Public Health

Is India ready for Universal Healthcare ?


Last week there was a flurry of announcements from the Union government on measures to improve the state of Healthcare in India. One among them was the first step towards a Universal Healthcare model in India. If the Union government is to be believed, soon Government run hospitals will stop charging for primary healthcare treatments like consultations, basic medical tests and immunization.

Healthcare in India is almost entirely funded by individuals through out of pocket expenses.(Please see graph below)

Health expenses are a big reason for rural debt. People often borrow money from money lenders to pay for medical treatment of a family member. This leads to a scenario where these loans are repaid at high rates of interest over long periods of time. Moving towards free primary care would be a first step to raise the standards of living in rural India. By early detection and preventive care through primary health services, patients with a probability of requiring secondary and tertiary care is heavily reduced. This reduces the financial burden on the family as well.

The second reason that such a move will address is the absolute shortage of doctors in India. According to the Ministry of Health India faces a shortage of 6 Lakh doctors. But primary care can be provided by paramedical staff and healthcare workers, reducing the dependency on doctors. This way health services can reach a vast majority of our population with minimal investment.

However, delivering free primary care has its challenges. Firstly, the initial cost to set up the necessary infrastructure would be high. Secondly,as the service is free, there would be heavy patient inflow that would require more paramedical staff, health workers and nurses int he initial phases. Thirdly, it is the tax payer in the end who will have to bear the burden of free primary care. As the ratio of tax payers to non-payers is heavily skewed, the number of beneficiaries will far out number those that pay for such services. This would mean an increased burden on the government, that is already dealing with high fiscal deficit. Currently India spends about 5% of its GDP on health care and this would have to increase. Lastly, like any other government scheme, there is likely to be heavy mismanagement here as well.

In conclusion, universal health is a noble concept. India definitely needs one. But is it ready for one? I would love to hear your views on the same…




Public Health

Eli Lilly & Boehringer Ingelheim partnership : A sign of things to come in Indian Pharmaceutical space

Though the role of Pharmaceutical companies in public health is very significant, it has often not been covered very extensively. One good example is the work done by Cipla in Africa to counter AIDS. Similarly Sanofi does extensive work in India to eradicate pneumonia and Novo Nordisk has been active in the diabetic’s space.

Many consumer healthcare firms have also been on the fore front of these activities. Colgate has been advocating strong Public dental health while GSK focuses on nutrition in the public health space . Incidentally GSK launched variants of its nutrition drink Horlicks to cater to women and expecting mothers.

But recently many pharmaceutical firms have joined hands to combat a situation.

The recent one being the collaboration between Boehringer Ingelheim (BI)and Eli Lilly in the diabetes control therapeutic area in India. (Source Mint :

Eli Lilly has been in this pace in India for a while mostly working in the human inject able insulin category. Boehringer also present in India and has a good Oral Anti Diabetes drug.

Diabetes is a condition that is characterized by High glucose levels. there are two varieties of diabetes, Type 1 which is present since childhood and type 2 which is adult onset diabetes. Most people in India suffer from type 2 diabetes which requires Oral hypoglycemics initially but eventually requires Insulin which is taken in inject able form. Some patients are prescribed a combination of both. In India there are almost 40 Million diabetics and this figure may be as high as 80 Million due to lack of awareness.

So what the two comapies would do is to share sales and marketing teams to reduce cost and leverage their natural synergies in this segment.

As Lilly does not make Oral Hypoglycemic and BI does not have inject able there is no conflict in the business interests of the two firms.

The other aspect of this battle is between prescripion drugs and generic drugs. This partnership could be another attempt bu drug companies based out of india to compete against the domestic palyers. Hopefully the partnership would also focus on diabetes prevention and not only on increasing the sales of their inject ables.

This is not the first time that there was been an alliance between two firms. Schering Plough (SP) used to partner with Merck earlier till Merck eventually acquired SP.

In a study launched last year called “Fade or Flourish” IBM had reasoned that the future of the Pharmaceutical industry would involve more collaboration and partnerships among the various stakeholders. The study can be downloaded from this link.

Whether this partnership will hold and prove beneficial to the two entities is a hard thing to say but at least this is a clear indication of things to come in the Pharmaceutical world.

