Healthcare Insurance sector in India is set for exciting times with the proposed entry of US based Healthcare giant Cigna. Cigna based in Bloomfield Connecticut has revenues of close to $19 billion globally. To enter India Cigna has formed a joint venture with India based TTK Healthcare which was founded in the 1920’s. TTK healthcare is already present in the Healthcare insurance as a third party administrator a business they would have to close down in order to formalize this JV.
Only 10% of Indians are covered by Insurance of any kind. Almost 2% are covered by private insurers and 8% through state and central government schemes. So there are almost 90% of the people without insurance in the Indians Healthcare market and they mostly pay for healthcare expenses from their private pockets.
For the US private healthcare insurers are sometimes blamed for the spiraling healthcare costs. But one has to wonder if the entry of private insurers in India will do the same?
Recently my wife availed her company sponsored private insurance for the birth of our first child. The total bill was more than that we would have to pay if we had paid from pocket.
So the question is does India need Private Healthcare Insurance ? Can we afford it?
After a recent grocery shopping experience I was wondering looking at the bill, how Indians from the lower economic strata were managing to buy food. My grocery bill has gone up since the birth of my baby daughter and I am sure members of the poorer sections of the society would have definitely felt the pinch if they had children.
As I check the economic figures for November, food inflation in India stands at 11.8 %. And this has resulted in a steep rise in cases of malnutrition in India.
The World Bank estimates that India is ranked 2nd in the world of the number of children suffering from malnutrition, after Bangladesh (in 1998), where 47% of the children exhibit a degree of malnutrition. The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub-Saharan Africa with dire consequences for mobility, mortality, productivity and economic growth. The UN estimates that 2.1 million Indian children die before reaching the age of 5 every year – four every minute – mostly from preventable illnesses such as diarrhoea, typhoid, malaria, measles and pneumonia. Every day, 1,000 Indian children die because of diarrhoea alone. According to the 1991 census of India, it has around 150 million children, constituting 17.5% of India’s population, who are below the age of 6 years. (Source Wikipedia.org)
Now these findings have some significance. Image being next to only Bangladesh, whom I am sure many Indians would consider a developing nation. But our own statistic is not very far behind. While many of our celebrities and film personalities focus on tackling HIV/AIDS, the real killer in India are diseases like Tuberculosis, which kills more people every year than the cumulative deaths due to HIV since 1984.
The main factor behind all this is the lack of proper nutrition. Most of us have read the balanced diet chart which includes carbohydrates, proteins, minerals, vitamins, fats and water. Indian diets for vast majority of children clearly lack that and this forms the root of the problem. Even if the children survive childhood, they would continue to suffer as they grow into adults leading to more diseases in adult life.
What can be done to reverse the situation?
Well the government has been tackling malnutrition at a national level and local and state governments are tackling the issue at the regional level. One of the best ways to fight malnutrition is to combine it with the large child development programs launched by the government. Former Tamilnadu chief minister MG Ramachandran had launched the mid day meal program to encourage children to come to school. This meal can be used to secure the right nutrients for the children especially proteins, Minerals and Vitamins. I think combining school and education is an excellent way of tackling the problem.
Secondly the government might have to step in to tackle food inflation. Many fruits are just beyond the reach of the middle class leave alone the poor. I cannot imagine while we have tones and tones of produce rotting in Food Corporation of India godowns, there are children dying due to malnutrition in the country. The problem is more in the rural areas than urban and more among girls than boys.
Finally as Individuals let us contribute to institutions those are trying to combat this issue. A good example is the Akshay Patra foundation. The Foundation feeds nearly 1.3 million children every day with part subsidies from the Government and the rest of the cost of every meal is generated from individuals, philanthropists and corporate entities. A contribution of Rs 675 is enough to feed a child for a year. The foundation also provides the break up cost for the same and is exempt from income tax for the Indian donors. Though I have been donating to the foundation, I personally am not a member there and this is just one of the many groups in India.
Finally I would like to conclude by saying a nation is only as strong as the health of its children, so let’s think about this very basic issue for once and come up with innovative solutions. I would like to hear from you as well, How do we tackle malnutrition?
Recently I read an article that reaffirmed the increasing applications of social media in Healthcare.
