2018 has been a happening year for healthcare in India. Developments such as the launch of the government’s flagship universal healthcare program, Ayushman Bharat; the insurance regulator’s direction to insurers to cover mental illness; the heightened focus on public screening of non-communicable diseases, all point to the fact that healthcare is starting to get the kind of attention it deserves in India. These developments could well determine the ‘health’ of India’s development story in the years ahead and thus need to be followed closely.
- Government-funded Universal Health Insurance
This year, the NDA government rolled out the ambitious Ayushman Bharat program, which envisages a two-pronged approach to provide universal access to primary, secondary and tertiary healthcare to nearly 40% of India’s population. One part of it focuses on providing comprehensive primary care at the community level, while the other aims at providing cashless health insurance cover up to Rs 500,000 per family annually to 100 million poor and vulnerable families through a network of empanelled hospitals under the Pradhan Mantri Jan Arogya Yojana (PMJAY).
The unveiling of the PMJAY program is a vital first step towards the implementation of universal healthcare coverage in our country as it recognizes universal health insurance as an essential component of universal healthcare delivery. This is especially true of India where over 60% of the population pay healthcare and hospitalization expenses from their own pockets as they aren’t covered under any health protection scheme.
Initial reports on the performance of this program are encouraging. In the 10 weeks since it was unveiled in September, nearly 500,000 people have availed the benefits of PMJAY, for which over Rs 700 crore has been authorised, according to the government. Moreover, the number of beneficiaries are expected to triple from about 10,000 a day now to 30,000 a day once the program picks up steam.
Private healthcare providers seem to have responded enthusiastically to PMJAY. Of the 14,000 empanelled hospitals, over 8,000 are privately run, government figures say.
Besides ensuring that a large number of Indians have adequate health protection, this scheme can create much-needed jobs. Its impact on employment generation is already evident. The Naukri JobSpeak Index recorded a 34% year-on-year increase for the healthcare industry in November 2018.
- Putting the Spotlight on NCDs
The proposal to set up 150,000 health and wellness centres (HWCs) in India by 2022 under Aysuhman Bharat is timely, given the looming threat from non-communicable diseases (NCDs). According to the Lancet, cardiovascular diseases, respiratory diseases and diabetes kill around 4 million Indians annually (as in 2016), and most of these deaths are premature, occurring among Indians aged 30–70 years. In fact, these diseases today account for over 50% of the overall disease burden compared to roughly 30% in the 1990s. As most of these conditions can be addressed at the primary level if identified early and managed appropriately, HWCs have a key role to play in the fight against NCDs.
Under Ayushman Bharat, all men and women over the age of 30 years will be screened for hypertension, diabetes, oral, breast and cervical cancers at the HWCs.
It is heartening to see the government adopting a technology-based approach to ensure the success of the Comprehensive Primary Healthcare NCD program under Ayushman Bharat. The Health Ministry is working with Dell as a technology partner and the Tata Trusts as deployment partner on a cloud-based mobile, web and analytics platform to digitize health records obtained from population-based screenings. The application of technology will enable surveillance, monitoring and evaluation of the health status of the population and improve the quality of healthcare interventions.
- Insurance Cover for Mental Illness
Another big stride forward in healthcare in India this year was the Insurance Regulatory and Development Authority of India’s (IRDA) directive asking insurance companies to provide coverage for mental illness. This is a significant development as one in five Indians face depression in their lifetime, according to the World Health Organization.
Apart from the social stigma, mental illness in India carries a substantial financial burden. According to the National Mental Health Survey of India 2015-16, families spent nearly Rs 1,000-1,500 a month on average for treatment, with the entire expenses coming out of the pocket.
Bringing mental health disorders under insurance coverage has brought them at par with physical illnesses and could in the long run lead many more to seek proper and timely treatment.
On the same positive note, IRDA has also asked insurers not to deny medical cover to HIV-positive individuals.
- First Uterine Transplant Birth
It was a proud moment for Indian healthcare when a 27-year-old woman from Vadodara, who had undergone a uterine transplant in 2017, delivered a baby girl in Pune this October. This was the twelfth baby in the world to be born through a uterus transplant and the first in all of Asia.
This feat not only speaks volumes of the kind of medical talent we have in our country but also offers hope to women born without a uterus and those with a non-functional uterus. There are about 400,000 women with congenital absence of the uterus in India, according to the Week magazine.
- ‘Made in India’ Biosimilars Make it to Developed Markets
The Indian pharmaceutical industry has stepped up its efforts in developing biosimilars, as a class of generic biopharmaceuticals that provide affordable access to key life saving drugs. India’s Biocon is a recognised front runner in this emerging opportunity with a large pipeline of Biosimilars both under development and in global markets. Several Indian companies have also initiated efforts in this direction. Over the last decade, we have seen a steady stream of biosimilars being launched in India, which augurs well for patients. To date, nearly 70 biosimilars have been approved in India.
While most Indian players are currently focussing on developing products for the Indian market, Biocon has successfully launched some of its biosimilars in the developed markets of U.S., Europe and Japan, as well as, some key emerging markets, establishing a ‘Made in India’ biosimilar capability that meets the quality and manufacturing standards demanded by stringent regulatory standards in developed markets.
- More Hospital Beds to Become Available for the Common Man
The government has recently decided to open up hundreds of hospitals running under the Employees State Insurance Corporation (ESIC) to the general public. Non-insured persons will now be able to avail medical services from underutilized ESIC hospitals at subsidised rates.
The labour ministry-run ESIC has over 150 hospitals and 1,500 dispensaries across India currently catering to the healthcare need of industrial workers who are subscribers of the corporation. According to newspaper reports, the ESIC will initially run a pilot and based on the outcome and experience in the first year, the move will become permanent.
The Budget announcement earlier this year of the government’s intention to set up 24 new government medical colleges and hospitals by upgrading existing district hospitals in the country is also noteworthy. This would ensure that there is at least one government medical college in each state.
These developments will immensely help the common man get quality medical care at very low cost and ensure better utilization of hospital resources. This is especially important in a country like ours where there is one government hospital bed for every 2,046 people and one state-run hospital for every 90,343 people.
The various developments during the year are definitely promising, but we cannot allow the momentum to slip. The aim going ahead should be to ensure ‘best-in-class’ healthcare services delivery in the public and private sphere for the larger benefit of Indian patients.