Growing opportunities and challenges in the Indian health care system
The health care sector in India continues to exhibit impressive growth in both revenue and employment opportunities. With a CAGR of 16% in the period 2008-2022, the Indian health care industry is projected to reach a valuation of $372 billion by 2022 and to create 40 million jobs by 2030.
Although the potential for growth in this sector is tremendous, several obstacles continue to stand in the way of achieving universal health coverage. A lack of affordability, accessibility, and awareness surrounding health care services throughout India continue to inhibit the penetration of quality medical services, especially in rural regions, where the majority of the Indian population lives. Most specialized physicians and high-end health care facilities are concentrated in large hospitals in tier I and tier II cities, resulting in unequal access to care, particularly when it comes to the latest medical technologies. Furthermore, India's health care system is heavily dependent on out-of-pocket payments, which amount to 70% of total health care expenditure in the country. This creates a huge financial burden on patients, rendering health care unaffordable for a majority of the population.
Several initiatives and forums have been developed to discuss the best ways to address these challenges. One such effort, the Philips Digital Healthcare Conclave 2018, was host to numerous discussions and debates surrounding the potential for digital innovation to shape and help improve the future of health care in India. Below are some of the most significant initiatives highlighted at that meeting.
Embracing technology for accessible and affordable health care
In line with the ‘Make in India’ and ‘Digital India Programme’ initiatives, the Indian government—through the Ministry of Health & Family Welfare—has numerous plans to leverage Information & Communication Technologies and establish e-governance initiatives in order to digitize the national health care sector as a means of increasing patient access to standardized and affordable health care. What follows are some examples of how India is attempting to improve its health care system through the use of innovative technologies:
1. To address some existing challenges, the Indian government launched Ayushman Bharat Yojana (National Health Protection Scheme), in September 2018. This plan, which is one of the world's largest government-funded health insurance schemes, aims to provide health care coverage for 100 million low-income families in India; it has been designed to be digital, cashless, and paperless, using IT platforms and data analytics for treatment preauthorization and processing claims in order to verify beneficiaries and prevent fraudulent claims.
2. The National Informatics Centre launched the e-Hospital program in 2017. This platform integrates digital information to improve health care processes and accessibility. For example, patients can register with the e-Hospital to remotely access their EHRs, while physicians can utilize the Clinical Decision Support System to obtain advice on decision making at the point of care; in addition, the e-Hospital improves digital prescription management by assisting in the elimination of prescription errors.
3. Several e-initiatives that use ICT and data analytics platforms will aim to significantly reduce maternal and under-five mortality rates in India by tracking Reproductive & Child Health (RCH) data. For example, Auxiliary Nurse Midwives Online is a mobile application that records RCH data from all states and union territories in a central repository to track and facilitate delivery of antenatal and postnatal care services. Similarly, the Intensified Mission Indradhanush program has launched the Innovative Mobile Phone Technology for Community Health Operation to identify specific areas where children are partially immunized or unimmunized in an effort to achieve universal immunization coverage among under-two children and new mothers.
4. Strategic alliances between medtech companies and providers can help cut down costs and significantly improve accessibility. For example, companies such as Philips Healthcare and GE Healthcare are increasingly using the Internet of Things to enable physicians in urban Indian hospitals to remotely monitor and manage their patients in remote areas through the Tele- ICU (eICU) services that use visual intelligence. This reduces interhospital transfers and the associated risks.
5. As health care in India continues to gradually shift toward value-based care, providers in Madhya Pradesh and other Indian states are increasingly applying geospatial intelligence to analyze health risks by region and determine the areas with the greatest health care needs
6. Biocon Foundation has made a significant contribution to the design and development of SMART clinics, termed ‘eLAJ’. These are preventive and primary health care centers based in rural areas in Karnataka and Rajasthan, which operate under the Public Private Partnership. These SMART clinics use multiparameter monitoring devices to facilitate multiple diagnostic tests and create EHRs that are accessible remotely through real-time dashboards. The EHRs are linked to the patient’s Aadhaar (unique identification of Indian residents), which enables birth-to-death tracking of the patient’s health information.
7. Andhra Pradesh (AP) is leveraging industrial initiatives that have been introduced in India in order to manufacture medical devices. For example, the AP Medtech zone—India’s first government-funded medical device manufacturing park—has set up the MedTech Innovation and Rapid prototyping facility, which promotes technology-centered domestic manufacturing of medical products such as low-cost Bluetooth- and IoT-enabled glucometers, linear accelerators for cancer care, and 3D printing services.
8. Indian health care startups based on advanced technology such as Artificial Intelligence (AI) are also going through a period of phenomenal growth and development. For instance, in response to the rising incidence of breast cancer in India, Bangalore-based startup company Niramai is developing a cost-effective, non-invasive, radiation-free breast cancer screening tool that uses machine-learning algorithms, big data analytics, and thermal image processing for early and accurate detection of breast cancer.
9. Realizing the huge potential for AI in Indian health care sector, IBM is collaborating with health facilities to launch some of its AI-driven tools, such as IBM Watson for oncology, which aids physicians in making personalized clinical decisions. Similarly, the Microsoft Intelligent Network for Eyecare project is a joint venture between Microsoft India and the LV Prasad Eye Institute that uses machine learning predictive models for vision impairment and eye disease and helps eliminate avoidable blindness.
10. The Central Drugs Standards Control Organisation has digitized the drug and medical device regulatory approval process with the launch of SUGAM, which enables online submission of clinical trial data, monitoring approved trials for patient safety, and maintaining a comprehensive central database, thereby hastening approval decisions.
11. The supply chain management of drugs, sutures, and surgical items has also been digitized with the launch of e-Aushadhi, a web-based robust drug procurement system providing the real-time status of the availability of medical products. Similarly, the electronic Vaccine Intelligence Network is a locally developed technology system in India that digitizes vaccine delivery, procurement, and planning for new antigens in Indian hospitals.
Going forward, the Indian government will require the support of blockchain technology and big data insights to further consolidate and streamline health care processes. Establishing a decentralized operational model will be difficult due to the security, accessibility, and accountability challenges that are inherent to such a system. Additionally, care providers will require appropriate training and practice to use these technologies effectively. While the digital revolution will continue to help bridge the labor shortage in some regions, it is still a matter of debate whether Indian health care professionals are prepared to deal with the disruptive shifts in technology and business models. Ultimately, however, facilitating the nationwide adoption of such technologies will allow the Indian government to address numerous existing challenges in the health care system, thereby improving the quality of and access to health care services throughout the country.