How Was The Year 2019 For Healthcare Sector

As the New Year begins, all of us look back and think of our personal balance sheets. As we introspect and consider the State of the Nation, in healthcare, we consider the Health of the Nation, because the two are inextricably linked. And when we think about the Health of the Nation – we think about our mission – to being quality healthcare within the grasp of every individual.

Against that backdrop, the past year has been a satisfying one for healthcare in general, and a year of promises kept for Apollo Hospitals in particular.

The headline-making news, of course, was the significant consolidation that the sector witnessed. The earnings multiples and the interest of private equity players we saw in these deals point to the structural demand which is intact for the sector, and to the positive outlook on the sector shared by stakeholders. Having said that, it is important to recognise that all the activity did not lead to new bed creation, especially in cities and districts that need them the most. And that must be our goal for the next 2-3 years – emphasis on quality bed additions which can help us bridge the 1,60,000 bed gap we have for Ayushman Bharat alone, at an infrastructure cost of 40,000 crores. I am sure the private sector will be willing to lead this, as long as we are given certain incentives like low-cost long-term financing, and subsidies for land, which is the most important capital cost.

Another important development that occurred during the year was that the National Medical Council Act was passed. As members of the sector, we are keen that the NMC finds ways to exponentially augment the healthcare skills in the country. Our current doctor density is 0.65 per 1000. In Brazil and China, it's 1.8. To fully serve our population, we will need 100,000 additional doctors every year from now until 2034. Yet, our medical education system only graduates ~ 70,000 doctors per year, so we are adding to the shortfall each year. We also need an additional 300,000 additional nurses every year through 2034, and we need to quadruple the number of paramedics. Given the shortage of jobs and unemployment which is the biggest challenge facing our Government today, this is a golden opportunity for them to work with the private players to build a large pool of healthcare skilled workers, who can not only serve India but can serve the world.

Make in India has been another area of focus where healthcare has played an important role. As healthcare providers, we are mindful of the role that we need to play in balancing the necessity of importing certain devices, drugs and consumables, while also being aware of the need to incubate quality indigenous substitutes, which will spur Make in India, without compromising the quality of care for the patient. We are happy to report that Indian stents today make-up 40% of our mix, a remarkable jump from just 5%, 6 years ago. We can do this across the inputs-value-chain and are committed to doing so.

The year was also the first full year of implementation of Ayushman Bharat (PMJAY), and the program has made good progress as India’s first step towards Universal healthcare. 

Over 11,48,33,583 beneficiaries have been empanelled and 68,37,588 people have availed of treatments under Pradhan Mantri Jan Arogya Yojana. We have stayed engaged with the NHA, as they have rolled the program out. In fact, throughout the year, we have had a sustained dialogue with the policymakers about the effects of trade margin capping, and the rates that were originally announced under Ayushman Bharat. Today, we believe there is an understanding that healthcare as a service is not just the sum of the inputs and consumables – there is an intrinsic value of the service delivery itself that needs to be valued and appreciated.

In the second round of package rates announcements under Ayushman Bharat, we did see some correction, and we are hopeful that we can continue engaging in this dialogue to ensure that most of the secondary care work can be done by the 40,000-50,000 nursing homes in India (under clear quality guidelines), while tertiary/quaternary care players such as us can take up the most complex work.

We all keep hearing that data is the new oil. Especially in health, data can provide remarkable insights and solutions, prognoses, diagnoses and cures that were impossible to imagine even a decade ago. Healthcare providers such as ourselves, are investing a lot of resources into mining the wealth of intelligence that health data can provide, especially focused on the Indian demographic. We could do a lot more, and faster, if we could have a focused R&D incentive, which rewards those companies that invest in finding patterns, markers and cures, and makes data work for India.

Above all, there is prevention. No nation can afford it if its entire population is sick. And the Tsunami of Non-Communicable Diseases or lifestyle diseases as we know them, are going to cost our nation USD 4.5 Trillion by 2030. The only answer is in increasing awareness about healthy living, and in ensuring early screening and detection for large segments of the population for NCDs. Apollo Hospitals is at the forefront of this fight, and we have already completed 20 million preventive health checks, including health checks for each of our employees. Building a healthy India is now our clarion call, and we hope that with the help of other corporates, Health Conscious Individuals and the Government, India will make the leap towards prevention.

As we talk about Universal Healthcare and how it is a long and arduous course to get there, we must not forget that with our population, there are 1.3 billion reasons why things can happen. 1.3 billion minds and hearts that can ideate and find solutions, recognising that in fact, the future is within us.

And if we invoke the infinite and the infinitesimal that lies within, we will soon ensure that in healthcare, we will reach the youngest, the poorest, the weakest with the same agility and efficiency as we reach our privileged. And that’s our collective dream.