By Prathiba Raju and Abhijeet Singh
Jaipur: Before fully shedding the infamous ‘BIMARU’ tag and reclaiming its lost glory, one of Rajasthan’s greatest challenges remains providing quality healthcare and ensuring its affordable, logistical access to its citizens.
Despite a few promising outcomes in the fifth edition of the National Family Health Survey (NFHS), Rajasthan’s healthcare ecosystem continues to lag in many critical areas. The state’s fourth-place finish from the bottom in the overall health category of NITI Aayog‘s fourth annual health index underscores this reality. However, thanks to entrepreneurial initiatives and policy reforms, Rajasthan’s healthcare sector is regaining momentum and presenting opportunities with bipartisan benefits.
In line with this progress, The Economic Times Rajasthan Business Summit featured a health track that included insightful panel discussions and presentations from key industry leaders. The focus was on embracing innovation and investment to enhance patient care and advance public healthcare in the state.
The health segment of the business summit began with a panel discussion on ‘Reimagining Pharma and Healthcare: Innovations, Challenges, and Future Directions. The panellists included Dr Manashvi Kumar, Joint Secretary, Ministry of Health & Family Welfare, Government of India; Neha Giri, Managing Director, Rajasthan Medical Services Corporation Ltd, Government of Rajasthan; K Raja Bhanu, Director General, Pharmexcil; and Dr Goverdhan Dutt Puri, Executive Director, AIIMS Jodhpur. The session was moderated by Prathiba Raju, Senior Assistant Editor, ETHealthworld.
Initiating the discussion with his remarks, Dr Manashvi Kumar briefed about the existing policy outlook and stressed that, “It is very important to focus on infection, prevention and control and we (MoHFW) have tried to weave our sister entity Depart of Health Research (DHR) and the Department of Pharma to create a right impetus of vaccines, drugs, diagnostics therapeutics.”
“We should work with a concerted effort to bring the right elements which actually address the social determinants of health rather than the economic ones,” he added.
Commenting over the state government’s Right to Health Act which was followed by a state wide protest by private healthcare practitioners Dr Kumar outrightly supported the policy and embraced it by voicing, “That every state government should start thinking on these progressive lines. The state of Rajasthan has gone a way beyond which is extremely important… The right to health is somehow embedded in the right to life.”
“We (bureaucrats) have difficulties when it comes to negotiating or navigating when the central sponsored schemes are pushed through the state and the priorities definitely vary from state to state… but the priorities of centre and state must match to make the kind of dent that we are supposed to make in the domain of public health,” he added.
Covering the pharmaceutical segment K Raja Bhanu said, “By 2030 the size of Indian pharmaceutical sector should reach USD 120-130 billion with USD 60 billion expected to be contributed by exports… but most of the drugs which we are exporting are of generic category so the states which are gearing up in this area have to take this as an important consideration to analyse that if there pharma sector can grow to this level and produce the required quantity. There are other spaces which we have to target such as biosimilars, biopharmaceuticals, complex generics, gene therapy etc.”
He further said that, “States like Rajasthan can consider this industry which can gear up and try to grab the opportunity by manufacturing such products and given their strategic advantage of sharing borders with six states, availability of required infrastructure and proximity to the ports of Gujarat the state can take advantage in the existing market.”
For achieving sustainable growth in the pharma sector in the state, Bhanu emphasised to focus on establishing a network of bulk drug parks and promoting investment for ensuring stability in both manufacturing and exports of drugs.
Speaking over the Mukhyamantri Nishulk Dava Yojna (MSDK) (a state scheme to provide free of cost drugs to patients), Giri stated that with more than one crore people living below poverty line… schemes like MSDK tries to take out the financial burden faced by the common people and with time we are also seeing that the total number of beneficiaries have also grown… Slowly and steadily the focus has shifted towards more critical care drugs. We obtain feedback from the industry and associated stakeholders to update our list and try to provide the drugs to various medical institutions as per the demand.”
Over the inclusion of digital solutions in healthcare such as e-prescriptions, Dr Goverdhan Dutt Puri said, “Initiatives like ABHA (Ayushman Bharat Health Account) have made it possible to use the data and are progressing positively… the process which is being initiated at these central institutes if these can be implemented in other institutes will rationalise the use of drugs such as those in the schedule H (antibiotics) and schedule X (psychotropic) and will also help to over the challenge of drug resistant emerging through the overuse of antibiotics.”
