Powering the health-care engine with innovation

Governance

Topic: General Studies 2:

• Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources 

• Awareness in the fields of IT

Powering the health-care engine with innovation

Context

It been 18 months since the launch of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY), or the national health protection scheme.

About Ayushman Bharat

• Ayushman Bharat adopts a continuum of care approach, comprising of two inter-related components, which are:

• 1. Health and Wellness Centres (HWCs).
  2. Pradhan Mantri Jan Arogya Yojana (PM-JAY).
• It aims to bring quality healthcare to around 50 crore poor and vulnerable Indians (based on the Socio-Economic Caste Census (SECC) data)
• PM-JAY is world’s largest health insurance fully financed by government which will provide free coverage of up to Rs 5 lakh per family per year at any government or even empanelled private hospitals all over India for secondary and tertiary medical care facilities.
• Centrally sponsored scheme with contribution from both Centre and State 
• Cashless access to health care services for the beneficiary at the point of service.
• Wellness Centres: The 1.5 lakh sub-centres that are converted into wellness centres will cater to majority of services such as detection and treatment of cardiovascular diseases, screening for common cancers, mental health, care of the elderly, eye care, etc.

Performance of the Scheme

• The scheme is currently being implemented in 32 of 36 States and Union Territories. (Delhi, Odisha, Telangana and West Bengal have opted out of the scheme saying that their own state schemes provides better coverage than PM-JAY)
• The scheme has resulted in saving of over ₹12,000 crore to the beneficiary families in one year of its operations.
• 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.

Shortage in Supply 

• 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% hospitalisation of PM-JAY-covered beneficiaries, the scheme is likely to provide treatment to 1.5 crore patients annually. 
• This means augmentation of physical and human infrastructure capacity i.e. there is a need more than 150,000 additional beds, especially in Tier-2 and -3 cities. 

Role of Innovation in Indian Health System

• A strong, yet under-tapped lever for accelerating health system efficiency and bridging these supply gaps, especially in short to medium term, is mainstreaming innovation in the Indian health system

• It is estimated that there are more than 4,000 health-care technology start-ups in India that can help leapfrog infrastructure, human resources, cost-effectiveness and efficiency challenges.
• Some of these innovation which holds promising future are:
  • 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

Challenges in mainstreaming health-care innovations:

1. Non-uniform regulatory and validation standards. 

• 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

2.  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.

3. 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.

4. Procurement challenges

• 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. 
• Private procurement is complicated by the presence of a fragmented customer base and limited systematic channels for distribution.

Way Forward

• Need to focus on identifying promising market-ready health-care innovations that are ready to be tested and deployed at scale. 
• Need to facilitate standardised operational validation studies that are required for market adoption.
• Ease out the start-up procurement process such that these solutions can be adopted across board

Conclusion

• 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.

Connecting the dots!

• Insurance model vs Public Health care provision model
• Linkages of Health care with other developmental parameters – Education, Sanitation, governance, civic participation, social empowerment etc.