Covid-19 making private health sector more expensive, tech-reliant, says Dr Prasanna H M

The Covid-19 pandemic has pushed the private medical industry to a crossroads. Costs are rising but not revenue, and on top of this, the industry has recognised that it needs to revamp some of its practices for the 21st century.

Dr Prasanna H M, the president of the Private Hospitals and Nursing Homes Association (PHANA), says the industry is looking to set up centralised databases to allow patient medical histories to be accessed by doctors across hospitals while creating a larger cluster cooperative which would allow hospitals in an area to pool manpower and resources.

On the flip side, a focus on higher technology use will herald a substantial increase in private healthcare costs, PHANA warns. This could further separate the poor from quality private healthcare. As the industry also tries to reconcile with the lessons learned from the pandemic, it grapples with serious holdover problems from the first wave such as profiteering due to governmental loopholes, especially when it comes to biomedical waste disposal and oxygen supply.

How has Covid-19 affected the way private medical industry operates?

There has been a 50% decline of in-person consulting. Doctors are adopting teleconsultation and telemedicine. Secondly, this increased reliance on technology is causing the slow demise of clinical examinations, which is being replaced by technologically-aided medical investigations. For example, the use of CT and MRI scans and blood tests is increasing. Doctors want better diagnosis and less interfacing with patients.

Won’t bringing in advanced technologies increase the general cost of healthcare?

Of course, it will. Not just because of higher tech use, but also because doctors and hospitals have become more focused on hygiene and can no longer accommodate the same load of patients as before the pandemic, due to social-distancing. But salaries and expenditures cannot be reduced. This is placing an increased financial burden on hospital administrators. In the end, that burden will be placed on patients.

Will this trend not potentially make private healthcare unaffordable for masses?

Out-of-pocket costs are rising. It will become difficult for the poor and even for the middle class to access quality healthcare. The situation is setting up a scenario where more people will have to buy insurance and other medical coverage. But in India, insurance penetration is low. In urban areas, it is only about 30%.

India's lack of a centralised medical database with patient histories has been a major stumbling block to accurate diagnosis and better healthcare. Is anything being done to correct this?

A central medical database accessible to all doctors is a major ambition of PHANA. In the US, there are two to three central medical databases which are linked to insurance coverage and companies. Our idea is that data which is available on one platform should be available on another platform when there is an emergency.

This would require a lot of scaling up in associated technologies, presumably?

Yes, we will need more people for data analytics, but also we need procedures to set in place for uniformity in data collection.

During the pandemic, concerns were raised that private hospitals were not coordinating properly. Is that a fair characterisation?

No. As soon as the private sector was brought in to handle Covid-19 patients in June, we adopted cluster management to pool our resources. We did this on a zonal basis. We ourselves called other hospitals to arrange ICU beds. If one hospital had a problem, others shared the load. All of this was done off-hand, without an app being involved. The system worked about 60% to 70% of the time. All hospitals were involved, including a big chain such as Apollo. People put their egos aside.

Some officials lament that the private sector did not get properly involved in the fight against Covid.

I am proud to tell you that once the private sector got involved, we bore the brunt of Covid-19 hospitalisations. Our ICUs took all the government’s critical care cases. The number of people dying in the streets came down. The mortality rate came down. There were initially hiccups, yes.

Have there been improvements since?

We now have a toll-free number to relay, in real time, how many beds are available. PHANA is, however, looking to implement a software which is being used in Delhi for bed allocation.

Is the private medical sector ready for a potential second wave of Covid-19 cases?

Loopholes in government regulations will cause major problems if a second wave ensues. One of the concerns is the price of medical waste management which saw a 700% hike in because the government initially did not fix prices. Through negotiations with waste disposal companies, we reduced the cost of disposal from Rs 75 to 90 to Rs 50.80, which is still five times more than what it was in the pre-pandemic period: Rs 10 to Rs 13. Another problem is oxygen supplies. Operators have found a way around price controls by charging a bigger transportation rate than the cost of the oxygen itself.

What lessons have been learned from the pandemic so far?

We have learned that every rupee is important. We have learned how to cut costs and increase productivity. In the pre-Covid days, most hospitals used to dole out discounts. This has stopped because everybody has been squeezed.