Emerging Paradigms in Healthcare - Krishna Giri, Health & Public Services, Accenture


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Emerging Paradigms in Healthcare - Krishna Giri, Health & Public Services, Accenture

  1. 1. Emerging Paradigms in Healthcare Krishna Giri Managing Director, H&PS, Accenture 15th Nov 2012 eindia.eletsonline.com
  2. 2. India Statistics – Source: Who.Int / National Commission on Macroeconomics and Health(NCMH)Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 2
  3. 3. India: Health & Development - 01 Total population (2011) 1.21 billion % Under 15 31 (2010) Life expectancy at birth (male/female) in years 63 / 66 (2009) Under-5 mortality rate per 1000 59 (2010) Maternal mortality rate per 100 000 live births 212 (2007-09) Total expenditure on health as % of GDP 4.2 (2009) General government expenditure on health as % of general 4.2 (2009) government Expenditure Human Development Index Rank, out of 187Countries 134 (2011) Effective literacy rate 74.04 (2011) % population with access to improved drinking water source 92 (2010) % population with improved access to Sanitation 34 (2010)Source: Census of India 2011; World Health Statistics 2012; India Country Report 2011Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 3
  4. 4. The Government has initiated major interventions toimprove the healthcare ecosystem in the country • Aims to provide quality healthcare for all National Rural Health • Increase expenditure on Healthcare from 0.9% Mission (NRHM) of GDP to 2-3 % by 2012 Health & Family Welfare • Budget for Ministry of Health & Family Welfare increased from USD 4.2 Bn in 2009-10 to USD Budget 5.6 Bn in 2011-12 • USD 1.23 Bn for six upcoming AIIMS- like institutions Tertiary Hospitals • Up-gradation of 13 existing Government Medical CollegesCopyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 4
  5. 5. India still has significant inequities in health serviceutilization and mortality Births attended by skilled DTP3 Immunization (1 year Under Five Mortality Rates health personnel olds) 82% 89% 116 69% 73% 93 51% 6037% 34% 39 19%Rural Urban Poorest Wealthiest Rural Urban Poorest Wealthiest Rural Urban Poorest Wealthiest 20% 20% 20% 20% 20% 20% Source: WHO Country Report 2012 (Data 2010)Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 5
  6. 6. India presents a unique mix of disease burden, whichis dual in nature Estimated Causes of Death - India Diabetes 2% Other Chronic Respiratory Chronic Disease Diseases 7% 8% Cluster 1: Lifestyle Cluster 2: Infections Diseases Cancer Communicable & & Deficiencies 8% Nutritional Dieseases 36% Cardiovascular Disease 28% Injuries 11%Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 6
  7. 7. Majority of Healthcare Spend in India is out-of pocket, withextremely limited insurance coverage, however, insurancepenetration is expected to increase Healthcare Financing 2% 2% 1% 100% 12% 3% 80% Out of Pocket State Insurance Local Center Social Total Healthcare Financing Health Insurance Penetration 2008 2013ECopyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com Source: „Emerging Trends in Healthcare‟ – ASSOCHAM 2011 7
  8. 8. However, India has a mixed record in publichealth indicators, both in comparison to Globaland Regional AveragesGlobal Averages are affected to a large extent due to factors from Sub-Saharan Africa 800 300 300 256 278 212 209 200 200 210 176 178 63 64 66 66 67 71 63 57 57 Life Expectancy at Life Expectancy at UFMR AMR MMR HIV Prevalence Tuberculosis Birth (Male) Birth (Female) Prevalence India Regional Average Global Average • UFMR : Under 5 Mortality Rate • AMR: Adult Mortality Rate (Probability of death between 15 & 60 years of age, per 1000 population • MMR: Maternal Mortality Ratio (per 100,000 live births) • HIV prevalence per 100,000 adults aged 15-49 • Tuberculosis Prevalence per 100,000 population All Data Source: WHO 2010Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 8
  9. 9. GDP & Healthcare Expenditures GDP vs. Healthcare cost per capita 9 US 8 7 6 5 Healthcare cost per United States-US capita ($000) FR 4 United Kingdom-UK UK France-FR 3 JP India-IN 2 China-CN Japan-JP 1 CN Average IN 0 0 10 20 30 40 50 60Notes: GDP per capita ($000)1. Source: OECD, Accenture analysis2. GDP, 2010, constant currency3. Healthcare 2010, $, PPP4. Statistical outliers excluded (Norway, Switzerland, Luxemburg, Turkey) Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 9
  10. 10. The spending on Healthcare in India is significantlylower in comparison to major G20 countries, and isdominated by the private sector Health Spending as % of GDP Comparison of Health Sector Spend 15.7% 81.7% 73.8% 58.4% 59.6% 55.3% 54.5% 9.7% 45.5% 8.4% 8.4% 44.7% 41.6% 40.4% 26.2% 4.3% 4.1% 18.3% China Brazil India USA UK Global China Brazil India USA UK Global Per Capita Health Spend (US$) Per Capita (PPP) Health Spending (US$) 7285 7285 3867 2992 606 802 837 863 108 40 233 109 China Brazil India USA UK Global China Brazil India USA UK Global Source: „Emerging Trends in Healthcare‟ –Copyright © 2012 Accenture. All rights reserved. ASSOCHAM 2011 eindia.eletsonline.com 10
