The COVID-19 pandemic is an unpleasant reminder of how a strong healthcare system matters for the well-being of a nation’s people and the economy. It would not be an overstatement to say that systems which are structured on value-based approaches are capable of providing affordable and equitable access to health services for all. Today, as countries re-envision healthcare and rebuild economies, there is a unique opportunity for the industry and governments to strengthen healthcare systems by adopting evidence-led interventions.
The Indian landscape
We, as a country, have made significant progress towards improving health indicators. The average life expectancy has increased from 58 to 69 years. In parallel, the loss of Disability Adjusted Life Years (DALY) has also decreased significantly by over 40%. Having served the healthcare ecosystem across developed and developing markets for nearly three decades, I have witnessed the massive impact that improved healthcare has on the productivity of a nation. In fact, this development in India took place in the same period when the Indian GDP growth had been at peak.
In addition, every health parameter has improved in the last decade – reduction in maternal mortality ratio by 60%, infant mortality ratio by 60%, universal immunization coverage has tripled, drop in diseases like TB, Polio, HIV, malaria.
While these outcomes indicate that we are moving in the right direction, our healthcare system remains an area of concern. However, it is also important to understand that, as a nation, we cannot merely duplicate models that are currently available in other countries. We will need to evolve our own systems and solutions which work for our country. Undoubtedly, our investment in healthcare is inadequate, but merely putting in money is not the solution to the problem. The question then is, what can be done?
Strengthening healthcare systems in India
The development and execution of a well laid out comprehensive strategy is of utmost priority as we endeavor to improve the performance of our health systems. With technology that exists today, we have a way to promote the right and expected behaviors in the health delivery system, and to monitor and link them back to corrective actions.
Building on a report by BCG on recommendations, there are some critical interventions from a governance point of view which can have immense multiplier effect on the healthcare system initiatives in our country:
- Revamping Standard Treatment Guidelines (STGs) for India specific requirements- STGs are defined norms and procedures for the diagnosis and treatment of medical conditions. In India, we have well-defined set of STGs for 200+ conditions in 21 clinical specialties that safeguard adherence to quality and ensure appropriate treatment. However, it would be relevant for some of the guidelines to be established as per India specific requirements for the diagnosis and treatment to be based on “home grown” evidence and situations.
Recently, some of the leading medical institutions in India have taken the lead in creating STGs. For instance, The Tata Memorial Hospital has started creating the National Cancer Grid for the treatment of cancer, in consultation with leading oncologists in India and with the participation of 100+ centers.
- Introducing outcome-based measurement in healthcare delivery- With the advent of improved technologies, it has become easier to measure outcomes and track results over a long period of time. Globally, there are many organizations which are now tracking their outcome levels and accordingly undertaking initiatives towards improving the overall success of their interventions. In India, Aravind Eye Hospitals serves as a model example. They have adopted metrics, leveraged cloud-based storage mobile systems, and integrated data collection to improve practice routines. Evidently, this has led to higher productivity and lower treatment costs per surgery.
Linking payouts to outcomes- Globally, a shift towards “value-based reimbursement” is accelerating. There is an increased consensus on the need for a pay model that encourages the delivery of superior value to patients. Novartis in the US, for example, has got into an agreement with a healthcare provider for a heart failure product where the final payment is based on reduction in hospitalization/readmission rate of patients in a hospital. These innovative ways must be improved regularly to refurbish outcomes and reduce the financial linkage between the outcome and treatment costs.
Over time, such an outcome-based measurement system could inform and affect policy and financing decisions.
Efforts like these can improve access to healthcare for Indian patients as well as drive economic growth by enhancing India’s global competitiveness. As we commit to achieving universal health coverage, there is a growing acknowledgement that this cannot be achieved without strengthening our health systems. Clearly, we will need to keep people-centeredness at the core of all decision-making and collectively develop and implement an evidence-based forward-looking strategy to achieve the goal of healthier lives and wellbeing for all.
Sanjay Murdeshwar, Country President and CPO Head, Novartis India
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