All of us are prisoners of a rigid conception of what is important and what is not, and so we fasten our anxious gaze on the important, while from a hiding place behind our backs, the unimportant wages its guerrilla war, which will end in surreptitiously changing the world and pouncing on us by surprise.
Wrote Milan Kundera in his “Book of Laughter and Forgetting” (1979)
December 2019, while many countries were grappling with pressing internal and external challenges that kept them preoccupied, a tiny organism spreading its tentacles in the most populous country did not alarm us into attention. Even after being christened Covid-19, and placed in the list of deadly viruses to have hit the earth, what was happening in China seemed far too distant and disconnected for the rest of the globe.
The world may rue its aloofness now, but when the virus started wreaking havoc, taking the gargantuan form of a pandemic, there was no time for regret. With unprecedented and unparalleled swiftness, even before humankind could gather its thoughts and tools, it spread faster than wildfire, affecting the physical, mental, social, and economic health of the 7.8 billion population on this planet.
Work-from-home became the norm around the world to ensure the safety of people, but this was not feasible for everyone—not for the daily wage earners and the migrant labour, and certainly not for the frontline in the battlefield—the members of the medical fraternity. Healthcare workers including doctors, nurses and paramedics, braved all odds and worked tirelessly to curb the infection and cure people, based on available knowledge and evolving treatment protocols, some even succumbing to the virus in the process.
When the virus hit India, our country’s healthcare system came under probably the most intense scrutiny that it ever had. Much as it tried to cope with the situation, the task of dealing with a virulent novel pathogen that infected hundreds of thousands at a fast clip, did expose the chinks in the system. India invests just about 1.3% of its GDP in public healthcare and the cumulative widening gap of many decades, between what was desirable and what actually got done, left us with far fewer hospital beds, life saving equipment and healthcare workers than required. While a costly lesson was learnt, the situation could certainly be improved before the next pandemic—which must be only a matter of time. There is no reason that a country that did outstandingly well in developing infrastructure in other areas— transportation, power, telecom, cannot achieve the same in healthcare if it puts its mind to it.
The lockdown imposed to curtail the spread of the Covid-19 virus affected the healthcare sector in multiple ways. Apart from a strain on their human resources, hospitals faced a host of other adversities during this extended period. A consumer survey by Deloitte revealed that 94% of the 400-plus respondents across the country had concerns about visiting a hospital during the lockdown, reflecting the overall sentiment of people. As non-emergency treatments and elective surgeries took a backseat and national and international medical travel came to a standstill, the private hospitals were hit badly, these being their primary revenue generators. According to a report by EY India, occupancy levels fell to 30-40% by late-March vis-à-vis pre-Covid occupancy levels of ~65-70%.
All this has sharply affected the private healthcare sector contrary to the conventional belief that hospitals must be doing well in a pandemic.
According to a recent EY report, the healthcare sector is expected to face short-term operating losses of Rs 14,000 crore to 24,000 crore for a quarter and a 20-35% drop in revenue in FY21 (compared to FY20), resulting in early single-digit or negative EBITDA for the full year. The Q1 results announced by listed hospital companies seem a case in point.
While some green shoots are now visible, with unlock steps and the central government’s stimulus packages coming into play, the full recoup of the Indian healthcare is some distance away. Apart from the financial revival, what is even more critical is the physical and emotional recovery of the healthcare personnel who have been relentlessly at it for the last six months, braving great personal risks and social pressures.
Although we are still very much in the midst of the pandemic to discuss conclusively about its impact, a few trends are certainly visible.
Boundaryless collaboration is now normal. Whether it is in sharing the genome of the virus or treatment protocols for Covid, supporting essential drugs, or working together in developing a vaccine, institutions are collaborating across industries and geopolitical positions. This augurs well for life beyond Covid.
At a more micro scale, hospitals have moved healthcare delivery beyond the confines of their buildings. Teleconsultations and remote monitoring are now commonplace and here to stay. Residential emergency centres and home based care have gained ground. More importantly, customers have rapidly adapted to digital routes for accessing care and have realised the ease and transparency that these offer. For example, some providers have already seen nearly 20% of their outpatient visits moving to video consultation platforms. This could also spur a change in the consumption behaviours and result in tailored offerings around ‘off-hospital’ services for segments like senior citizens.
Technology that had a predominantly enabling or backend role in the Indian healthcare delivery context is moving to the forefront. While many other enterprises had embraced AI / ML over the last few years, hospitals are now following suit. Use of data analytics together with digital tools to transform care delivery, integrating across clinical departments, is enhancing patient experience as also transparency and is seen as feasible and acceptable in the Indian context, that for long felt that these could interfere with personalised care. Although a very welcome trend, widespread adoption and acceptance would be required to characterise this as a new feature of the sector.
Much of these initiatives were led by the private healthcare ecosystem in India. It is no surprise therefore, that one other trend that is visible is a growing recognition of the role that the private enterprises play and would need to continue to play in this area. Well over half of the total hospital beds in the country are in private hospitals, which also account for over 70% of all advanced care. Often times, the two streams—public and private healthcare providers have missed the opportunity to collaborate, but the pandemic gave an opening for these as well as other elements of the larger system – payors, pharma and medtech companies among others, to come together and with strong support from Governments at all levels, demonstrated the capability of rapid and agile responses to serious and evolving problems. The multitude of healthcare challenges the populace face from preventive to primary to quaternary levels, could be better addressed if this collaborative approach continues beyond Covid. Hopefully, the early success that this broad alliance has been able to achieve, would lead towards a lasting trend.
The world has witnessed several outbreaks—SARS, MERS, H1N1 to name some, in the last two decades and Covid19 would not be the final one either. Amidst the unprecedented suffering that it has caused across all spheres of life, perhaps one silver lining one can glean is that it dared the healthcare systems to step out and step up, learn and unlearn, innovate and adapt. This would stand in good stead as we face the challenges that are in store. Finally, it also taught the sector to join forces. Healthcare is far too important to be left to hospitals alone. All stakeholders—governments, public and private healthcare providers, pharmaceuticals, medtech companies, and payors came together to fight what they collectively recognized as a common enemy. The test now is to ensure that it lasts.
Let man not separate what the virus has brought together!
Views are personal. The author is MD and CEO, Manipal Hospitals.