  11. 11. India: Health & Development - 02 Challenges Opportunities 1. The “unfinished agenda” of health system 1. Policy driven healthcare service and health modernization including high out-of-pocket insurance. expenditures, insufficiency and uneven 2. Using economic development to pull millions distribution of staff, service provision of people out of poverty by creation of (overwhelmingly in private hands) and its employment, providing water and sanitation. quality, and a better alignment of regulation 3. Supporting countries that see India as a with present day needs reference through South–South cooperation. 2. Need for expediting progress toward 4. Facing the emergence of “consumerism” by achieving Millennium Development Goals opening a new era of service (MDGs) 4 and 5 (child health, under-nutrition responsiveness. and gender equity problems) 5. ICT initiatives that enable better healthcare 3. High burden of disease (BoD), even though and health insurance important progress has been achieved with 6. Technological advancement by research some diseases (medical schools, research institutes, etc) 4. Change in the epidemiological profile, with 7. Strengthening of Pharmaceutical sector emergence of cardiovascular and including drug regulatory capacity, trade and cerebrovascular diseases, metabolic health. diseases, cancer and mental illnesses as 8. Accrediting service delivery institutions. first order problems while tuberculosis, acquired immunodeficiency syndrome, water-borne 5. diseases and sexually transmitted diseases remain frequentCopyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 11
  12. 12. Issues Impacting Healthcare Worldwide Affordability Accessibility QualityCopyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 12
  13. 13. Necessity, Opportunity & Leapfrogging Necessity breeds innovation Countries with increasing costs and low wealth have no choice but to find faster, better and cheaper ways to deliver quality healthcare to their people Emerging market advantage Countries with weak infrastructure, healthcare institutions and fewer unskilled resources face fewer constraints Innovation Leapfrog As with other industries, many countries are positioned to leapfrog Western models of healthcare provision Notes: 1. Source: Kaiser PermanenteCopyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 13
  14. 14. Balancing a Multi-medicine Healthcare Ecosystem  Over 2,700 institutions with over 52,000 beds  Over 5,400 sub centres under Directorate of Health Services  Medical services provided through co-operative sector as well, 74 hospitals with over 6,700 beds India Healthcare  Telemedicine Network consists of 245 Hospitals – 205 Demographics Rural/District Hospital /Health Centre connected to 40 Super Specialty Hospital located in the major cities – 250,000 patients treated Allopathy Ayurveda Homeopathy 46% of infrastructure 32% of infrastructure 21% of infrastructureOver 1,250 institutions and 119 Hospitals and 745 Over 550 dispensaries and37,000 beds including dispensaries, 900 small to 30 hospitals with totalPrimary and Community medium size private strength of ~1,000 bedsHealth hospitals, over 15 AyurvedaCentres, Taluk, District and medical colleges , InSpecialty hospitals total, close to 3,000 beds in the state Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 14
  15. 15. There are several examples of Public Private Partnerships to tackle health challenges at both the central and state level• Universal Immunization Program • Contracting („in‟ and „out‟)• Epidemic Control (H1N1, HIV etc.)• Karnataka Karuna Trust: Yeshaswini Scheme • Joint Ventures• Karnataka Integrated Tele-medicine & Tele- • Build/ Rehabilitate, Operate, Transfer health, Chamrajnagar• Tamil Nadu Mobile Health Services • Health Financing• Andhra Pradesh Arogyashri (Vouchers, CBHI, Illness fund)• Andhra Pradesh Diagnostic Services for 4 medical colleges • Mobile Health Units• West Bengal Mobile Health Services• Madhya Pradesh Community Outreach • Franchising Healthcare program• Rajasthan Contracting in Public Hospitals • Social Marketing• Gujarat Chiranjeevi Project• Uttaranchal Mobile Health and Research Clinic • Technology demos (e.g. Telemedicine)• Call 108: Hyderabad/ Ahmedabad. • Public-Private Mix Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 15
