Healthcare reform: Bringing focus back to value

Of the 18 million cases of cancer detected globally in the year 2018, 2.25 million were from India. Of these, nearly 0.78 million succumbed to this life-threatening condition. While the lack of a definitive cure for cancer certainly contributes towards these deaths, the gaps in India’s healthcare sector lie at the core of the situation. It is the disparate healthcare infrastructure that causes major bottlenecks in early detection and treatment of cancer as well as other chronic and communicable disease, leading to the mortalities and the overall low performance of our country on global health indices.

With initiatives such as Ayushman Bharat, the government is attempting to address the need for affordable healthcare in India for the masses. The scheme extends an insurance cover of upto ₹5 lacs per year to over 10 crore families, and instituting structure to deliver primary and secondary care at subsidised prices. While the government is spending $31 billion on overall healthcare each year, the amount allocated per individual is way below compared to the average person in the U.S. or Europe. In India, while the government provides low-cost treatment and subsidised medicines to the average common man, the quality of care still continues to be a key challenge.

Quality gaps in India’s healthcare system need value-based approach

India’s healthcare infrastructure is plagued with underfunding, overcrowding, and inconsistent rural coverage, with close to half of the country’s population travelling over 100 kms to access quality care. The private sector accounts for over half of the healthcare infrastructure, almost 60% hospital, and 80% of doctors. Further, contributing to the gaps is the fact that authorities still struggle to implement regulatory measures at every level of the system. While various reasons can be cited for this disbalanced landscape, 57% households stated the lack of access to quality public healthcare as the primary reason. However, an unwanted result of this disbalance is the high out-of-pocket expenditure, which comprises over two-thirds of the total healthcare spending in India. For a country that is already struggling to bring quality care to its large population, scattered across a vast geography, a reform in the system is needed for greater efficiency and better outcomes.

By undertaking a value-based focus for healthcare, the traditional fee-for-service reimbursement system can be transformed to define the cost of treatment basis quality and outcome. Most existing systems around the world are largely based on access, cost containment, convenience, or customer service. This new framework, however, would take healthcare away from the questions of how many patients each hospital is seeing, how many tests and procedures are being ordered, and how much is being charged for them. Instead, quality healthcare will directly be linked to outcomes, resulting in quicker recoveries, fewer re-admissions, lower infection rates, and fewer medical errors.

Strengthening the primary care potential of the country, and building a foundation for secondary and tertiary care, value-based health care will ensure that patients are spending less money to achieve better results, and providers are able to deliver greater satisfaction and, control cost and risk.

Strong government and private sector focus integral to implementing value-based healthcare

Inherent to executing a value-based model in India is the privatisation of healthcare, wherein measures can be implemented in a systematic manner. With private hospitals dispensing better care than government hospital on average, implementing a value-based system through privatisation will likely have a higher success rate. For the government to aid this further, it must drive the agenda with a bigger budget, as should be the focus on the interim budget 2019.

Schemes such as Ayushman Bharat should cover care given in private hospitals – something that many states in the country are struggling with. States asking patients to visit only government hospitals to receive benefits of Ayushman Bharat could be addressed with a cut in the funding, driving the same money towards other states. Additionally, hospitals, whether private or government, taking part in government schemes should be obliged to publish outcomes on how many patients were treated under the scheme and their success rate should be audited by a designated authority. Doubling tax on goods that harm public health, such as cigarettes, can also be explored, using the additionally generated money towards funding healthcare.

The focus of India’s healthcare system should be on delivery value and positive outcomes, as opposed to providing cheap medicine or care. For an impactful reformation, the allocation of government funding towards healthcare must increase, and uniformity in treatment must be implemented. Privatisation is a viable method of rolling this out on a scale, in a way that time and resources are not wasted on plugging gaps in the public sector, but on addressing the problem head-on. With over 1.7 million new cancer cases, and 0.8 million new cancer deaths expected by the year 2020 in India, it is imperative that drastic measures be taken to reform healthcare infrastructure in the country and provide the common man with the care he deserves.

Views are personal.

The author is chairman and CEO, Healthcare Global Enterprises.