The smart way of providing affordable health care

Affordable quality health care diagnostics must be available to both rural and urban areas (Photo: Amit Verma)

As India’s masses increase in affluence and awareness, they are demanding access to better health care. But the supply of conventionally-delivered health care services cannot hope to keep up with the ever-increasing demand. The clamour for specialists able to address issues beyond what often poorly-trained general practitioners can handle is getting especially loud. To understand the scope of the issue, here are the statistics for selected health care specialists in India vs the US.

The US is widely considered to have a shortage of specialists, as well as a shortage of primary care physicians in rural areas. It has suffered from such shortages for decades. By comparison, India has a super-shortage of specialists, with less than 1 specialist per 1 lakh people. The US vs India ratio in this case ranges from 5x to 25x. While these per capita gaps will narrow over time, it will take many years.

So how are the crores of Indians, who have no access to a specialist, going to get help in the next 10 years? Providing new means of affordable access is no small task. We see five factors that must be addressed: First, services of specialists must not only accessible, but also affordable to both urban and rural India. Indians have a high willingness to pay for quality health care diagnostics that are reasonably affordable. There is growing health care consumer awareness in India, so demand will continue to grow if care is affordable and accessible.

Second, services must be from a trustworthy source. Because of all the quacks and healers here, Indians are generally sceptical unless they can find genuine medical credentials. This is even true of “branded” health care services. People want “board certified” or the equivalent along with references.

Third, convenience is a major factor for consumers. People lead busy lives. If you want to visit a specialist, appointments are hard to get and then you end up waiting in a queue. For many people, this means complicated logistics with family, cost of transport to a specialist facility, and lost income. Getting treated for the simplest of maladies, too, is an expensive investment.

Fourth, providing consultation needs to be convenient for specialists. Most specialists are busy, so to take on new clients, they need a solution which enables them to get more services done in the same time, and/or to make better use of their time when they are between patients or in transit.

Fifth, specialists need to earn money. While motivations vary for specialists, it is fair and right that they get paid for additional services delivered based on the time invested. Ensuring fair remuneration also helps ensure that they pay attention to quality. It must also be reasonably easy for a specialist to reliably receive payment.

Enter the new smart mobile platforms, which are soon going to be ubiquitous. The cost of a basic Android smartphone is now Rs 2,500 and falling. In not too many years, it won’t be possible to purchase a new mobile phone that isn’t a smartphone. India has the cheapest mobile services on the planet. 3G is already available across much of India; there will continue to be a ferocious price war to capitalise on the 3G and 4G spectrum purchased by the mobile carriers. This is all good news for consumers and health care providers. Why? Because, the combo of ubiquitous smartphones and 3G data creates a massive low-cost platform for delivering health care services–the foundation of Telemedicine 3.0.

Mobile platforms are changing the game for diagnostics, creating opportunities for Telemedicine 3.0. Here’s the formula for the future of diagnostics by many specialists: Smartphones, tablets and laptops (bring your own) at health clinic. Connected non-invasive diagnostic devices capture diagnostic and patient info. Phones/tablets connect securely via 3G/4G data to cloud-based apps. Cloud services connect to a network of specialists using smartphones/tablets, ready to provide fast responses.

Here are some of the diagnostic services ready for disruptive growth:

Ophthalmology: Eye screening for disease and refraction issues can now be done by a technician using new low-cost devices such as Forus’ 3netra, routed via mobile networks to ophthalmologists working in their homes, in the back seat of a taxi, or waiting for a flight and diagnosed with a tap on their smartphone. In fact, one of our portfolio companies does exactly this.

Radiology: CT scans, X-rays, ultrasounds can be captured by a technician. The remote radiologists can then view these images along with other relevant patient data wherever they are on their smartphones, tablets or laptops and provide diagnosis. Numerous companies provide this technology today in developed markets, and numerous startups are looking to create low-cost versions of the same in India.

Cardiac care: Today, ECG monitoring devices are primarily sold to health facilities that have a cardiologist in near proximity. If you could easily transmit an ECG image via a smartphone to a group of on-demand cardiologists, you could suddenly put ECG devices in a 100 more places.

Dermatology: Eighty-five percent of skin issues can be fully diagnosed by a dermatologist with a photo taken by a smartphone. From the embarrassing STDs and acne to rashes that don’t go away and other skin issues, there is a huge efficiency to the consumer and the doctor in managing the interactions through a mobile platform.

“Diagnostics as a service”: Disrupting and serving

In the next few years, the traditional model of selling diagnostic devices is going to be replaced with selling “diagnostics as a service”. Rather than paying for a diagnostic device upfront, a health centre will get a no- or-low-cost device installed and a technician trained. This device will be integrated through 3G/4G with a group of quality specialists who can deliver opinions on patient diagnostics within minutes. And the business model will be revenue sharing. This “diagnostics as a service” has the potential to increase the diagnostic device market size in India in magnitude, connect under-utilised specialists with previously-neglected populations, and usher in a much-needed realisation of the long-held vision of telemedicine.