Government Investment, Industry Expansion and Responsibility in a Crisis
Dr A Velumani, Founder & CEO, Thyrocare; Sunil Thakur, Managing Director, Quadria Capital; Vivek Srivastava, Co-Founder & CEO, HealthCare at Home; Dr Ruchi Dass, Founder & Managing Director, HealthCursor Consulting Group; and Sudhir Mishra, Founder & Managing Partner, Trust Legal; speak with Dr Annurag Batra, Chairman & Editor-in-Chief, BW Businessworld & Exchange4Media about expanding the healthcare industry, government investment and the role of media in spreading accurate and balanced information.
Dr Batra: Let us start with the big questions. What has gone wrong? How can it be corrected? What do we do move forward? And, if someone dies due to the unavailability of oxygen, what shall we call it?
Dr Velumani: We are 400 days old with this new enemy and if somebody is allowed to suffocate and die without oxygen, I call it murder. There are a lot of opportunities in healthcare, to invest. It is time to scale up.
Dr Batra: How do we double up on investments and what are the policy interventions needed to make healthcare even more attractive?
Dr Velumani: There is an uneven distribution of resources in the country. Where there is demand for oxygen, there is low supply, and where there is supply, there is no demand. So, a lot in needed to run a low risk, scalable and profitable business, only then will investors come in. Investors need some returns and profits never come from customers; it comes from floor efficiency. That is the way the system is made; single speciality will always make more profit than multi-speciality. Multi-speciality gives you security and single speciality gives you prosperity. In the end, efficiency matters.
Dr Batra: In the UK there was a discussion surrounding national health services and their effectiveness. Bearing that in mind, what do you think is the solution in India, both in the short term and the long term?
Dr Dass: The way the Indian healthcare structure and delivery is designed, it is very decentralised. So, majority regulatory body at the Ministry of Health and Family Welfare hold decisions on most of the regulations and policymaking, while they are not involved in healthcare delivery at the endpoint. So, states are responsible for that and that is why there is so much disparity between state, healthcare, insurance, service delivery, coverage, access, and affordability across India. Secondly, India does not understand where the demand lies and where supply is lacking. The way the healthcare delivery is done, it is with a grand infrastructure, poor governance, and very few methods of ubiquitous financial access by the patients. It is a very profit motivated market where even the demand is very supply induced so when you look at the microeconomic level of how in India service delivery is done, you will understand that fulfilment is done based on who has more money. I also want to add that it is time that healthcare became both the doctor and the patient’s responsibility. No amount of intervention will have any impact if the mindset does not change.
Sudhir Mishra: Today our pride has been broken. The constitution says that health is a state subject, but health is never a priority. When the pandemic began, we had a centralised system, which has become more and more decentralised with time, without passing the bat. No one really knows who is in charge
Vivek Srivastava: The demand is just so high; we are missing a thousand leads a day. Despite doubling our capacity, we are still not able to take cases. We need the government to support entrepreneurs in this sector. Especially because hospitals are not designed for primary healthcare. So, we need chronic disease centres, diagnostic labs, and many new ideas to gain traction.
Dr Batra: Give us a sense of what is happening in the Indian healthcare system. Should we be hopeful of the future? What are the steps we need to take?
Sunil Thakur: There are big lessons here for us to learn. First, there is a lack of communication. Second, there is no coherence in policy. Finally, the supply chain has completely broken down. We need role clarity; the public does not know who to turn to. So, I think if we can still see this as an opportunity to learn, we can fix things going forward. The way to fix it is through empowering the consumer through digitisation and distributing the responsibility of clinical intervention. Fixing the entire supply chain simply mean to have consistency of services. This crisis has forced us to work with lower manpower. It has also, highlighted the need for an integrated care pathway, this means, if someone can be taken care at home, they should stay at home. Finally, as an investor backing entrepreneurs, I do not think anyone needs to be dishearten, there are opportunities in this crisis.
Dr Batra: We are one of the most depressed nations in the world and we do not have enough trained psychologists and counsellors. Do you think the mental health space will also see more investments?
Sunil Thakur: Absolutely. Mental health is one area that can be largely taken care of by digital therapy, and not require clinical intervention, especially in the early stages. For entrepreneurs and investors, it’s a huge opportunity to create digital platforms that reaches to people everywhere.
Dr Batra: Is ‘Interferon alfa 2b’ a welcome development? Do you think it will have an impact on the treatment of COVID19?
Dr Velumani: Last year Chlorphen was said to solve the problem, and it did not, so I do not think it is solving the problem. That being said, something is better than nothing. If I had to guess, in the next 10 years, 10% of deaths will be because of COVID. If there is a drug maybe it will be 2%. However, currently none. We are in desperate need to invent a drugs or combination of drugs to help us. Without this there will continue to be panic.
Dr Batra: What are the immediate solutions available to us to save lives? What can the government do? What can the healthcare providers do? And what can the citizens do?
Dr Velumani: Ours is a unique country, we cannot compare it to any other nation, and we cannot copy anyone else. We all blame the state government, but the power is shared. What we lack is priorities, not resources. We need to get higher percentage of investments from GDP.
Dr Dass: First, there needs to be visibility and sharing of resources. Second is predictive AI. Once you have data, predictive AI can cast models on how the situation is going to peak. Third is to build resources. This is the need of the hour and all it takes is government initiative, willingness, and some announcement for everybody to come together on the same page and start sharing.
Sudhir Mishra: The most important step is to have our communication modelled because somehow the message has gone out that no one is in charge. This cannot happen within 15 days of a crisis, no matter what the magnitude is.
Vivek Srivastav: The most important thing is to not panic. This message needs to be communicated. 85% of cases can be treated at home by services like ours. Then there 10% that require oxygen and 5% that are more serious.
Dr Batra: How do you think the media doing when it comes to playing its role?
Sunil Thakur: As far as the panic is concerned now media is creating a hyper panic situation. This time around, people are staying at home, not because somebody on the media told them or the government directive account, it is because of fear.
Dr Dass: I think in every panic situation. I have seen media only portraying and heighten the panic. I have not seen any consistent coherent messages coming. The message is different, what is happening on the ground and what people are seeing is also different. There is no congruence. Right now, the priority is that everyone should get the right message. I know people are angry, but we need to calm down a bit, let the panic go away and see what we can do with the resources.
Dr Velumani: Media has segregated itself between the ruling party and opposing party. There is no news there, there’s only manipulation there. Truth is gone. Transparency is gone. Credible news dissemination is very important in the government websites, our media, televisions or even Twitter.
Sudhir Mishra: What is the normal daily death of this country? I want to know because we keep on hearing this that 2500 which was the number for yesterday. How much I should panic?
Vivek Srivastav: Why do we have a media? Its there to educate. So, educate on the first page, media should tell us what needs to be done and publish the reporting on the second.
Dr Velumani: We lose 5000+ people daily to cancer and tuberculosis. Covid is not the only problem, but we have undue priority for it because there is this fear that it will wipe out humanity. We need to recalibrate and give importance to other things as well.
Sudhir Mishra: Hindi newspapers are far more restrained.
Sunil Thakur: We need to bring the decimal level down in news and give importance to other stories as well. These two things will bring panic down significantly.
Dr Batra: Clearly healthcare needs more investment and the field itself needs to be expanded to include mental health, chronic illness, etc. We need to look at actualising 6% of GDP into healthcare investments. State and central government need to work together. Lastly, the media needs to mindful of reporting balanced information and use this as an opportunity to score political points or shock the readers.
