Health care in India faces unique challenges.
Though Government promises health care to every citizen free of cost, majority of the health care expenses in India are paid out of pocket by most families. India has a diverse population with vast differences in their ability to access affordable health care, depending on their social strata and where they live.
There is a discrepancy in treatment standards and availability of health care services in India depending on where the person is getting treatment from. Quality control is lacking with many players like RMPs, Homeopaths, Ayurvedic doctors and sometimes chemists at the pharmacies dispensing medications and providing medical consults. There are inadequate regulations on the billings of corporate hospitals. Often, the common man, who cannot afford corporate medical care, finds himself in a situation where he does not want to go to government hospitals which lack infrastructure and do not maintain minimum standards of hygiene.
The central government contributes with budget allocation and the Ministry of Health and Family Welfare (MOHFW) plays a crucial and important role in guiding India’s public health system, health care is a state subject in India. Some special health plans by state governments provide free inpatient and surgical services but outpatient care and preventive services are often not covered and diseases are neglected until it is too late, requiring hospital admissions and invasive procedures. Though primary health centers in rural areas are set to provide necessary primary care free of cost, they are often not equipped with essential medicines, infrastructure and lack adequate supervision and quality control. Situation is changing to some extent now with expansion of health plans to outpatient services, establishment of generic medical shops and betterment of Primary health centers with some states like Kerala and Tamil nadu setting good examples.
Huge portion of health care expenditure goes into private pockets, the office visits are short, discharge planning is poor, proactive reach out is lacking and private health centers’ contribution to disease prevention and efforts to cut down healthcare costs with best disease management programs is sub-optimal for obvious reasons.
People seek medical care at different stages of life, however; the personal health data is missing, paper records are disjointed and continuity of care is missing even in the best of health care systems. This often results in repetition of tests, medication errors and poly-pharmacy. This is made worse when people directly consult specialists bypassing a primary physician who is the anchor for all the specialists. Additionally, disease registries are not maintained and statistics of incidence and prevalence of a particular disease are not accurate.
While Indians are always ready to adapt to technological developments and are first to use fancy devices, when it comes to disease education with mass media campaigns and implementing strategies for disease prevention through authenticated sources in health sector, we are lagging behind in using technological advances and in reaching out to masses.
Whereas we were battling with communicable diseases until 1960s and 70s, with the discovery of antibiotics, vaccines coupled with the vigorous implementation of Vaccination programs, now our struggle has shifted towards tackling Lifestyle diseases, due to enormous change in lifestyles of Indians in the last 30 years. These non-communicable diseases (NCDs) now contribute to 60% of total deaths. A person in India has 26% probability of dying between ages 30 and 70 years from four major NCDs, i.e. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes.
As India is marching towards fulfilling the Sustainable Development Goals, there is a lot that is still to be done to achieve the targets. Bringing all stakeholders together and using all available resources is the key to success. Central and State governments as well as private health systems working hand in hand by utilizing services of paramedical workers and ancillary health workers such as ANMs, ASHAs and Anganwadi workers, developing public-private partnerships, encouraging NGOs, running effective mass media campaigns, maintaining disease registries and performing situation analysis when needed will go a long way in reaching the targets.
Another valuable tool in this struggle for a healthy 21st century India is the nascent telemedicine service which is far from realizing its full potential. With young enthusiastic entrepreneurs entering into this space and technology companies dreaming about changing the face of Indian health care, it is time for both governments and general public to be open to change.
India being a country of the young (half the population of India is in the 20 to 59 age group), we need to think ahead and protect the health of this young population by adopting innovative strategies. It is alarming that lifestyle diseases like Diabetes, Hypertension, Heart disease, Stroke and some cancers like Breast cancer are affecting people at a younger age compared to before. – Dr. Lavanya Aribandi, Chief Medical Officer, eKincare
If attention is not paid to curb this situation urgently, the disease burden on the country is going to be huge. As technologically savvy youth is more adept at using electronic devices and internet communication, healthcare technology companies have a lot to offer and a huge role to play in health sector. With increasing prevalence of mental disorders in India, availability of evidence-based (electronic) clinical decision support systems for adopting standard levels of care by doctors, and creating systems for longitudinal follow-up of affected persons to ensure continued care through electronic databases and registers can greatly help.
With the emergence of health technology companies with ability to effectively collect healthcare data, it is now possible to identify people at high risk, to diagnose diseases at early stages, and properly initiate and guide treatments. Patients can be educated about their diseases and appropriately referred to a specialist when needed. Chronic conditions can now be managed better with regular reminders being sent with the help of better communication technology. Health technology can now truly make a difference in improving the quality of health while reducing the health care costs across the country, mitigating the geographic limitations.
All of this is made possible with the ability of health care technology to store patient data with the help of electronic health records and leveraging their computing power for data mining and running back-end analytics. They can now offer personalized care and implement individualized risk reduction strategies. Similar plans can be drawn for larger populations by devising prevention strategies, assisting physicians by enabling them in using clinical decision support systems with evidence based guidelines incorporated into the system. Technology can be used for promoting continuing medical education and knowledge transfer for medical and paramedical personnel. With the availability of sensor devices, using cloud based transferring and storing of data we can improve monitoring of chronic diseases and prevent long term complications.
All of this will result in reduction in incidence of diseases due to better implementation of prevention strategies, early diagnosis of diseases, and reduction in complications from chronic diseases due to better management of the conditions as well as decreased hospitalizations due to identification of acute problems and early deployment of treatments.
For Corporates, health care technology companies can provide information about problem areas in employees’ health, suggestions for improvements in institutional policies, work infrastructure and approach to employee health with positive changes in work environment which in turn would reduce employee burnout, absenteeism and attrition.
For insurance companies, this will result in reduced claims; their money is well spent, early but appropriately.
For the common man, Telemedicine cuts down health care costs, reduces commutes whenever possible, facilitates proper health record maintenance, provides continuity of care leading to availability of better health care even in remote areas.
The current challenges to health technology companies in India are: lack of proper telemedicine law, no clarity regarding the dos and don’ts and lack of proper guidelines for maintaining confidentiality of health care data. The common man’s lack of skills in using technology is also a challenge, but with some innovative strategies, it is possible to overcome this.
For India, telemedicine and other services of health care technology companies could be invaluable addition if used judiciously.
– Dr. Lavanya Aribandi, Chief Medical Officer, eKincare
- Role of government in public health: Current scenario in India and future scope https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114612/
- Burden of NCDs and their risk factors in India (Excerpted from Global Status Report on NCDs – 2014) http://www.searo.who.int/india/topics/noncommunicable_diseases/ncd_situation_global_report_ncds_2014.pdf?ua=1
- National Mental Health Survey of India, 2015-2016 http://www.nimhans.ac.in/sites/default/files/u197/National%20Mental%20Health%20Survey%20-2015-16%20Summary_0.pdf