Crusader for Affordable Healthcare

Financial Chronicle: Big Interview: Biocon CMD Kiran Mazumdar-Shaw spoke to FC on a range of topics, including women as entrepreneurs, philanthropy, affordable healthcare, citizen activism etc. Here’s the full version of the interview.

  1. As a woman business leader, what are some of the challenges you have encountered in getting to the top and how were you able to surmount them? Has the situation improved for women entrepreneurs today?

I am happy to note that a large number of women entrepreneurs are coming to the fore in India today. In fact, India has been ranked as the most active country for successful women entrepreneurs, with one-third of early-stage entrepreneurs being women.

This is a huge change from when I started Biocon in 1978. I had to function in a fairly hostile business environment and surmount a lot of credibility challenges. Professionals did not want to work for me as they felt that I could not provide them ‘job security’ being a woman, and some even assumed I was the secretary to the Managing Director (MD) and not the MD.  Suppliers told me they were reluctant to give me credit because they did not have confidence in my business abilities. Banks and financial institutions were reluctant to fund me and some even suggested that my father should be the guarantor for any loans.

While more women are coming forward with new entrepreneurial ventures, women-led startups still find it difficult to get funding. A recent media report said only 2% of all the fund raised by startups in India in 2017 went into women led start-ups.

Researchers from the University of California, San Diego in the US, have found that men, who make up 90% of venture capitalists, prefer to invest in companies run by other males. Since female-led startups face tougher funding prospects than male-led startups, fewer women enter the tech entrepreneur pipeline that ultimately feeds the ranks of venture capitalists, according to the study.

Thankfully, Bengaluru is blessed to have a booming ecosystem for women entrepreneurs. I hope such an environment can be replicated pan-India to enable women-led businesses to overcome challenges, manage risk and deliver growth.

  1. Given the high cost of healthcare, what steps are needed to improve healthcare delivery in rural India?

India needs a healthcare model that hinges on affordability and access. This calls for existing public health infrastructure to be revitalised, new medical centres to be built and modern Information and Communication Technology (ICT)-based telemedicine technology to be leveraged for addressing the demand-supply gaps in terms of doctors and health facilities, especially in the rural areas. There is an urgent need to promote Public Private Partnership (PPP) models in healthcare.

The government alone cannot meet the healthcare infrastructure and capacity gaps in Tier II and Tier III cities as well as rural areas. While it’s true that some PPP projects attempted earlier have failed, clear policy guidelines can ensure the successful implementation and sustainability of healthcare PPP models in future.

I believe advances in ICTs provide a very effective tool for improving healthcare delivery and reducing healthcare disparities in rural areas. A modern ICT-based universal healthcare system can help leverage modern diagnostics in primary healthcare for early detection and treatment, and integration with telemedicine could bridge the deficit of specialists at the primary care level. Through cloud based data collection for patient profiling, epidemiological and patient centric data can be generated which will enable mapping of the disease burden at the level of the smallest administrative unit.  Comprehensive databases and disease registries can enable better evaluation of the incidence and diversity of diseases thereby allowing for more effective healthcare interventions.

Biocon Foundation, Biocon’s CSR arm, has embraced technology for healthcare delivery at various levels – through mobile phones, handheld diagnostic devices, ICT-enabled eLAJ smart clinics and digitized patient records. We have also entered into public private partnerships (PPPs) in Rajasthan and Karnataka to scale up our various CSR programs. These initiatives have contributed to expanding the reach of our programs.

  1. What are your views on the recent controversy over the KPME Act, which has brought into focus the issue of high cost of private medical treatment in the country?

We all know the dismal state of healthcare in our country where public healthcare services are almost non-existent and people have to rely on private healthcare ecosystem for high quality healthcare delivery. Inadequate public investment in health infrastructure gets compensated by large-scale investments by the private sector, which is over 3% of GDP or almost double  of the government’s spending on healthcare in India.

The proposed Karnataka Private Medical Establishments (KPME) Amendment Bill that includes price control on private healthcare sector will be detrimental for the health of this sector and suicidal for patients.

