“Healthcare in India needs increased funding and policy intervention. In India, people tend to take healthcare issues to politicians and bureaucrats, while doctors are kept out of the management aspect. Healthcare can be transformative to India’s growth. Hence summits like ‘Ayusmat’ at IIMB are vital to throw light on fundamental issues of healthcare like financing, quality, insurance, price capping, efficiency, accessibility,” said Chief Guest K Sujatha Rao, author and former Union Secretary of the Ministry of Health and Family Welfare, Government of India, while talking about ‘Indian Healthcare Scenario - Actual vs Ideal – Roadmap to Bridge the Gap’ at IIM Bangalore on March 3.
Ms Rao was speaking at Ayusmat 2019, a healthcare leadership summit organised by participants of the General Management Programme for Healthcare Executives (GMHE) at IIM Bangalore. Ayusmat is a platform for academicians, researchers, students, practitioners, policy-makers, CXOs of healthcare organizations, health-tech consultants, venture capitalists, start-ups and thought leaders in the field of healthcare. The theme for this year’s Ayusmat was “Cost, Quality and Accessibility”.
Low healthcare spend
Ms Rao said overall public spending on healthcare in India was very low, and listed a few remedial measures. “Due to low spending, the challenge becomes how to prioritise the utilisation of funds. Ideally, we must prevent people from getting ill, but if they do fall sick, they should have access to quality healthcare. Another problem in the Indian system is that there is little data on clinical outcomes. Patients should be the main drivers in healthcare. Efficiency is another aspect to focus on. Financial structures of Indian hospitals, whether private or public, need to be based on appropriate models.”
Different sectors interlacing with healthcare, namely finance, management and leadership, policy, technology, insurance, pharmaceuticals, and start-ups, among others, play a significant role in designing service delivery systems that balance these dilemmas. The conference aimed to address these issues in detail.
Talking on ‘Quality in Healthcare’ by Dr TS Ravikumar, Director, SVIMS, Tirupati. He listed the problems plaguing the healthcare system in India: supply-demand mismatch of resource, knowledge gap, infrastructure, inadequate spend, and the lack of accountability in terms of quality. “We need to create better care for the individual patient and the population at an affordable and sustainable cost. Quality is critical for the success of universal health care. A high cost does not necessarily signal good quality. Increasing GDP does not guarantee increased quality in healthcare, and improved processes do not guarantee desired outcomes. What matters in quality is the output, not the inputs. You need to measure, report and reward.”
Patient safety, error reporting
Dr Ravikumar added that: “Patient safety is at the core of quality. There can be passive or active harm – reporting of errors is essential. Risk adjustments are required. Safe practices include multiple wedges of improvement for continuous optimal performance. We need retooling of healthcare providers. Quality is everyone’s responsibility and we never have to stop getting better. Overall, a patient-centred approach is crucial.”
This session was followed by a discussion on ‘Ayushman Bharath: Decoded for Management Executives’ by NT Abroo, IAS, Executive Director, Suvarna Arogya Suraksha Trust, Government of Karnataka. She explained how Karnataka is making quality and affordable healthcare accessible to everyone in the State. According to her, reducing health inequities is crucial because health is a fundamental human right. She spoke in detail about the Yeshasvini Scheme and the Arogya Karnataka Scheme. “The top 10 performing hospitals are government hospitals. We are on the road to success. We must merge private and public sectors, and ensure systematic quality by offering schemes universally to the needy.”
Medical leadership
Dr Chitra Sarkar, Dean (Research) and Professor of Pathology, AIIMS Delhi, while discussing ‘Leadership in Healthcare – Does it Demand Uniqueness?’ focussed on the aspect of ‘Medical Leadership’, based on research conducted by AIIMS. “Leadership needs to align vision, culture and operations to deliver sustained value. A leader has to implement innovation and change,” she observed.
