A World Bank report states that the Covid-19 pandemic has exposed the limitations of India’s healthcare system. It mentions that the national response system, especially in the wake of natural disasters such as the current pandemic, has proved to be inadequate.

It goes on to highlight the disparity between the quality and access of healthcare services in the country and the lack of adequate focus on fundamental areas such as monitoring, testing and contact tracing.

Another key concern is the high ‘out-of-pocket’ healthcare expenditure in India. This has been cited as a cause that makes millions of citizens fall below the poverty line every year. This economic plight is aggravated by poor insurance coverage and loss of earning capacity due to health problems.

Given the above limitations, the World Bank and other experts believe that the solution to most of these problems is to increase government expenditure on healthcare.

There is no doubt that this would recalibrate the government spending as a percentage of GDP. However, is this alone capable of eliminating all the healthcare problems affecting India, especially in a comparatively short period?

There is enough evidence to believe that pandemics like this don’t give the disease management system adequate time to respond. This leads us to the question: Are there alternative and complementary pathways of healthcare delivery, which will not only deepen the reach but simultaneously be able to offer a standardised quality of care and at an affordable cost?

We are optimistic that there are options. These initiatives will require strategic shifts in the approach to planning and the regulatory framework and acceptance and a shift in the mindset at the policymaking level.

Out of hospital care

This is an alternative yet complementary delivery channel.

The limitations identified are not “isolated problems” but converge and highlight the disconnect between the health needs of the public and the capability of the current institutional care system.

An integrated “Out of Hospital Care (OOHC)” delivery network is the solution to bridge this gap. This framework should have components of care delivery, to not only deepen the reach and deliver a standardised quality of care but also reduce the cost of care — thus addressing all challenges together.

Here are the key components of OOHC.

Home-based care

Home-based care is a core anchor of this OOHC bridge. It has been established that a large number of common ailments can be managed (including clinical consultations/ investigations/treatment/drug prescriptions/patient monitoring) at home. There is also a clear recognition that certain clinical conditions, can and should, only be managed in hospitals. Therein lies the opportunity for a bridge in the care continuum.

Since the imposition of Covid-19 lockdown, people are more comfortable receiving consultation, medication, and diagnostic support remotely. For example, those with chronic diseases or non-emergency cases are being examined and monitored remotely with digitally enabled devices and medication prescribed.

Through well-established clinical protocols, it is also possible to manage “step down intensive care” (respiratory, neuro, chemo infusions, intensive monitoring) at home. Community-based care is also emerging as an acceptable solution to significantly unburden the hospital infrastructure. This direct access to consumers at home/near home, powered through technology, is most suitable for enabling surveillance, testing, contact tracing, and monitoring.

Trained manpower

For at-home care, there is a need for more trained paraclinical personnel (nursing/attendant /physiotherapist). While this is not without associated challenges, there is an inherent opportunity too. Local youth, at a micro-local level, can be trained in paraclinical and soft skills to deliver this service which will open up tremendous employment potential with significant spin-offs.

Healthtech

Healthtech product developers and service providers are crucial participants in the implementation of this alternative channel. For it to be a potent tool, various technology solutions must create a tech-enabled ecosystem to support care delivery.

Enabling framework

Some enablers that can help make out-of-hospital care a successful partner in the government’s initiatives and, bridge the chasms and reduce inequality are:

* Developing a robust “patient triaging protocol”, which should define what services can be provided at the home and what needs to be escalated to a hospital.

* Formulation of disease-specific treatment/patient management protocols by the Health Ministry to ensure patient confidence in the quality and authenticity of the care provided.

* Bringing out-of-hospital care under the cover provided by Insurance companies to help reduce the burden of out-of-pocket expenses and overall cost of home care.

Home-based healthcare has a force multiplier effect both with respect to reducing the separation anxiety caused due to hospitalisation and reducing the commute for patients and doctors.

This makes the process cost-effective and reduces the burden on existing hospital infrastructure thereby enabling governments to prioritise and phase out the investment in new capacity creation.

In the backdrop of the challenges indicated in the World Bank study, adopting “out of hospital care” as part of mainstream care delivery, ushers in a breath of fresh air and hope — a distinct opportunity to expand the reach of quality care and make it more affordable.

Ganesh is the MD and CEO, Portea Medical and Sharma is Board member Portea Medical

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