While government’s intention to safeguard patient’s interests and make healthcare delivery affordable is good, the mechanism proposed through KPME Amendment Bill is sub-optimal. Seeking to cap prices of various medical procedures at private hospitals will be detrimental to the fiscal health of those who have invested heavily in setting up world-class hospitals, as well as for the patients in the long run.

While undue profiteering at the cost of patients’ needs to be discouraged, these hospitals need to make  decent returns on investment (RoIs) to make their business sustainable. If not, the private healthcare sector will meet the same fate as the existing government hospitals, which have failed to provide good quality healthcare to people. Therefore, in my view, we need to have a more comprehensive regulatory framework that looks beyond price caps in private sector to ensure quality healthcare coverage for all.

Another proposed modification in the KPME (A) Bill calls for imprisonment of doctors found guilty of negligence. Such a provision could prove counterproductive by deterring doctors from taking quick decisions in emergency cases. A more pragmatic ‘3 Strikes, You’re Out’ approach could help curb malpractices by doctors as erring individuals could stand to lose their licenses if they step out of line despite two previous warnings.

The proposal to set up a specific patient grievance redressal cell to fast track patient complaints is again good in its intent but not thought through well, since doctors can be held liable under current consumer protection laws and complaints against them can be made to Karnataka Medical Council (KMC), Medical Council of India (MCI) and the Lokayukta. Adding another forum will only complicate the matter further, unless some of the existing channels are closed for complaints against doctors.

I am glad that Karnataka Chief Minister Mr Siddaramaiah has engaged with the protesting community and has agreed to look into their concerns. I think he is amenable to modifying some of the harsher aspects of the KPME (A) Bill and I believe that healthcare providers  have also agreed for price regulation for procedures under govt. health insurance schemes. So, I hope the modified bill when tabled will be in the best interest of patients and healthcare providers.

While there can be no debate over the need to increase access to affordable healthcare for the common man, the government also needs to upgrade the public healthcare delivery and not just  focus on controlling the private sector which is the major provider of tertiary healthcare in the country today. It is time that the government increases its spending on public health and starts investing more in hospitals to bring them at par with the private hospitals both in terms of infrastructure and high-end talent. The government also needs to create mechanisms that allow patients’ grievances to be addressed in an expeditious and fair manner. The aim should be to ensure ‘best-in-class’ healthcare services delivery in the public and private sphere, for the larger benefit of Indian patients.

  1. If technology can be leveraged to improve healthcare delivery, can it work in improving the level of governance in India?

I believe the government needs to leverage technology in a big way to deliver governance that is efficient, transparent and accountable. The goods and services tax (GST) as originally envisaged could have been a model of how a simple, technology-based tax administration can effectively raise compliance and tax collections in the country. However, messy political bargaining has led to the GST’s current structure that is seriously flawed, defeating the very purpose it was meant to serve.

If the government had taken the views of all stakeholders on board before implementing GST, they would not have to constantly run to the drawing board to tweak the tax slabs to ensure better ease of doing business and improve India’s global competitiveness.

Take for example, ambulances with a capacity of 10-13 people, including the driver, now attract the highest GST rate of 28% plus 15% compensation cess. The huge tax component inflates the cost of the ambulance. Similarly, hospitals pay GST at a rate of 28% on all purchases and services availed for air-conditioned hospital beds. Hospitals, however, cannot offset this higher tax incidence by taking input credit for the GST paid as healthcare services are exempt from service tax. If this anomaly is not addressed, it will lead to a deterioration of hospital services and worse, make businesses unviable.  Hospital care is not a luxury service and the government should not confuse hospitals with hospitality!

  1. You have channelled some of your philanthropic activities towards boosting entrepreneurship in the country. What other areas do you focus on as part of your philanthropy?

As the founder of a Biopharmaceutical company, I believe innovation and commerce are as powerful for driving technological advancement as they are for creating social progress. It is my long-held belief in the power of entrepreneurship to drive change that has led me to support startups, especially in the area of healthcare.

