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Published on: March 30, 2022, 11 a.m.
Let’s focus on total health
  • Concerted efforts by the public and private sectors can bring about remarkable improvements in three key areas: Access, Affordability, and Quality

By Dr. Suneeta Reddy. The author is Managing Director, Apollo Hospitals

In 2019, the United States Business Roundtable changed its over-arching principle from being centred on shareholder primacy, to explicitly defining that the purpose of corporations is to benefit all stakeholders – customers, employees, suppliers, communities, and shareholders. This change affirms the role corporations can play in improving our society and sets the bar for a modern standard of corporate governance.

With the evolution and momentum of ESG frameworks and assessments around the globe, corporations are increasingly devoting attention to these themes. This is an acknowledgement of the fact that responsible corporations can play a pivotal role in achieving social, environmental and equity goals, thereby contributing to the UN SDGs in a significant way.

Health and well-being: With specific reference to my area of interest – Health and well-being, there is no doubt that concerted efforts by the public and private sectors can bring about remarkable improvements in three key areas: Access, Affordability, and Quality. I wish to share some illustrative examples of how Apollo Hospitals has worked towards these goals.

Access: Apollo Hospitals established a tele-medicine programme in India as early as the year 2000. We currently have over 700 installations around India and the world, and this enables convenient access to specialist care. Specialised solutions like Tele-Emergency, Tele-Radiology, Tele-Cardiology, Tele-Condition Management have evolved, and are currently deployed in urban and rural Public Health Centres in several states, empowering remotely located patients. 

Affordability: In a country where over 67 per cent of healthcare spending is out-of-pocket, affordable healthcare is a priority. At Apollo Hospitals, offering a range of bed categories from the standard bed to semi-sharing, twin-sharing is an effort to make high-quality care affordable to larger sections of society. In addition, the cost of treatment and hospitalisation is transparently communicated to patients prior to any scheduled procedures through Assured Pricing Plans with the help of financial counsellors.

However, there is a cost to deliver quality healthcare in a financially sustainable way, whether in the private or public sector. Alongside, there is a pressing imperative to solve the barrier of affordability. The only way these two imperatives can be bridged is by building a strong programme for Health Insurance. This can be accomplished by a combination of initiatives. The government has already announced a meaningful family cover for around 50 crore beneficiaries under the Ayushman Bharat programme. However, we still confront the problem of the ‘Missing Middle’ in a country where private health insurance penetration is in the low single-digits. 

As next steps, we could consider the following steps in a phased/stratified way: (a) Employees in the organised sector should be mandated to be covered by the employer under an attractive Group Insurance scheme

(b) Professionals such as Lawyers, Doctors, Chartered Accountants, Architects, etc., should be mandated to obtain health insurance cover for themselves and their dependents

(c) Affordable Insurance Policy for elders (aged 55 and above) to cover specific health risks arising from vulnerabilities of old age such as Parkinson’s, Alzheimer’s, Incontinence, Vertigo, Osteoporosis (among women). These steps will create the change in behaviour among healthcare consumers and will create sufficient risk pooling for insurers. This can help in eventually making Universal Health Insurance a reality.

Addressing the burden of NCDs: We must not forget the key challenge of Non-Communicable Diseases (NCD) that the world, and India faces over the next decade. These lifestyle diseases are developing rapidly and have grown to be 55 per cent of the disease burden of India currently. Disturbingly, they are affecting people in increasingly younger age groups, and resulting in deaths as early as age 30. The answer to this challenge lies in widespread awareness, prevention, screening, and early detection. As much as 80 per cent of NCD deaths are preventable, and we must make it our mission to do so.

In partnership with Microsoft, Apollo Hospitals has launched an AI-powered Cardiac Risk Assessment as part of our preventive health programme, by which risk of cardiac disease is predicted early on, and the individual can be supported to reverse the risk through lifestyle and behaviour modifications.

The Central government is piloting comprehensive health and wellness centres, and eventually aims to set up 1,50,000 of them. This is a pivotal initiative in taking population health to the last mile, and in ensuring that over time, disease burdens are controlled, with early intervention. This is another area where corporates can play a significant role, by adopting several centres under their CSR budgets. 

Caring for the elderly: We have a duty to care for our elderly – India’s geriatric population is growing at a fast rate and is expected to touch 194 million by 2031. As a responsible society, it is imperative that we sow the seeds of a social safety net for them now, which includes high-quality healthcare, in addition to dignified retired living options.

Total health - A model for happiness: Total Health is Apollo Hospitals’ flagship CSR initiative, in Aragonda, Chittoor District, Andhra Pradesh. Chairman Dr Reddy’s dream was to organically build a model of care in his native village, that extended from cradle to grave, and which also holistically addressed social determinants of health including nutrition, sanitation, water, education and livelihood, fitness, etc., as a model for the world. 

Over 1,20,000 persons have availed clinical services under the programme. Their health records are integrated and digitised. Six nutrition centres provide nutritious meals to all expecting mothers. This intervention has ensured that there is zero Maternal Mortality and Infant Mortality in the area in the last two years, a complete reversal from worrying statistics earlier.

Over 5,000 women were screened for cancers of cervix and breast. Of these, 17 cases were diagnosed early, and successfully cured through surgical intervention free of cost. More than 500 women have been trained in areas of social entrepreneurship and are earning around Rs8,000 per month. All children attend school, and young adults are encouraged to participate in sports.

The model is now mature, is capable of replication across districts, and can work well in a public-private partnership model. The model is being used as a teaching case study by the Harvard School of Public Health.

Health and economy inextricably intertwined: While those of us in the healthcare sector have always been cognizant of the importance of health for the health of the economy, it took a once-in-a-lifetime pandemic for the broader collective to truly understand what health means for the economy. 

In addition to creating meaningful, skilled jobs, the health sector keeps the country’s workforce productive and engaged. And when healthcare infrastructure is inadequate, or the manpower is stretched or unaffordable, it creates ripple effects in terms of impact on individual families, on corporations and on local, regional and national economies.

To build this infrastructure, and the skilled healthcare workforce, we need investments in the sector at levels much higher than the historical range of 1-1.5 per cent of GDP.

Winston Churchill said, “Never let a good crisis go to waste”. Perhaps one positive outcome of the shared experience of the last 20 months will be the acknowledgement of the primacy of health, and thoughtful investments in healthcare, both on the public spending, and private side. If building a $5 trillion economy is a stated vision for our country, then surely health must occupy centre stage in those plans. 

Building a healthier tomorrow: Disease is not personal. It is a systemic problem requiring holistic solutions. Building a healthier India is a joint responsibility – private players and individual members of the public should work in synchrony with the Government. All our efforts should be towards ensuring participation of a new set of consumers who were previously ignored or completely shut out. 

Margaret Mead once said, “Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.” We must be that group.

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