MEDICAL DEVICE DEVELOPMENT

ASSIGNMENT-5: HEALTHCARE DELIVERY

1. Define Healthcare industry in India.

Healthcare industry in India comprises of hospitals, medical devices, clinical trials,
outsourcing, telemedicine, medical tourism, health insurance, and medical equipment. The
healthcare sector is growing at a tremendous pace owing to its strengthening coverage,
services, and increasing expenditure by public as well private players.

2. Healthcare Delivery Infrastructure of India

• Under  National Health Mission (NHM), Financial support is provided to States to
strengthen the public health system including upgradation of existing or construction of new
infrastructure.

• Under NHM high focus states can spend upto 33% and other States upto 25% of their NHM
funds on infrastructure.

• The population Norms for setting up of public health facilities are as under :

o Sub Centre: 1 per 5,000 population in general areas and 1 per 3,000 population in
difficult/tribal and hilly areas
o Primary Health Centre: 1 per 30,000 population in general areas and 1 per 20,000 population
in difficult/tribal and hilly areas
o Community Health Centre: 1 per 1,20,000 population in general areas and 1 per 80,000
population in difficult/tribal and hilly areas. 

• A new norm has also been adopted for setting up a SHC based on ‘time to care’ within 30
minutes by walk from a habitation has been adopted for selected district of hilly and Desert
areas.

• It has also been decided to strengthen Sub-Health Centres based on 'time to care' within
minutes by walk from habitations has been adopted in selected districts of hilly States and
desert areas.

• As per the Rural Health Statistics (RHS) 2020, as on 31.3.2020 the status of public health
facilities function in the Country is as under:

  o 1,57,921 Sub Centres (SCs),

  o 30,813 Primary Health Centres (PHCs),

  o 5,649 Community Health Centres (CHCs),

  o 1193 Sub-divisional Hospitals (SDHs) & 810 Districts Hospitals (DH) in the country

• There is  a shortfall of 46140 SCs (24%), 9231 PHCs (29%) and 3002 CHCs (38%) across the
country as per the Rural Health Statistics (RHS) 2020. 

• First Referral Units (FRU) provides comprehensive obstetric care services including like
cesarean section,  newborn care,emergency care of sick children, full range of  family
planning services, safe abortion services treatment of STI/RTI availability of blood storage
unit and referral transport services. Number of FRUs has increased significantly from 940 in
2005 to  2996 in 2020 (upto 31.12.2020).

• There are 10453 PHCs that are operational as 24X7 facilities as on 31.12.2020. 

3. Gaps in Healthcare in India

The gaps in healthcare in India include the following

Lack of infrastructure

The epidemic showed that the Indian healthcare system is not ready for any
catastrophic events similar to COVID. The government’s spending on healthcare, the
gap in demand and supply, and chronic shortages are some of the concerns that need
urgent attention. Data suggests that India has 1.4 beds per 1,000 people, 1 doctor per
1,445 people, and 1.7 nurses per 1,000 people.

The disparity in the Rural-Urban healthcare system

Over 75% of the healthcare infrastructure is concentrated in metro cities, where only
27% of the total population resides—the rest 73% of the Indian population lack even
basic medical facilities. The primary medical centers are lacking over 3,000 doctors and
in the last decade, the shortage has increased by ~200%. Quality healthcare treatment
can be found in the urban areas but often the person from a rural part of the country
cannot afford to come to the metro cities for the treatment.

Lack of trained and skilled resources

One of the most critical concerns is the gap in the doctor-patient ratio. According to the
Indian Journal of Public Health India needs 2070000 doctors by 2030. However, a
doctor in the government hospital attends to ~11000 patients, which is more than the
WHO recommendation of 1:1000.

Expensive healthcare treatment

Medical procedures similar to cancer treatment, transplants, and critical ails bear
immediate attention. Overburdened government hospitals often delay in offering
timely treatment which diverts individuals to seek medical care in the costlier private
hospitals. Even though, The Insurance Regulatory and Development Authority (IRDAI)
directed all health insurance companies to offer obligatory Arogya Sanjeevani policies
in April 2020. The policy will provide coverage up to Rs 5 lakh – 10 lakhs for essential
healthcare treatment, but the policy is not sufficient to cover advanced treatments,
transplants, and critical surgeries.