As part of my philanthropic efforts I also passionately support the pursuit of science to target cancer, which is a debilitating disease that imposes unbearable financial burden on patients in poor countries.  The Mazumdar-Shaw Medical Center, my philanthropic initiative in partnership with Dr Devi Shetty, aims to create a sustainable affordable cancer care model that leverages advanced technologies, state-of-the-art diagnostics and best-in-class talent to address the challenges associated with this fatal disease. Our unique cancer care model enables the poor to access treatment at costs subsidized by those who can afford it.  The Mazumdar-Shaw Centre for Translational Research, which is an integral part of the hospital, has developed a number of advanced yet affordable genomics based cancer diagnostics including liquid biopsies.  This is enabling early diagnosis and better treatment outcomes based on personalized medicine.

Biocon, the company that I founded in 1978, has committed its Corporate Social Responsibility to ensure that marginalized communities living in underserved urban and rural areas of India can enjoy the ‘Right to Health’, the ‘Right to Education’ and the ‘Right to Sanitation’. Over the years, Biocon Foundation has built a strong reputation for the quality of its programs and their impact in addressing the social, humanitarian and environmental challenges of India.

My love for the arts influences my philanthropic efforts aimed at encouraging new artists. Deteriorating civic amenities in another area of concern that I try to address through my philanthropy.

I am inspired to join Bill & Melinda Gates and the growing fraternity of the Giving Pledge in their philanthropic efforts to make this world a better place. I have been giving away half of my income towards philanthropy on an annual basis. My will reflects this intent very succinctly. In 2016, I became the second Indian to take the Giving Pledge.

Having grown up in a middle class family in India, I was brought up by my parents to believe that wealth creation is about making a difference to society. As a first generation entrepreneur, I built my company Biocon with these guiding principles. My success with Biocon has given me the wherewithal to pursue my overarching commitment to social inclusiveness.

  1. Tell us more about your work with B.PAC. Bengaluru known for its lakes is becoming a city of neglect with its choked drains and lakes. what is B.PAC doing in this area?

B.PAC has today emerged as a platform for participative governance by galvanizing ordinary citizens of Bengaluru to engage proactively with government and civic bodies.

We as citizens cannot stand by and blame the government for all that ails our cities today, we need to demonstrate ownership as well as exhibit responsible behaviour. For instance, a large part of the problem of dead or dying water bodies is on account of garbage and untreated sewage from residential colonies and commercial establishments is being allowed to flow into lakes. Unfortunately, when this happens the burden of finding a solution is passed on to key individuals or corporates, besides government bodies and citizens are not held accountable for creating these problems. B.PAC is trying to address this anomaly through better citizen engagement in finding solutions for the problems of our city and restoring its past glory.

While corporates are ready to contribute, Citizens too need to get involved by vigilantly guarding against attempts by land sharks to grab lakebeds and ensuring that untreated effluents and sewage do not end up polluting lakes. The government, on its part, needs to ensure that heavy fines are imposed to deter people from polluting lakes and dumping garbage.

B.PAC is actively working towards citizen engagement in addressing various issues. For example in order to get citizens involved in lake conservation at the ward level, B.PAC has selected community representatives staying around lakes to actively participate in the process. B.PAC teams are also providing authorities with the necessary data for selection of lakes in the city for rejuvenation.

Similarly, under the B.Safe program B.PAC has joined hands with the Bangalore City Police for the ‘A Billon Eyes – For a Safer Bengaluru’ Initiative. Research shows that bystander intervention helps prevent harassment and increases the sense of safety among women. Hence, this campaign is helping ensure citizens are prepared to actively help in ensuring the safety of women and children in the city.

Recently, B.PAC has also launched the My Place of Pride (MYPOP) contest, which rates, ranks and awards the communities that exhibit best practices in solid waste management, water conservation, power management, fire safety and hygiene and cleanliness.

B.PAC is pushing Bengaluru citizens to shed their apathy and engage effectively with the political system to find solutions to the myriad issues that bedevil our city.

 

This article originally appeared in Financial Chronicle, November 25, 2017 issue.

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