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The Indian healthcare system should be reengineered for delivering healthcare to all by tailoring the model for inclusion, aiming for true care and building stakeholder trust

 61% patients surveyed in 2019 believe that hospitals did not act in their best interests, as against 37% patients in 2016

  • 63% patients indicated that they were not happy with hospital responsiveness and waiting times
  • 59% patients felt that hospitals are not concerned about feedback and do not actively seek it

The Indian healthcare system needs to tailor its current model for inclusion and mass healthcare to deliver true care with a focus on primary care, wellness and health outcomes, states the latest edition of the EY- FICCI report Re-engineering Indian Healthcare 2.0. Launched at 13th FICCI HEAL, on the theme Health of Indian Healthcare, the report reveals that 61% patients believe that hospitals did not act in their best interest.  EY conducted an online survey with 1,000 patients across India. The survey findings also state that the key gaps in patient experience which have contributed trust deficit are – poor hospital responsiveness and waiting times as stated by 63% patients, and no concern for feedback as stated by 59% patients.

The Indian healthcare system should be reengineered for delivering healthcare to all by tailoring the model for inclusion, aiming for true care and building stakeholder trust

For building trust across all principal stakeholders, i.e., policy makers, healthcare providers, payors and the public, EY recommends a ‘5E framework’ comprising integrating empathy, efficiency, empowerment, ease and environment to achieve the agenda of universal health access and the right to health. India offers the lowest cost healthcare services when compared to global peers, yet the services are overwhelmingly prohibitive to a majority population. This calls for a focus on rationalizing healthcare costs across the country. Rural primary health where ~70% of the population resides is a key area for development. Engaging private players for innovative primary care provisioning in remote locations, enabling Make in India for frugal medical supplies, increasing the penetration of low cost domestically manufactured products are all steps in this direction.

Kaivaan Movdawalla, Partner – Healthcare, EY India, says, “For realising the aspired levels of efficiency, it is imperative for healthcare providers to shift from an incremental performance plus approach to a radical design to cost or design-to-cost approach for redesigning their operating models and cost structures. For private providers, it is imperative to understand that the very nature of healthcare as a sector is characterized by social obligations and has an inherent risk of market failure. The economics of the business will always lend itself to highest scrutiny and sceptical inquiries. The need of the hour is to be proactive in reinventing the model, methods and measures for best possible efficiencies, both capital and operational, to effectively offer services across sections of the society.”

Commenting on the launch of ‘Re-engineering Indian Healthcare 2.0’, Sangita Reddy Sr. Vice President FICCI and Jt. Managing Director Apollo Hospitals, says, “A definitive is that healthcare must be equitable and inclusive to be true to its intent. It is wonderful that a very timely and pertinent report has been put together to help all in rethinking and redesigning processes and steer the course towards requisite decision making. Healthcare is at the cusp of tremendous change and the need of the hour is for radical thinking and disruptive solutions to address the dynamic economic and social milieu. Above all, the extent of the impact is the best barometer and the journey towards it would need to accommodate current expectations for greater involvement, clarity, and convenience in the healthcare delivery process. Furthermore, a healthier nation is the bedrock of a healthier economy.”

(Hony) Brig Dr Arvind Lal, Chair, FICCI Healthservices Committee and CMD, Dr Lal PathLabs, says, “Although Indian government has launched several significant initiatives that will take us closer to achieving the SDG3 goal, including Ayushya Bharat, we have a long way to go before we can call ourselves a healthy nation in entirety. It is time we re-engineer our healthcare ecosystem with systemic and structural changes, keeping the ground realities in mind, through innovative and sustainable models of care delivery as well as business processes. But above all, there is an urgent need to bridge the ‘trust deficit’ between the patient and the doctor; patient and the hospital; as well as government and the private healthcare provider for the Health of the Indian Healthcare.

Bringing about trust in healthcare

Several steps have been undertaken by the Government and the medical community in India to bring about transparency in the sector, but implementation continues to remain a challenge. Healthcare providers must focus on redesigning their business models to ensure that patients are satisfied with the services provided. They must build a strong positive emotional connect with patients which eventually translates into trust.

Effective interpersonal communication and developing relationships between patients and doctors are important steps towards bridging the trust deficit. Hospitals must create separate cells to handle difficult situations which need expert capabilities. Incorporating operational efficiencies in the processes impacting different patient touchpoints will enhance satisfaction levels. The tactical planning of resources will help achieve equitable access for patients and serve the strategically agreed number of patients through efficient resource utilisation. Future-ready billing solutions incorporating- standard nomenclature, standard treatment guidelines and order sets, AI based bill estimator, robust procedural costing, process controls will empower patients. Up-skilling nurses or the creation of new roles like physician assistants or counsellors who can spend more time with patients will ensure also enhance trust.

Promoting true care focused on primary care, wellness and health outcome

Establishment of a Department of Public Health at the central and state levels will ensure coordinated, collaborative and comprehensive multi-dimensional support to providing true healthcare for all at the last mile. Adoption of healthy behavior and wellness among individuals prevent the development of key risk factors of chronic diseases. The EY BRIDGE framework focusing on promoting true care and wellness:

o   Boost the social determinants of health including physical environment and socio-economic conditions such as economic stability, education, food and community.

o   Regulate unhealthy products and practices by internalizing the social costs of unhealthy behavior by increasing taxes, imposing regulations, introducing penalties, etc.

o   Inspire through improved health awareness by ensuring the availability of appropriate health information through educational programs, mass media awareness campaigns and information regulation.

o   Democratize access to healthy options through the availability of healthy food, infrastructure to facilitate physical activity in daily life and increased availability of rejuvenation, wellness and cessation support centers.

o   Gamify individual behavior by introducing structured intervention programs that incentivize healthy behavior through rewards such as tax credit, allowance, gift cards and discounts on insurance premiums.

o   Empower through personal health information from wearables, mobile apps and genomics thereby improving the likelihood of taking ownership of individual wellbeing.

The EY-FICCI study states that there is a need to create at least 2,000 family medicine seats in medical schools in India so there could be 6,000 practitioners by 2025 accountable for community health outcomes, each linked to a community health centers (CHC) with rotational service in the reporting primary health centers (PHCs).

Promoting a sustainable and efficient healthcare model

With an allocation of 25% of hospital capacity to Ayushman Bharat patients, National Accreditation Board for Hospitals & Healthcare Providers (NABH) accredited hospitals will have to focus on driving efficiency improvement of 30-35% across major cost heads to achieve healthy profit margins and return on capital employed, slightly higher than the cost of capital of 14%.

Developing a national framework to promote public private partnerships (PPPs) in healthcare can act as a guiding reference point for private healthcare providers, the State Governments and the Central Government. A focus on health performance and not just services through reporting of health outcomes, will enhance healthcare delivery.

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