Challenge of caring for a billion
- India is the second most populous country in the world and soon to be the most populous.
- Public Health and Societal care structure in the country isn’t developing at a pace suitable to serve the ever-increasing population.
Burden of Disease in the new millennium
- India faces the twin epidemic of continuing/emerging infectious diseases as well as chronic degenerative diseases.
- The former is related to poor implementation of the public health programs, and the latter to demographic transition with increase in life expectancy.
- Age-adjusted incidence rates of cancer, which were traditionally low in a demographically young country have been steadily increasing in recent years. Cancer claims an estimated 7,00,000 lives annually, making it the second biggest cause of death after heart diseases.
e.g. Twenty-eight women die in Uttar Pradesh daily of cervical cancer, which, if diagnosed early, is treatable.
- Many illnesses aren’t detected, are under-diagnosed or deaths due to cancer etc. aren’t registered, making the situation more alarming
- Full impact of the HIV epidemic and tobacco related diseases is yet to be felt.
- India faces high burden of disease because of lack of environmental sanitation and safe drinking water, under-nutrition, poor living conditions, and limited access to preventive and curative health services.
Public Health Scenario in India – Inequity in Healthcare
- The healthcare divide between rich and poor remains very wide. Addressing this problem is one of the greatest challenges of facing our nation.
- Various state and federal agencies under financial constraints cut expenditure on health.
- Poor facilities even in large Government institutions compared to corporate hospitals (Lack of funds, poor management, political and bureaucratic interference, lack of leadership in medical community).
- Health insurance is expensive and more than 75% of our population live without medical insurance.
- Private practitioners and hospitals are major providers of health care in India.
- According to the World Health Organization, India has just one doctor for every 1,600 people, placing a huge burden on medical practitioners.
- Increasing cost of curative medical services and curative health services not accessible to rural populations.
What can we do?
- Prevention, and early diagnosis and treatment, if feasible, are the most cost-effective strategies for most diseases.
- Promoting healthy life style from early life is a ‘no cost’ intervention which needs to be incorporated from early life.
- Existing infrastructure for health and societal care needs to be strengthened. Health should be perceived as an investment.
- Better implementation of national health and social welfare programs.
- Judicious use of the scant resources by promoting most cost-effective strategies for disease prevention.
- Inclusion of all level of stakeholders in planning and policy making using tremendous human potential available in the country.
- Hospitals, doctors and clinics are to up their game:
Hospitals, clinics, and doctors will need to prepare and face a market which is driven by customer satisfaction. In our current incentive structure, these providers get paid for the number of services they provide such as number of patient visits, number of surgeries, etc. However, in a consumer-driven marketplace, they will be paid for reducing hospital stays, improving safety and quality, and providing tools for consumers to manage their own health.
- Health insurers are going to have to reinvent themselves:
While health insurance marketplace is nascent in India, it is still one of the fastest growing segments of business. Health insurers will have to carefully reinvent themselves by appealing to consumers who are increasingly involved in the health care landscape. In the US, insurance companies provide tools and technologies that help with real-time diagnosis via Google and Apple Apps, provide cost transparency so that consumers are not shocked to see their final bills, and pay for wellness programmes which have shown to reduce cost over the long run. These are some of the trends expected soon.
- Tremendous amount of data generated from individuals and various Health related processes can be mined, curated and used to derive insights towards chronic disease management and lower healthcare costs.
- Healthcare IT can help with avoiding hospital readmissions, managing better outcomes and solving population health challenges. It can also help provide access to health info for patients, payers, providers, doctors and other healthcare workers.
- Cognitive or AI based systems can help improve the quality of care. E.g. they can help an oncologist sift through vast volumes of data in minutes which would have normally taken days or, at times, weeks. This is possible because of the IT system’s ability to instantly analyse billions of terabytes of data like medical histories, clinical trial information, journals etc. Such systems – Understand, Learn, Reason, Interact.
- IT companies are embracing the challenge of developing cognitive systems for the Indian health care market. Cognitive Application Program Interfaces (APIs) are now available on the cloud for companies to build applications. Cognitive systems become better with each interaction; hence more the number of applications and systems, the closer we are to solving the healthcare issues of India and the rest of the world.
We have a rather large set problem definitions and a few possible options to solve these challenges. Challenges of this complexity and magnitude cannot be solved by the government or the agencies alone. They require a collaborative approach involving business and healthcare leaders, the healthcare ecosystem and community members, academia, innovators, public health entrepreneurs and healthcare IT companies. Together, our impact is going to be greater.