Building a path to healthcare access

Express Pharma and Express Healthcare, supported by India Health Progress, recently hosted a panel discussion on ‘Universal Access to Health—What should government priorities be?’ which brought together various stakeholders to frame a road map towards attaining ‘Affordable and Accessible Health for All’. We present glimpses of the event …

Access to healthcare has been an unending issue in our country. Despite the fact that the healthcare sector has seen considerable growth  over the past few decades, the healthcare system is still ailing and more than 65 per cent of the Indian population does not have access to quality healthcare. In view of this fact, the Express Pharma and Express Healthcare, organised a panel discussion entitled, ‘Universal Access to Healthcare: What should Government priorities be?’ in association with the India Health Progress (IHP), an independent forum which advocates the concept of ‘health for all’.  This panel discussion was an initiative to bring together various industry stakeholders on a common platform to address all issues that impede access to healthcare and discuss strategies to integrate efforts to ensure universal access to healthcare in the country.

The panel discussion was organised in two phases that highlighted topics covering the access gap within healthcare delivery system as well as drug manufacturers’ perspective and the access to medicine problem in India.  As Aman Gupta, Principal Advisor, IHP said in his welcome address, “Universal healthcare access cannot be achieved in isolation. Given the complex interplay of obstacles that encapsulate healthcare access, a holistic approach needs to be taken to address the entire gamut of core healthcare issues.”

Bridging the access gap in the healthcare system
The first phase of the discussion focused on addressing various issues related to healthcare infrastructure, health insurance penetration, the urban-rural divide in healthcare and shortage of trained and skilled medical and para-medical professionals in India.

The panelists for this discussion comprised Dr Sanjay Oak, Dean, KEM and Director of Medical Education and Major Hospitals of the MCGM,  Dr Ravindra V Karanjekar —Executive Director–Medical Services and Quality, CEO-Global Hospitals, Mumbai, Dr Nikhil Datar—Health Right Activist and Medico-legal Expert and Shreeraj Deshpande—Head—Health Insurance, Future Generali India Insurance. The panel discussion was moderated by Viveka Roychowdhury, Editor, Express Pharma and Express Healthcare.

Raising the alarm regarding the current public sector healthcare secenario, Oak said, “It is a misconception that public healthcare facilities do not have the required funding. In fact public sector hospitals have the required funds but they are unable to utilise those funds due to the red tape within the healthcare system, which leads to surplus left over funds.” Oak  also pointed out that the public sector needs to utilise these funds efficiently.

Drawing attention towards other critical areas that requires changes, Oak cited an example of the long waiting list of patients at KEM Hospital for various diagnostic and surgical procedures. He pointed out that the industry needs to think out-of-the-box and come up with new mechanisms for better logistic management of waiting patients. Moreover, he also raised concerns regarding the efficent management of TB patients and cancer as well as organising the current emergency medicine system in our country.  He further revealed that the under five years mortality rate in our country is high and for that both  the private and public sectors need to concentrate on promoting motherhood and childhood schemes. Oak also spoke about increasing infrastructure for healthcare facilities and for promoting Public Private Partnership (PPP) within the sector. “A good PPP model is like a good marriage which works well if both parties are faithful to each other”, he added.

Karanjekar on the other hand spoke about bringing in new strategies for increasing affordable, accessible  quality healthcare. He emphasised that the industry should not associate quality with money. Further on, he informed that a lot of the things that can be done to ensure good quality in a hospital cost almost nothing. For example, maintaining cleanliness, good medical personnel, keeping infections at bay, etc., are some factors that ensure quality at almost no cost. He also gave the example of a government hospital in Trichy that provides quality healthcare while maintaining quality in every aspect of their service.

Insurance being one of the major topics of discussion, Deshpande spoke of strategies that can increase insurance penetration. He said, “India is still a young nation. But the ageing population of over 60 years is growing and very soon the country will require more healthcare for senior citizens. Where insurance is concerned, the country has seen a expotential growth in this spectrum over the past few years with the insurance sector reaching the $110 billion mark . However, 80 per cent of the healthcare spend of the country is still funded out of pocket and only five per cent of the population is covered under private insurance. The Rashtriya Swasthya Bima Yojna is a good initiative by the government, yet this is not enough.” Speaking of  healthcare finance planning he urged the industry to think in terms of the Obama health reforms as a scheme to look up to. He mentioned that this scheme promotes the health insurance exchange, which can make insurance pricing policies beneficial to people who can afford insurance and also to those who cannot. “To increase insurance coverage in the country the government has to make insurance mandatory”, he urged.