  16. 16. Other Emerging Trends in the Health Sector in India• Audit of Foreign Direct Investment (FDI) • Skill upgradation & Capacity Building• Health Sector Policy • Health-IT Policy • Awareness Campaigns • PPP Health sector Strategy • Regional Diagnostic Centres- • Etc. Hub/Spoke• Shift from Communicable to Lifestyle Diseases• Expansion of Modern Healthcare to tier II & • Medicity III cities• Management Contracts for hospitals • Co-location of Specialty services• Technological Advancement (Emergence of telemedicine) • District Hospital + Medical College• Increasing focus on HMIS (Hub)• Increased ICT usage at the grassroots level• Better Infrastructure for healthy India • Franchised /Accredited Health Units• Better healthcare insurance• Healthcare for Aam Aadmi based on Research • RBF – Incentive Contracts Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 16
  17. 17. Current Issues to be discussed….1 Isolated ICT initiatives across Different States, Private and Public Hospitals and Health Departments2 The demand for health insurance coverage and supply of healthcare services are not in sync, which impedes the realization of the sector‟s potential for growth.3 Lack of information sharing between the Health Institutions for effective delivery of Services4 No Interoperability of Systems and lack on connectivity between Health Institutions5 Capacity building needs of the Medical Professional in ICT and e-Health Requirements6 Lack of funding for ICT initiatives in the Health Sector7 Comprehensive network of outreach workers, however need for ICT tools for effectively monitoring the activities8 Linking of the past history of clinical tests/results not available Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 17
  18. 18. Focus on Citizen Facing Services …1 Providing Health Facilities to Citizens in his locality and in a cost–effective manner2 Providing accurate results on the medical tests conducted3 Providing secured access to Clinical records through ICT tools4 Innovative and Incentive Health Insurance Packages to increase the coverage in rural areas5 Providing advise/treatment of qualified doctors to remote/rural areas through ICT tools6 Easy Access and Availability to the beneficiaries of the Health related schemes such as RSBY, JSY, MCH etc.7 Empowerment of Outreach workers( ASHA, others) with ICT tools to be able to support the rural sector onsite with valuable health related information8 Awareness of the Health Related Schemes, Hospitals, Doctors etc to enable the citizen to avail the services faster Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 18
  19. 19. Relevant Innovation Themes Connectedness – Increasing role of technology • 1 patient – 1 record • Mobility • Remote monitoring – linked to interventions • Tele-medicine Smart delivery & infrastructure • Fewer high-cost hospitals • More low-cost clinics • Increased home/remote healthcare – requires remote monitoring Focus on big cost drivers • The 1%, 5% & 10% • Co-morbidity & chronic conditions Regulation and oversight • Introduce guidelines and regulations that promote unification of India‟s three forms of medicine • Create incentives for biotech, pharmaceutical and medical companiesCopyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 19
  20. 20. Way Forward Agenda 2020 for the Health Sector comprises of four broad focus areas Health Service Healthcare Healthcare Metrics Investment Focus Delivery Infrastructure• Reduction in the • Increasing • Improvement of • Create incentives incidence of linkages and capacity and for lifestyle improving capabilities at biotech, biophar diseases, commu referral systems government ma, and nicable diseases health facilities biomedical and mental • Ensuring quality companies illnesses of care and • Improved patient safety provision of • Create guidelines• Reduction of through healthcare for and regulations mortality and accreditation the for the Ayurveda morbidity, IMR, elderly, women industry MMR • Medical and children education • Improve market training, for the wellness, tourism industries Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 20
  21. 21. Accenture Recommendations Goal 1: Steps to achieve Universal access to Quality Healthcare Enhancing Public Engage Private Sector Re-engineering of Quality Assurance Private Partnership for imparting quality existing public services through Accreditation (PPP) health services Goal II: Enabling Data Driven Healthcare Provision Strengthening and Leveraging Mobile Leveraging Electronic Increase the practice of Reinforcing use of health for efficient Medical Records (EMR) Evidence Based HMIS healthcare delivery Medicine in Public Health Analytics (Increase Use -- -- -- of Surveillance data for decision making) Goal III: Architectural Correction of Healthcare Services Evolving new Delivery Innovations in Augmentation of Supply chain and Models in Healthcare governance (exploring Health Personnel distribution system in option of e- healthcare Governance)Copyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 21
  22. 22. Accenture Recommendations: India Public healthcareWay Forward with Strategic change HorizonsCopyright © 2012 Accenture. All rights reserved. eindia.eletsonline.com 22
  23. 23. Thank You eindia.eletsonline.com