A group of physicians in France have been using Google + to discuss their cases. They have formed a close circle on G + and they upload cases that they want to discuss and finally arrive at a conclusion. It may be the economic conditions in Europe but using the network to clinically discuss a case supported by images and videos is really a very effective method of getting the right clinical expertise into a clinical discussion. For more on that article please visit http://scienceroll.com/2011/10/23/case-presentations-on-google/
Similarly Physician groups in Spain have been using a Facebook group called Med & Learn to do the same. They discuss clinical case studies and also sometimes discuss cases from their daily practice. Also a bunch of Spanish USMLE aspirants have been using Facebook for their clinical case discussion. To learn more on it please visit http://www.somosmedicina.com/
In the dental field I have seen increasingly cases being discussed online. I feel this is an excellent method to discuss cases, but there might be issues on security and patient confidentiality that might be barriers and have to be overcome within the boundaries of national healthcare policies.
According to latest Human Development Index(HDI) report released by the UN, India has done very well in the field of education. In last ten years there has been a 28.5% increase in the number of children going to school and this has been a remarkable achievement.
But unfortunately Public Health continues to suffer and the indicators are not positive. Though smaller states like Kerala, Delhi and Goa have been able to provide both preventive health and nutrition services the much more populous states like Uttar Pradesh (UP), Bihar and Madhya Pradesh (MP) continue to languish.
UP for example now boasts of a world class formula one circuit, but continues to have abysmal primary health infrastructure. This is the divide in India which i am never able to understand.
Providing primary health, adequate nutrition and sanitation are the basic requirements that a citizen asks of its government.
India’s record on public health are also very dismal. In a report published in 2006, India’s public health expenditure as a percentage of GDP stood at .9% while the private contribution was almost 4.2%. Similarly our per capita public expenditure on Health is close to $80 but the private out of the pocket expense is around $100. The report can be accessed here http://www.macroscan.org/anl/oct06/pdf/Health_Expenditure.pdf
So clearly the government has decided that running an Airline is a priority but not providing basic medical facilities. But I wonder if this is a viable situation which will have implications for the future. With a young population it is important for public health facilities to be upgraded, immunization provided and stress laid on nutrition.
I believe the best way out of the mess is to provide most of these facilities in the schools. As the percentage of children going to schools are increasing, most schools could also double up as a public health facility with focus on primary care and nutrition.
Some years ago Mr MG Ramachandran the late Chief Minister of Tamil Nadu had stated the mid day meal initiative to give added incentive to parents from poor back grounds to send their children to schools. The same scheme could be used to provide a balanced diet to the children.
Indian politics and governance has a habit of making up strategy as we go along. Health unfortunately is a matter of strategic importance and government will do well to wake up to it.
Why has healthcare analytics become very important in healthcare?
Well the reasons are three fold.
Firstly , IT adoption in healthcare industry is on the rise. In the US even before Obama care cam e into the picture, many healthcare providers, physician groups and community health centers had started adopting IT. In Europe NHS was at the fore front of concepts like ‘One Patient, One Record’. Though the NHS strategy has undergone a change but the objective remains to digitize Healthcare. Continental Europe has been adopting IT at a faster rate than US or UK, with countries like Holland, Belgium, Norway and Germany leading the way. Not to be left behind India and China are on the same route.
Secondly there has been increasing adoption of IT standards in Healthcare. Many hospitals are on HL7 and with the adoption of ICD 10 by the US, most Healthcare providers and Insurance firms will be on the same standard. Similarly there are moves to bring the Medical Devices and Pharmaceuticals on the same standards as the EMRs so as to enable the interoperability of data.
Thirdly, Due to IT adoption and introduction of standards there is tonnes of data available. Technically there are three sources of medical data available to a hospital or care giver.
The patient record and medical history
The hospital records that are available with the care provider of treatment regime for similar diseases
Online medical encyclopedias and dictionaries
Now a good treatment regime should involve information from all three sources. and here is greatest scope for analytics. A good clinical decision support system based on analytical technology will be able to help the physician to narrow down on the disease and chart a course for an effective treatment regime.
The objective of a healthcare provider is to improve clinical outcomes and to restore functionality. And I am sure that analytics would come in very useful in meeting that objective.