In India, a disappointing 9.6% of the overall healthcare expenditure goes towards preventive healthcare, and 90% goes into treating diseases and their complications—amounting to more than Rs 3.6 lakh crore per year. Also, close to 50% of such expenses go towards inpatient beds for lifestyle diseases, especially in urban and semi-urban pockets
A couple of years ago, the ministry of road transport and highways came out with a chilling statistic—that around 15 people die in car crashes in India every day because they refuse to wear a seatbelt. Put that in perspective—a simple preventive measure like strapping on a seatbelt could save the lives of almost 500 people every month, or more than 5,000 people every year. Just like a seatbelt, prevention has always been affordable and easy. The cure, however, is largely expensive and usually very painful and unusually obtrusive—not stress-free in any way plausible.
The fact is that the chances of getting cured or being able to manage a condition successfully are much lesser after being diagnosed with a disease. Preventive measures such as getting annual health check-ups keep one informed. And the adage “knowing is half the battle” seems to work here as well. The preventive health check-up lets one know what’s going on inside the body, and what needs to be worked upon and what doesn’t. Based on this information, a person can make a few simple lifestyle and nutrition changes and, in many cases, reduce the necessity of having to go to a specialist doctor—like a diabetologist, a neurologist or a cardiac surgeon or even a physiotherapist—for getting treatment done for a protracted ailment.
Unfortunately, in our country, a disappointing 9.6% of the overall healthcare expenditure is spent on preventive healthcare (according to the National Health Accounts, 2013-14). In other words, more than 90% of overall healthcare expenses go into treating diseases and their complications—amounting to more than Rs 3.6 lakh crore per year. Furthermore, close to 50% of such expenses goes towards inpatient beds for lifestyle diseases, especially in urban and semi-urban pockets (according to the IBEF Healthcare, 2014).
Then there are the infrastructural issues. India’s ratio of doctors and nurses per 1,000 people is dramatically lower than the World Health Organisation (WHO) average of 2.5 doctors and nurses per 1,000 people. The situation is aggravated by the concentration of medical professionals in urban areas, which have roughly 30% of the country’s population. It is estimated that India will require 2.07 million more doctors by 2030 in order to achieve a doctor-to-population ratio of 1:1,000 (according to the IBEF Healthcare, 2018).
Measures such as primary, secondary and tertiary prevention can take the form of clinical preventive services, offered through clinicians. And, at the same time, these can also be taken at an individual or at the community level, often with greater effectiveness, to help the general public adopt healthier lifestyles and reduce harmful practices that precipitate diseases and injuries. With the increased importance given to preventive healthcare, the pressure on secondary and tertiary healthcare systems shall significantly come down.
The biggest advantage of moving towards a preventive, rather than a curative, healthcare mindset is that non-communicable diseases (NCDs)—such as heart/cardiac disease, hypertension, obesity, type 2 diabetes, and diseases caused due to smoking or alcoholism—are invariably tackled first. These diseases and their complications tend to be the monkey on one’s back that just won’t go away. These are also the diseases that end up having to be managed for the rest of a person’s life, and could prove fatal if not properly managed.
NCDs can be prevented more easily than communicable diseases—such as malaria, tuberculosis, pneumonia or dengue. Yet NCDs are responsible for seven out of every 10 deaths worldwide, reported the WHO in its September 2017 release note, while as many as 61% of deaths in India occur due to NCDs.
NCDs also tend to have a better chance of getting successfully managed if detected early, and the chances of detecting them early are more with a preventive mindset when regular health check-ups are done. Even the government has realised the importance of preventive healthcare, although there is a lot more that needs to be done. In the Union Budget of 2011-12, the government of India introduced tax benefits under Section 80D of the Income-tax Act on preventive health check-ups of up to Rs 5,000. Although the incentives provided were minimal, the intent was clear—the public at large must get into a routine of regular health check-ups.
This is where the diagnostic industry has a massive role to play. It is up to the diagnostic industry to innovate and work together towards driving not just the change in mindset, but also address issues pertaining to quality and affordability. The shift in focus towards preventive healthcare would mean investing in research and development, especially technology. We are already seeing the use of artificial intelligence (AI) and Big Data Analytics in diagnostics. AI can use algorithms to ‘learn’ patterns from a large volume of healthcare data, and then use the obtained insights to assist reporting of diagnostic tests for use in clinical practice. For example, even a normal report made on a panel of tests can be personalised based on an individual’s demographics and clinical history, and a health score can be attributed to that individual. AI can also be equipped with machine learning and self-correcting abilities to improve its accuracy based on an expert’s feedback.
However, much has to change at the fundamental level if the public at large is expected to believe in the advantages of preventive healthcare. Greater accountability, shorter turnaround times through automation, next-generation logistics networks, value-added services like mobile application with real-time information, and a greater customer-centric approach starting with the basic establishment of a connection with customers are just a few changes that will make the biggest differences.
As awareness spreads, the focus will shift from a physician-centric approach to a customer-centric one. While this shift is already palpable, we expect it to gather momentum as the diagnostics service provider becomes the integrated healthcare solution provider.
Much like the seatbelt—the cost of which is a tiny fraction of the overall cost of a car, let alone the cost of accident care—preventive care and health check-ups should be seen as an absolute necessity, to the extent of seen as compulsory for all.
With a preventive mindset and the consequential lesser spends on overall healthcare, a healthier country is born with an ability to spend more on other important aspects of socio-economic development. If for nothing else, for the goal of money well spent.
The Author is Chief Executive Officer, SRL Diagnostics. Views are personal