“On the way of initiating the use of technology as a daily practice there are hurdles but if the government puts up some schedule on how to go ahead step by step will help to gather massive data which can greatly help in both patient care and future policy planning,” the expert added.
The panel discussion was followed by a trialogue on, ‘Ensuring Health Assurance for All: Strategies to Achieve Universal Healthcare Coverage by Public Private Partnership’. The speakers for the session included Dr Rakesh Shah, Cluster Head, Shalby Hospitals; Sandhya Sriram, Group CFO, Narayana Health; and the session was moderated by Dr Harsh Mahajan, Founder & Chief Radiologist, Mahajan Imaging & Labs.
Giving her opening remarks over the possibility of PPP models in healthcare Sandhya Sriram, flagged the problem of scaling PPP models which driven by CSR funds, said,” The next level of PPP’s where the healthcare institutions participating in government schemes which works on cross subsidisation model where sometimes they recover the variable cost and sometimes don’t which eventually transfer the burdens on rest of the patients who don’t come under the schemes. So the survival of healthcare entities becomes difficult at the rates these schemes operate and it is very difficult to create a business model through this.”
Adding to her remarks, another speaker, Dr Shah stressed, “There are two major challenges, one is affordability and second is access. For making the PPP model a success we need to create an ecosystem wherein both the parties get benefitted but CSR can’t help to scale the model anywhere… To provide quality healthcare under centre and state government schemes is a challenge.”
Over the ongoing argument of where the government should subsidise the premium or the patient should fully contribute based on their paying capacity
Responding to the question raised by Dr Mahajan is insurance the only way to achieve Universal Health Coverage (UHC) giving its fiscal burden which may not be sustainable for a private hospital, Sriram said, “For our country which is operating at a tax to GDP ratio of 11 per cent I don’t think its affordable no matter the vision of our country to create a universal health platform and with the current model used for Budgetary allocations in that kind of model the hospitals will always have to work in certain kind of mix but it is very difficult the balance the cost of realisation and cost of running the hospitals.”
“We have to create a health insurance model based on a low cost premium which can be achieved by eliminating the cost of mistrust in the ecosystem because today there are a lot of contradictory incentives, lack of transparency and hidden agenda leading to loss of trust between the insurance provider, patient and hospitals,” she added.
Contributing to the discussion the moderator Dr Mahajan said, “Relatively in our neighboring region India is the cheapest quality healthcare destination in the world and we are 20-25 per cent cheaper than them. However, there is a limit to which we can go down in cost and even at these low costs affordability of our population is a problem so health insurance schemes can help in that its about two per cent of the insured who actually seek inpatient care and the rest of the population is defraying those costs.”
“The government needs to work out the actual scientific cost in collaboration with the private sector, and then determine the prices of its various healthcare schemes, ” he concluded.
Following the panel discussion on ‘Ensuring Health Assurance for All: Strategies to Achieve Universal Healthcare Coverage by Public Private Partnership’ there was a fireside chat on ‘Digital Health Interventions and Lasting Impact at the Grassroots Level: Challenges and Opportunities’, featuring Dr Sarvesh Agarwal, CEO & Vice President, Rajasthan Hospital. The session was moderated by Prathiba Raju, Senior Assistant Editor, ETHealthworld.
Initiating with his opening comments on the impact of digital technologies like AI, tele-medicine etc on rural healthcare Dr Sarvesh Agarwal voiced that the entire technology revolution was meant to provide access to these peripheral areas.. On similar lines we should focus on how the AI revolution can enable mass prevention and screening programmes … in a country like India it could be a game changer.”
“When it comes to tele-medicine, its adoption rate escalated during covid but post that it is halted because we are looking toward very high specialised care through tele-medicine which is probably not the right way of doing things and we have to look at it from the primary level. This would help reduce the load on government setups, making the process more feasible and can also decrease the economic expense that comes out from it,” he added.
Dr Agarwal flagged that most of the PPPs are forced at the higher part of the healthcare chain and suggested bringing such efforts towards primary healthcare centres which in turn can act as a central hub.. that’s how we can appropriately utilise the digital infrastructure and can make a targeted impact at the grassroot level.”
The expert also shared three possible reasons behind the unwillings of private hospitals to participate in government run schemes, where he cited, there is a lack of trust on both ends (government and hospitals), secondly frequent policy changes leading to uncertainty for private players and thirdly the fear of losing the sanctity of data because of the methods employed to transfer and share data by government set ups. The health segment of the business Summit concluded with this fireside chat.
