POWERING THE HEALTH-CARE ENGINE WITH INNOVATION
Context: It has been close to 18 months since the Prime Minister, launched the country-wide implementation of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY), or the national health protection scheme.
- The scheme is currently being implemented in 32 of 36 States and Union Territories.
- It has provided 84 lakh free treatments to poor and vulnerable patients for secondary and tertiary ailments at 22,000 empanelled hospitals, countrywide.
- Under PM-JAY, there is one free treatment every three seconds and two beneficiaries verified every second.
EXPANDING THE SUPPLY SIDE
- As the scale of this scheme grows, a key area of focus is to expand the secondary and tertiary hospitals empanelled under PM-JAY and ensure their quality and capacity while keeping the costs down.
- At present, there is one government bed for every 1,844 patients and one doctor for every 11,082 patients.
- In the coming years, considering 3% hospitalization of PM-JAY-covered beneficiaries, the scheme is likely to provide treatment to 1.5 crore patients annually.
- This means physical and human infrastructure capacity would need to be augmented vastly.
- Conservative estimates suggest that we would need more than 150,000 additional beds, especially in Tier-2 and -3 cities.
- While a comprehensive long-term strategy will focus on expanding hospital and human resources infrastructure, an effective near-term approach is needed to improve efficiencies and bridge gaps within the existing supply and likely demand.
- The development of a start-up ecosystem has led to a plethora of innovations in health care.
- It is estimated that there are more than 4,000 health-care technology start-ups in India.
- Today, start-ups are working to bring innovative technologies and business models that leapfrog infrastructure, human resources, cost-effectiveness and efficiency challenges in Tier-2 and -3 cities.
- Artificial Intelligence platforms that aid in rapid radiology diagnoses in low resource settings, tele-ICU platforms to bridge the gap in high-skilled critical care personnel, centralised drone delivery of blood, medicines and vaccines to reach remote locations cost-effectively and reliably are all no longer just theoretical ideas.
- They are real solutions that are ready to be tested on the ground and potentially implemented.
- It is high time for transformative solutions to make their way into our hospitals, especially in Tier-2 and -3 cities, to turbocharge the way health care is delivered at scale.
- One challenge is non-uniform regulatory and validation standards.
- Regulatory requirements, specifically for biomedical start-ups, are still evolving in India.
- As a result, hospitals often rely on foreign regulatory certifications such as FDA and CE, especially for riskier devices and instruments.
- In addition, it is difficult for a start-up to understand the minimum necessary validation requirements in order to qualify for procurement by hospitals.
- Lack of standards in this area leads to a huge variation in validation requirements at States and hospitals, forcing the start-up into a spiral of piloting studies.
- Another problem in promoting start-ups is the operational liquidity crunch due to a long gestation period.
- Health-care start-ups spend long periods of time in the early development of their product, especially where potential clinical risks are concerned.
- The process of testing the idea and working prototype, receiving certifications, performing clinical and commercial validations, and raising funds, in a low-trust and unstructured environment makes the gestational period unusually long thereby limiting the operational liquidity of the start-up.
- Another hurdle is the lack of incentives and adequate frameworks to grade and adopt innovations.
- Health-care providers and clinicians, given limited bandwidth, often lack the incentives, operational capacity, and frameworks necessary to consider and adopt innovations.
- This leads to limited traction for start-ups promoting innovative solutions.
- Start-ups also face procurement challenges in both public and private procurement.
- They lack the financial capacity to deal with lengthy tenders and the roundabout process of price discovery.
- To accelerate this process of mainstreaming innovations within the hospital system in India, we need to focus on identifying promising market-ready health-care innovations that are ready to be tested and deployed at scale.
- There is a need to facilitate standardised operational validation studies that are required for market adoption, to help ease out the start-up procurement process such that these solutions can be adopted with confidence.
- This, in effect, will serve the entire ecosystem of health-care innovators by opening up health-care markets for all.
- A strong theme in mature health-care systems in other parts of the world is a vibrant and seamless interface between hospitals and health-care start-ups.
- Through Ayushman Bharat, India has the unique opportunity to develop a robust ecosystem where hospitals actively engage with health-care start-ups by providing access to testbeds, communicating their needs effectively and adopting promising innovations.
- Start-ups can be effective collaborators for the most pressing health-care delivery challenges faced by hospitals, as opposed to being mere suppliers of technology or services.
- The launch and expansion of Ayushman Bharat-PM-JAY is a watershed moment for the Indian health-care service delivery ecosystem.
- The government has taken a big step by rolling out world’s largest and most ambitious publicly funded health-care assurance programme.
- There is a need for private sector health-care providers, health innovators, industry and start-ups to become equal partners in this movement.
- The dream of an accessible, affordable and high-quality health-care system for all will be achieved when we work in alignment to complement each other and jointly undertake the mission of creating an Ayushman Bharat.