the masses: India has a wealth of innovative start-ups, more than 15 per cent targeting the healthcare sector.8 One such start-up has launched a solution to improve access to A&E services. The technology aggregates data on the capacity of ambulances and emergency rooms from private and public hospitals and brings them together on one collective platform to enable more efficient access in real time. The technology also enables the tracking of a patient’s vital signs on a real time basis, allows the scheduling of appointments and facilitates inter-hospital transfers. The technology also enables all emergency staff to access the patient’s medical profile.9 Another notable example efficient and cost effective healthcare services is:
- Narayana Health (NH), offers high-quality cardiac care at dramatically lower prices than its competitors. It has achieved this through a high-volume, highly standardised model of care and a central buying unit for purchasing and leasing consumables and equipment. NH provides bypass surgeries costing on average of $1,500, substantially less than the $144,000 average seen in the US.10 As a result of the economic and outcomes success of the NH network, it performs 12 per cent of all heart operations in India each year, including 50 per cent on patients with low incomes.11
Telemedicine: In 2015, India launched a health initiative in line with its Digital India mission named ‘SEHAT - Social Endeavour for Health and Telemedicine’.12 The aim is to connect regional and local healthcare services to provide point of delivery services to all citizens irrespective of geographical location. With the launch of 4G broadband services and further plans to expand coverage to the entire nation by 2018, the future for telemedicine services in India looks strong. For example:
- The Aravind Tele-Ophthalmology Network (ATN), part of the renowned Aravind eye care hospital chain, has installed kiosk centres in rural areas and run modern vision care vans equipped with slit lamps and software for gathering and transmitting patient information safely. The van operator collects the data and sends it to a consultant, who generates reports of patients within one hour, thereby eliminating the need to go to a hospital.13, 14
Technology enabled care is seen as the way forward for the Indian healthcare industry, however wide scale adoption of technology within India is fraught with challenges, such as:
- the IT budget for Indian hospitals is usually only around 10 per cent of their revenues
- the initial need for high capital investments
- a lack of standardisation amongst various healthcare management systems
- concerns around confidentiality, privacy, ownership and cybersecurity of patient’s personal medical records
- healthcare providers struggling with a lack of in-house IT-expertise and support from IT vendors
- start-ups in the digital health space hampered by a lack of connectivity across India, along with factors such as illiteracy and poverty, which hinder their penetration into rural areas.
Despite these challenges, technological innovations have made huge progress in the last few years, largely thanks to India’s start-up culture focused on providing cost-effective services to those residing in remote areas. Progress has been aided by recent increases in government finance, infrastructure investment and administrative support. As a result, India is now improving its ability to deliver affordable healthcare to increasing numbers of its population. Importantly, this improvement does not stem from grand designs but from necessity, incessant experimentation and constant adaption - an approach that could provide valuable lessons for the UK in its search for value for money.