High out-of-pocket expenses

Indians pay ~63% of their medical expenses out-of-pocket, which is considered to be

the highest in the world. A report from Brookings India based on NSSO surveys claims
that ~7% of India’s population is pushed into poverty every year due to healthcare
expenses.

4. Disease and Age trend

Age pattern of mortality and hospitalisation in India has been presented in figures 1

and 2, respectively. While the age pattern of mortality is taken from the Cause of
Death Report, India 2001–2003, the age pattern of hospitalisation for 2014 has been
estimated from NSS data. In general, the age pattern of mortality and hospitalisation
by disease are similar in India. For children below 15 years of age, communicable
diseases are the leading cause of death and hospitalisation. Injury is the leading cause
of death for those in the age group 25–34 years, while communicable diseases are the
leading cause of hospitalisation. NCDs are the leading cause of death and
hospitalisation in India for those who are aged 35+ years.
Figure 1: Age pattern of death In India by cause of death classification,2001-
2003,NCD’s non communicable diseases

Figure 2: Age pattern of death In India by cause of death classification,2014,NCD’s

non communicable diseases

5. Digital/Mobile/e health trends in India

India is climbing the peak of the digital health revolution. The majority of healthcare

professionals (HCPs) use electronic medical records (EMRs) for more efficient medical

practice.

For a few years, novel digital solutions are gaining popularity with joints from private and

public sectors. The government has recently launched the much needed National Digital
 Health Mission (NDHM). The private sector has rolled out mobile apps, telemedicine,

research centers among other initiatives. Telemedicine, Artificial Intelligence (AI), mobile

apps, robotics, and virtual reality (VR) are gaining popularity. Digital intervention in

healthcare is expected to drive the industry at a CAGR of 23% by 2020.

India is climbing the peak of the digital health revolution. The majority of

healthcare professionals (HCPs) use electronic medical records (EMRs) for

more efficient medical practice.

Top 10 Digital Health Solutions

1. M-health: A simple mobile app that provides online video consultation and an added feature
to book laboratory tests online. It has an estimated market size of 5,184 crore INR in 2020.
2. Remote diagnosis - These products provide point-of-care diagnostics, teleconsultation, and
online prescription capabilities thus increasing access to healthcare in rural areas. For
example, a wireless monitor that measures blood pressure, oxygen saturation, pulse, body
temperature, blood sugar, blood cholesterol, and total hemoglobin (Hb) count with a mobile
application on your smartphone. It is expected to grow at a CAGR of 20%.
3. Telemedicine - It is the use of digital technology for remote diagnosis, monitoring, and
patient counseling. The high volume of patient load (millions) on a few doctors (thousands)
may burden the whole system and reduce its efficiency. Telemedicine or Virtual consultation
will enhance patient experience and engagement; fewer tests would be prescribed; the rate
of hospital re-admission will be less; better medication and patient adherence would lead to
desired clinical outcomes.  It is a rapidly emerging sector in India and the telemedicine
market in India is expected to reach $32 million by 2020
4. Digital Connectivity : support groups and knowledge portals for patients and digital chatting
platforms for medical professionals.
5. Wearables :- They are used to measure basic health parameters such as heart rate, number
of steps, sleep pattern, etc. For example, exercise trackers, oximeters. The overall market for
this is currently valued at 30 crore INR.
6. Big Data Analytics - Healthcare players have realized the value of combining consumer
insights and internal company data to optimize their products. Advantages are a) lower rate
of medication errors, b) Facilitating Preventive Care c) More Accurate.
7. Artificial Intelligence (AI) :- It helps in automation of clinical tasks and virtual nursing
assistants. AI has the capability to transform health management. It is used in precision
medicine, medical imaging, drug discovery, and genomics. DeepGenix helps the user in
understanding their problems based on questions and then predicts the diagnosis. It uses
deep phenotyping and deep learning (a form of AI).
8. Electronic medical records (EMR): This should help reduce medical errors and improve
health outcomes. Automated patient history has a lot of benefits. Arintra, an AI-based
software incorporates branching techniques to collect and store patient history. It also helps
in diagnosing and suggesting laboratory tests. It can also be used in telemedicine before the
consultation.
9. Virtual reality :- Surgeons are using virtual-reality simulations to improve their skills or to
plan complicated surgeries. 
10. Blockchain :- It is proven to be effective in preventing data breaches, improving the accuracy
of medical records, and reducing costs.

Image Source: PwC Analysis