“Transformational Leadership is more important than Transactional Leadership. Leaders should be able to think about the way things are and how they should be. Leadership requires talent with passion, attitude, and skills to seize new opportunities, understanding of external factors like IT, economics, finance, new insights on best practices, etc., being self-aware, being able to take calculated risks, and being ethical.
Dr Sarkar lamented the fact that physicians in India tended to stay away from management and said organizational performance would be better if doctors lead organisations. “Doctors tend to move away from such functions due to job description, medical education system, intellectual elitism, expectation for hospitals to perform such duties, low career prospect, weak incentives, not being recognised as speciality, being under resourced, etc. But doctors should treat this as a challenge, take initiatives, because their focus only on clinical medicine has led to a gap in medicine. If healthcare organizations, hospitals and industry are to remain at the forefront of service delivery, they require leaders capable of leading them.”
Healthcare financing
The first half of the day also saw a panel discussion, titled: ‘Healthcare Financing in India – What and Who will be the Game Changer?’ moderated by Dr Srinivasa Rao Pulijala, Chief Executive Officer, Apollo MedSkills. The panelists spoke about world-class hospitals, on the one hand, and people struggling for accessibility and affordability, on the other, the start-up ecosystem and addressing the challenges of funding.
Dr J Radhakrishnan, IAS, Principal Secretary, Health and Family Welfare, Government of Tamil Nadu, recommended sustained, preventive and promotive health as well as innovative partnerships.
Amrita Agarwal, Health System Design, Bill and Melinda Gates Foundation, discussed insufficient funding for the sector, sources of funding and the proper utilisation needed to get maximum value. She also spoke about lack of outcome measurement and a fragmented healthcare system.
Dr Ramesh B, Managing Director, Endiya Partners, discussed how healthcare system is evolving in India and the role of start-ups. He said there is huge scope for innovation in the sector and that data is a crucial factor.
PPP model
Dr (Maj) Snigdha Paddalwar, Head, NH Mahalaxmi, Mumbai, recounted her experience in working for the Army and explained how financing works in a public-private partnership (PPP) model. “We need to focus on reforming and redesigning healthcare at all levels. Preventive healthcare is very important. PPP if implemented after proper research can be a game changer,” she said.
Dr Manish Rai, Head of Operations, Manipal Hospitals, gave a private provider perspective and discussed ways to manage trust. He also spoke about healthcare in the Railway sector. He suggested measures that could improve the healthcare system in India. “Quality indicators are needed. Integration with the private sector would prove beneficial. A PPP model is recommended. We also need a regulatory framework and a framework to judge the efficacy of the private sector. We need to look at the healthcare system in entirety and try to get massive support from Government.”
The panelists were united in their opinion that all stakeholders in the healthcare system need to work in tandem and that there were more positives than negatives in the sector, today. “It is our India, and it is up to us to take it forward,” said Dr Pulijala.
Innovative technologies
The second half of the day saw another panel discussion, titled: ‘Transitions Driven by Innovative Technology in Healthcare’ was moderated by Professor Shankar Venkatagiri, IIM-B faculty from the Information Systems area and Director, GMHE.
It featured Arnab Chattopadhayay, Associate Director, IBM; Dr Jagdish Chaturvedi, Founder and CEO, HiiiH Innovations; Mohammad Ameel, Senior Consultant, NHSRC; Anil Kumar Jagirdar, Principal Consultant (Healthcare), PwC India; Kedar Medhi, Director, Philips HealthWorks; and Nirod Kumar Singh Thokchom, Director MEASA, Frost & Sullivan. This was followed by a debate on ‘Will Price Capping in India Kill Quality and Investment in Healthcare?’ featuring Ganesh Sabat, CEO, Sahajanand Medical Technologies, Dr Ravi Kannan, Director, Cachar Cancer Hospital and Research Centre, Assam, and moderated by Dr Santosh Kumar, Senior Advisor in Healthcare Quality Assurance.