Context

India needs to tap the potential of the health-care start-ups in India and make the necessary provision to deal with the problems in the adoption of innovations in health-care.

Expanding the supply side

• Need to increase the hospital empanelled: As the scale of this scheme grows, a key area of focus is-
  • To expand the secondary and tertiary hospitals empanelled under PM-JAY and
  • To ensure their quality and capacity while keeping the costs down.
• The ratio of doctors and beds: At present, there is one government bed for every 1,844 patients and one doctor for every 11,082 patients.
• 3% hospitalisation under the scheme: In the coming years, considering 3% hospitalisation of PM-JAY-covered beneficiaries, the scheme is likely to provide treatment to 1.5 crore patients annually.
  • This means physical and human infrastructure capacity would need to be augmented vastly.
• Need for more beds: Conservative estimates suggest that we would need more than 150,000 additional beds, especially in Tier-2 and -3 cities.
• Long-term strategy: While a comprehensive long-term strategy will focus on expanding hospital and human resources infrastructure, an effective near-term approach is needed to improve efficiencies and bridge gaps within the existing supply and likely demand.
• Mainstreaming innovation: A strong, yet under-tapped lever for accelerating health system efficiency and bridging these gaps is mainstreaming innovation in the Indian health system.

Transformative solutions

• India’s burgeoning entrepreneurial spirit combined with a systematic push for the development of a start-up ecosystem has led to a plethora of innovations in health care.
• It is estimated that there are more than 4,000 health-care technology start-ups in India.
• How do start-ups help? Today, start-ups are working to bring-
  • Innovative technologies and business models that leapfrog infrastructure.
  • Human resources.
  • Cost-effectiveness and efficiency challenges in Tier-2 and -3 cities.
• How other innovations could help?
  • Artificial Intelligence platforms that aid in rapid radiology diagnoses in low resource settings.
  • Tele-ICU platforms to bridge the gap in high-skilled critical care personnel.
  • Centralised drone delivery of blood, medicines and vaccines to reach remote locations cost-effectively and reliably are all no longer just theoretical ideas.
• Time to implement transformative solutions: It is high time for transformative solutions to make their way into our hospitals, especially in Tier-2 and -3 cities, to turbocharge the way health care is delivered at scale.

Challenges in mainstreaming healthcare innovations

• Lack of uniform regulatory standards: One challenge is non-uniform regulatory and validation standards.
  • Regulations evolving in India: Regulatory requirements, specifically for biomedical start-ups, are still evolving in India.
  • As a result, hospitals often rely on foreign regulatory certifications such as FDA and CE, especially for riskier devices and instruments.
  • Government to overhaul standards: The government is now pushing ahead to overhaul Indian med-tech regulatory standards and product standards which will help bridge this trust-deficit.
• Difficulty in the promotion of start-ups: Another problem in promoting start-ups is the operational liquidity crunch due to a long gestation period.
  • Health-care start-ups spend long periods of time in the early development of their product, especially where potential clinical risks are concerned.
  • Long gestation period: The process of testing the idea and working prototype, receiving certifications, performing clinical and commercial validations, and raising funds, in a low-trust and unstructured environment makes the gestational period unusually long thereby limiting the operational liquidity of the start-up.
• Lack of framework to adopt innovation: Another hurdle is the lack of incentives and adequate frameworks to grade and adopt innovations.
  • Health-care providers and clinicians, given limited bandwidth, often lack the incentives, operational capacity, and frameworks necessary to consider and adopt innovations.
  • This leads to limited traction for start-ups promoting innovative solutions.
• Procurement challenges: Start-ups also face procurement challenges in both public and private procurement.
  • They lack the financial capacity to deal with lengthy tenders and the roundabout process of price discovery.
  • Private procurement is complicated by the presence of a fragmented customer base and limited systematic channels for distribution.

Way forward

• Identify promising market-ready products: To accelerate the process of mainstreaming innovations within the hospital system in India-
  • We need to focus on identifying promising market-ready health-care innovations that are ready to be tested and deployed at scale.
• Facilitate standard operational validation studies: There is a need to-
  • Facilitate standardised operational validation studies that are required for market adoption.
  • To help ease out the start-up procurement process such that these solutions can be adopted with confidence.
  • This, in effect, will serve the entire ecosystem of health-care innovators by opening up health-care markets for all.
• Need to develop an interface between hospital and start-ups: A strong theme in mature health-care systems in other parts of the world is a vibrant and seamless interface between hospitals and health-care start-ups.
  • Through Ayushman Bharat, India has the unique opportunity to develop a robust ecosystem where-
  • Hospitals actively engage with health-care start-ups by providing access to testbeds, communicating their needs effectively and adopting promising innovations.
  • Start-ups as collaborators: Start-ups can be effective collaborators for the most pressing health-care delivery challenges faced by hospitals.

Conclusion

The dream of an accessible, affordable and high-quality health-care system for all, will be achieved when we work in alignment to complement each other and jointly undertake the mission of creating an Ayushman Bharat.

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