While  Oak and  Karanjekar voiced the opinion of the private and public sector caregivers, Datar brought in the perspective of the pateint. He stressed on the need for a proper law on abortion. Citing an example of the Nikita Mehta case, he said the lack of a law, even when there is a deformity diagnosed causes a lot of unnecessary complications. Young women often end up going to quacks for abortions putting their health and life in jeopardy.

Solving the medicine problem in India
The second phase of the discussion, moderated by M G Arun, Chief of Bureau, Financial Express, Mumbai, focused on the drug manufacturing side, featuring  both domestic and MNCs and organisations like AmeriCares which bridge the gap between manufacturers and patients by facilitating medicine donations. The panelists for this discussion were Kewal Handa, Managing Director, Pfizer India, Daara Patel, Secretary General, Indian Drug Manufacturers’ Association, (IDMA), Amit Backliwal, Managing Director, IMS Health and Dr Purvish Parikh, Managing Director, AmeriCares India. These experts stressed the need for public private partnerships, a more robust health insurance sector, greater push from the authorities to provide healthcare access and disease prevention through better public hygiene and health awareness. Speakers highlighted the need to separate drug pricing issues from access to medicine, which is primarily a function of good healthcare delivery infrastructure, comprising stockists, dispensaries and medical practitioners.

Kicking off the session, Handa said, “We haven’t yet realised the power of the ‘National Health Insurance Programme’. This scheme enables inpatient medical care of up to Rs 30,000 per family per year in any of the empaneled  hospitals. Many hospitals and small clinics are emerging, to which people below the poverty line will have access.” He was also of the opinion that the private insurance sector is going to play an important role in providing healthcare access to the larger population. Explaining, he pointed out that the country has at least four to five such insurance providers, all of which cover hospitalisation. India is witnessing a trend towards corporate hospitalisation, and since some of these hospital chains have their own insurance schemes or tie up with other insurance providers, eventually healthcare insurance will have very minimal leakages as these private insurance providers will ensure quality and affordable healthcare. Overall, the government and private insurance sector will decide the growth of the healthcare environment.

Speaking about the government’s role in taking quality healthcare to the needy of our country,  Patel, stated “Not just the pharma industry, but the government also has to play an important role in taking quality healthcare and medicines to the needy.” He pointed out that even though prices of medicine in India are already the lowest in the world, NGOs and the government wants pharma manufacturers to reduce prices further. Alluding to lack of support from the government, he observed that the finance minister hasn’t mentioned the pharma industry in the annual budget at least for the last five years. His point was that although the industry provided free of cost or low cost medicines, the government did not have sufficient infrastructure and manpower to take such medicines to every nook and corner in the country. Underlining his argument, he asked, “Do we have the stockists, dispensaries and doctors to dispense these medicines?” He believes that we will succeed in providing affordable and quality medicines to all through the PPP model.

Drawing on his experience across geographies, Backliwal said, “If we really want to make healthcare available to citizens, we need to dramatically change our speed of development. Significant amount of execution and speed of change should be brought in.” He pointed out that markets are changing and every government is concerned about the cost containment issue; India is not alone in this regard. He opined that while every government is trying to make healthcare affordable, it is important to strike a balance between access and innovation. Referring to the stance of the Indian authorities, he pointed out that merely criticising drug pricing would not increase access to healthcare and medicines; we still need to look at things like basic medical insurance. Giving an example, he alluded to China, where every single citizen has basic medical insurance and the government is making investments there. Echoing the perspectives of the previous panelists, he said, “Basic medical insurance would be the fundamental driver of healthcare access. Government initiative or PPP model is necessary to give impetus to primary healthcare centres.”

Rounding off this session with the people’s perspective, Parikh stressed on materialising the dream of healthcare access. He said, “The focus should be on prevention rather than treatment. People below the poverty line find it difficult to afford treatment. There are 30-35 per cent middle class patients who understand the treatment. They are even aware of healthcare developments but they are not necessarily capable of spending on all kind of treatments. Therefore, I believe in universal healthcare — we have to have different kinds of treatments. We should try to provide appropriate healthcare in a personalised manner to our population.”

After a very engaging discussion between both panels and moderators, the house was open to questions from the audience. The discussion ended with the hope that the recommendations of the Planning Commission would build a road map towards attaining health for all.

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