Public Health

Why Public Health programs should factor in the weather

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Public Health programs often ignore a very critical factor that affects the health of many. That factor is the weather. Since time immemorial, weather has affected the general population. It is not uncommon to see certain diseases make their appearance during the turn of weather. A good example in India is the cough during the advent of winter in northern parts of India.
Community Health programs need to incorporate more of the meteorological department data in their programs. In other words the Health departments need to collaborate more with Met departments in order to focus on prevention which is the focus of public health in the first place.
The study reportedly looked at 7,054 people who attended casualty with severe head pain, and examined whether the weather conditions in the past three days was linked to the frequency of these headaches. It found that an increase of 5ºC raised the risk of a severe headache within 24 hours by 7.5%. The study was Dr Kenneth J. Mukamal and colleagues from the Beth Israel Deaconess Medical Center and the Harvard School of Public Health in Boston carried out this research
There is another pilot run in one of the NHS trust hospitals where they teamed up with the local Met office to send out Public Health alerts to patients registered with the trust. These were community health center patients that were suffering from Congestive Heart failure and an increase in humidity was actually a precursor to triggering a heart attack.

A similar collaboration between community health centers, health departments and weather office could really help reduce the incidence of health issues that are triggered by the weather. Community health programs are run on prevention and such steps would definitely help in balancing the health economics of these prevention programs.

Public Health

In defense of the humble physician!

I have been observing a trend. It has become fashionable for most consultants and technologists to blame the physician for all that is wrong with the healthcare industry.They have been accused of not adapting technology, being resistant to change and ensuring that healthcare as an industry remains unproductive.

But how can a technologist, who has never held a scalpel in his life take a call on physicians? I not only find that absurd but also ludicrous.

Physicians have formed the most vital component of the healthcare provider industry, performing a wide range of therapeutic services across many disciplines. Most physicians come from medical schools that are still seeped in the traditional form of learning, mostly theory and clinical. Business or technology does not form a part of the curriculum, and there comes the biggest challenge for most physicians.

Imagine you have never been trained to look at technology as a tool to improve clinical outcomes. As a matter of fact most senior clinicians abhor even basic tests encouraged to rely on their experience and expertise. How many times we have looked down upon doctors who perform more tests than we feel are required.

I believe the issue is a serious one an needs some rethink, these are some of my thoughts on this issue

1) Technology and tools like analytics should be introduced in medical schools as part of the curriculum. They need to be educated rights from the undergraduate days that there are tools that are available that can help in diagnosis and improve clinical outcomes.

2) technology for the sake of it should not be implemented. There has to be a clear road map on what technology would help the physician make an informed decision and what would be the return on investment both for time and effort for the physician.

3) There has be increased emphasis on security, data safety and confidentiality and this has to be in line with HIPAA norms and part of the education modules.

4) Physicians have to be involved in the technology implementation process, many healthcare providers have roles like the CMIO (Chief Medical Information officer) and I think this trend will continue and spread to others.

But I would also like to hear your views, both from physicians and non physicians, what are the other challenges, are we there yet? What else can be done to improve clinical outcomes? Are the current avenues for physician education enough?

Public Health

From Treatment to wellness:Is India really unhealthy

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Yesterday I was doing some research on the chyawanprash market in India and I found some rather interesting stats. The Chyawanprash market which is roughly Rs 400 crore saw a 25% growth in 2010. This is after a decade of single digit growth for the category.

Then in the evening I was reading how Pepsico was investing heavily in the health and wellness segment with its juices and brands like Quaker oats.

And at night I read an article which showed that Britannia was heavily investing in the ‘Nutrichoice’ brand to promote wellness.

So everyone has suddenly jumped on the wellness band wagon. From Dabur to Ranbaxy and from Britannia to Pepsi all want to make products to make you healthy.
But that brought me to another question, what has changed all of a sudden? Why concentrate on wellness now? Is Indian really in danger of being declared unhealthy?

One easy solution I found on the WHO site was that when corporations focus on disease they limit their market, but when they concentrate on wellness they have the entire human population. In India’s case almost 1 billion plus market make a very attractive proposition.

Terms like baked, low fat, no fat, cholesterol free, 3 omega, etc have become marketing clutch words. The focus is to get us healthy and wise. But do we really need these products?

My twelve years in the healthcare industry combined with the 7 years in medical school have taught me that the human body is more than capable of taking care of itself absorbing the right nutrients from the diet. The balaced diet chart that all of us read since kindergarten.

Stress levels among Indians is actually lower this year as compared to last year. Ina survey by accounting and consulting firm Grant Thornton, reveals that only 42% of Indian businesses felt an increase in stress levels as compared to 56% last year. The study was conducted amongst 6,000 businesses globally.

So probably taking these wellness supplements have helped Indians reduce their stress levels. To add to this many other initiatives like Yoga Camps and Art of living classes might have contributed to the lowering stress levels.

But the question still remains why the emphasis on wellness now, maybe the competition in normal products have forced companies to jump on to the wellness bandwagon.

The results will be known only after a while but for now enjoy your low fat snack…