Smoothen the process of changeMarch 7, 2019
The year 2018 was a momentous year for the Indian healthcare industry as I had mentioned in my previous column. It is in the midst of an unsettling flux, where the prevailing order finds itself inadequate to meet the emerging imperatives even as the new order is struggling to find its form. In this backdrop, 2019 will again be a very momentous year, perhaps more so than 2018, and will likely witness the evolution of a foundation for a future healthcare system, models and practices. I am very optimistic that these changes are for the good of everyone in the long run, even though there will be unavoidable challenges of transition. Accordingly, my wishlist for 2019 includes what I believe should become key imperatives for different stakeholders to lubricate this process of change in pursuit of the true north for the sector.
Central Government: The most important expectation from the central government is to focus on the real implementation of what has already been conceptualised, instead of rhetoric and optics for projecting a transformation. The design of Ayushmann Bharat (AB) has its heart in the right place, but the implementation is currently focused only on cosmetic aspects to derive political mileage rather than to follow the spirit of the design: A robust, primary care-driven, holistic healthcare management through a strong public health system ably complemented by private sector capabilities. Alas, I do not foresee any change in the current approach till the elections in May at least. And I sincerely hope the scheme continues in its essence — cosmetic changes notwithstanding — irrespective of who comes to power after the elections. One of the first things I will look forward to will be a realistic budget outlay for the scheme, separately for HWCs (Health and Wellness Centre) and inpatient care insurance. Importantly, I look forward to the passing of the much needed and much awaited National Medical Commission bill in 2019.
Private Healthcare: Transparency, efficiency (both capital and operational) and empathy should be the key elements of private health care players’ imperatives for 2019 and ahead. Theirs is the important agenda of building credibility among stakeholders, both public and policymakers. It will not help them to play the victim as much of the trust deficit emanates from the way the players have conducted themselves, though the degree may vary from one to another. This has resulted in a lack of empathy even for their legitimate issues. It is imperative for them to demonstrate transparency in their commercial practices, and as a first step, a robust costing system accompanied by a true and patient-friendly billing structure is an urgent need. Equally, given the headwinds on pricing, the emergence of a value segment (including extra urban markets) as a key growth driver and stretched balance sheets, optimising their infrastructure, the design of procedures and resource utilisation (man, material & machine), along with a robust framework for capital prioritisation and allocation will be a critical need, even while staying fully committed to the agenda of quality and patient safety.
Private Equity: I do foresee consolidation and promoter stake sale in a big way where PE players are going to play a bigger role in times to come. While PE players have been a critical catalyst in driving the efficiency agenda, they have a time-bound agenda for value creation and hence have a sharp focus on short- to medium-term growth. This can, at times, result in a higher performance in the short-term but may not be conducive to the long-term health of the business, or to building best practices for the industry. This problem gets compounded if PE bought into an unrealistic business plan, which is not uncommon. While PE players have played and will play a critical role in shaping the private healthcare industry, it is imperative that they understand the underlying nuances of business performance, growth and sustainability in a dispassionate way through competent, sincere diligence. Importantly, they should set realistic expectations for potential exit valuations before doing a deal.
State Government: The government must earn the moral right to regulate and dictate to private players, if there has to be dignity, balance and synergy in public and private healthcare partnerships. While public healthcare has a long way to go in many states — which also unfortunately tend to be also the most populous ones — it will be very welcome to see them target at least a 5 percent increase of public consumption in the public-private share of hospitalisation in the states where the public share is less than 50 percent. At the same time, the government should leverage the Health and Wellness Centre model of AB to revamp their primary care set up. Additionally, they should facilitate greater focus on the quality of care, both by incentivising quality-conscious players with superior reimbursement rates and making quality accreditation mandatory for all hospitals with more than 30 beds.
People: The patient voice will be the all-powerful change agent in future and it is the need of the hour. Exercise your voice and vote for a better healthcare. Do not revere or revile the doctor, just respect him/her like a professional. Trust between the doctor and patient is crucial for efficient and effective treatment and let not half baked information from internet spoil the chemistry of this relation even as you rightly evolve from a relation of blind trust in doctors. Solicit discussion, seek second opinion and be aware of your treatment but trust him/ her till there is a reason to doubt rather than the other way, particularly based on half baked information from internet. Understand that knowledge is different from information in the same way as parenthood is different from being a parent which even a teenager can but it takes much experience for an adult to understand parenthood. Last but not the least, be accountable for your health.
Clinicians: Frankly, clinicians, as a community, have to accept that the deepening mistrust of the public is not without reason and hiding behind high cost of medical education and lengthy period of education etc as possible reasons to explain their susceptibility to succumb to commercial considerations over Hippocratic oath, is just hollow and deplorable I have said this before in a previous column, repeating it again, know that “morality is evolved self interest” and with the passing of Consumer Protection Bill recently, the element of rhetoric in the statement has been replaced, substantially, with imminent legality. In fact it is in their best interest, individually and collectively, to be pro active and take the lead in winning back the respect for their integrity as well.
The author has long-standing association with EY India but the views are strictly personal.