Monthly Archives: July 2009

Healthcare opportunities in India Part 1

There are a lot of reports about the healthcare industry in India, the growth potential and opportunities like here by PWC (circa 2007), the US Commercial Service, the India Brand Equity Foundation (IBEF).

All of them highlight:

  • India spend s~6% of it’s GDP on healthcare
  • On a per capita basis this is miniscule to meet the needs of the 1.1 billion people
  • Majority of spend is private $$ by middle class and rich citizens
  • Heath insurance penetration is very low
  • Huge gap in the number of trained staff and facilities required for the large population

Over the last decade or so, there have been some phenomenal improvements in the healthcare diagnostics and delivery with companies like Apollo, Fortis and Manipal opening up great centers across the major urban center.  The biggest catch is these companies are still targeting the less 10% of the population that can afford to spend on healthcare or have insurance coverage

With this situation, if we look at the opportunities in the sector is really in addressing the needs of the non urban and low income groups.  These groups currently rely only on the government for the healthcare services.  Unfortunately the government alone cannot address their needs.

For example in the state of Karnataka there is an acuate shortage of staff and facilities as seen in the table below.  The state needs 254 Radiographers and has only 30.

Particulars Required Actual Short Fall Short Fall %
Radiographers 254 30 224 88%
Paediatricians at CHCs 254 116 138 54%
Health Worker (Male) 8,143 3,762 4,381 54%
Health Assistant (Male) 1,679 837 842 50%
Laboratory Technicians 1,933 1,242 691 36%
Total specialists at CHCs 1,016 691 325 32%
Health Assistant (Female) 1,679 1,170 509 30%
Multipurpose worker (Female) 9,822 7,244 2,578 26%
Physicians at CHCs 254 192 62 24%
Pharmacist 1,933 1,472 461 24%
Community Health Centre 302 254 48 16%
OBGYN 254 215 39 15%
Nurse/Midwife 3,457 3,100 357 10%

Source: Ministry of Health, Government of India 2008-09 report

Looking at this one obvious opportunities is:

Micro health insurance:  Current government schemes which utilize a re-embursement mechanism have failed as affordability is still an issue for the group.  We need schemes that provide cash less insurance coverage.  One good case of this a company called ARC – Accident relief Care for short.  ARC provides cash group accident cover for the low income groups for as little Rs 2-3 / day.  Their target market is auto drivers, waiters who live from day to day cash collections and a single day’s lost due to any accident can lead to dire consequences for them and their families.  Extending the ARC concept to other markets and offering new products is a great opportunity.


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Brush with Swine Flu

Ok so I had  swine flu.  The funny thing is I did not get it from traveling but caught the virus right at home.   In India they say it is my karma.

The good parts first:

  • I stayed at the Rajiv Gandhi hospital which had a sanatorium like feel with lots of trees, low rise buildings and no traffic
  • The staff, nurses and doctors were just amazing.  Lots of great care and support
  • Gave me a couple of days to look and experience the real state of  healthcare in India rather than have an academic view of it

Now the real meat:

  • We have a limited supply of the drug and test kits.  When I got tested, the lab in Pune was only testing for swine flu
  • I got tested after repeated requested for 3 days and it toke another 2 days to get my results back. that is 5 days to get a result
  • I was not shown the results but the information was given to someone at the hospital by phone. No verification, no paper trail, nothing.  Human beings make mistakes and not having proper communication mechanisms in this day and age (an email, a fax anything will do) is ridiculous
  • The government forces all people who undergo a test and are awaiting the results to stay at the Rajiv Gandhi institute so they can contain the spread.  Two issues here: one a person who has not tested positive has a high probability of getting infected by being in such close proximity to an infected patient; second: the facilities at the hospital are just disastrous (see pictures below).  Most people feld the hospital without getting tested when they just saw the place. Bangalore has some great medical facilities but we were forced to only stay at this government run hospital.  Here are some key features of the place:
    • 14 beds in a dorm style.  Bed were old, sheet did not look clean and blankets definitely had stains.
    • 2 toilets both Indian style (do a google to figure this out). One for the guys and another for the ladies
    • No soaps or toilet paper
    • There was active construction work going on, so patients were entertained by constant banging on the roofs, strong smell of paint and dust everywhere
  • The hospital did not have a simple thermometer to test patients. I bought them one
  • Finally I had a cheat x-ray taken and the lab was from another world.  It had one seemingly working machine and lots of old crap with tons of dust on them.  There was no changing rooms, no proper magnetic protective shields
  • Another big issue is the staff though competent have not been trained to handle swine flu.  I saw vague uninformative circulars being sent by bureaucrats.
  • Finally: there was no food and everything had to be got from restaurants near by.  I don’t think unhygienic restaurant food is ideal for flu

So here are some quick things that can be done to solve these issues:

  1. Allow other private hospital to test patients and have those suffering from the virus at least get comfortable accommodation, food and facilities
  2. Open up more testing labs- especially the great lab we have in Bangalore
  3. Charge patients for the health services – Most people infected with swine flu are more than willing to pay for the testing, stay and medication.  Please charge them and in return provide them with adequate facilities
  4. Spruce up the facilities at Rajiv Gandhi – Instead of building gazebos outside, please build a couple of additional toilets, get some basic supplies like sheets, thermometers, masks and soaps
  5. We have some very competent healthcare professionals.  Please get a group of them together and develop a well thought through strategy and action plan.  Please train medical staff on these and empower them with processes and techniques to address the key issues.

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