Tuesday, August 14, 2018
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American Healthcare Reforms


– Dr. R. B. Smarta
American Healthcare system is perhaps more driven by costs and not as much by the
outcome. It is evident from spending of 17% of GDP on healthcare. Still 77% of
Americans have atleast one chronic disease. 31st in life expectancy and 40th in child
mortality in all nations. On top of it, US healthcare system ranks 37th amongst nations!
All over the world economic downtown has pressurized all nations to bring down their
healthcare cost and reform their healthcare systems. Like US, in most nations, key parts
of healthcare bills are cost, corporate healthcare costs and health insurance cost.
Indian pharma companies are mostly operating in Generic space in US. In next few years
Generics will occupy almost 65% of pharma space. All Indian companies have an
opportunity provided they follow the specifics of this market right from market
dynamics to marketing mix.
Indian Healthcare Reforms:
In India, reforms can develop on sound principles on the basis of learnings of all
available systems and our strengths and needs. To make common man healthy in Indian
demographics, needs a different approach.
 37% of Indian population is undernourished. They have difficulty in meeting even
the foundation needs. 55% of the population have diet which is calorie sufficient but
nutrient deficient whereas 8% of the population is overnourished. Hence, there is a
total imbalance of nutrition which leads to anemia, TB and many other diseases
which increases the disease burden of India.
 Statistics tells us Arthritis, Hypertension, Diabetes, CVD and Cancer patients and
elderly patients are major part of our disease burden. Besides, acute diseases,
almost all of them trace their origin to nutrition.
 As Indian population is getting increasingly health conscious, almost 64% of out-ofpocket
expenditure in India constitutes healthcare expenditure as compared to 18%
globally. This population can be called as Healthy boomers. They need to be properly
directed towards maintaining their health.
 All nations have significant role of Health Insurance in healthcare. In India, patient
and payer is almost same. Sharing model between Health Insurance and patient can
be adopted. 70% to 75% of the burden can be still carried by patient or medical
consumer, depending on the nature of disease. This sharing ratio should even
reverse dependant on the severity of the disease.
 65% of Indian population lives in rural areas while qualified medical doctors are
available in these areas are only 2% are needed. Indian healthcare today is urban
centric. It needs to be reformed through medical infrastructure inclusive of doctors,
nurses, paramedicos, etc.
 Indian healthcare system should start from preventive care through nutrition.
Reforms must provide impetus to lift the population which is at the bottom of the
 ‘Health is Wealth’ is an old paradigm of India. It is forgotten due to scarcity thinking
Indians. As the demographics are changing, the abundant thinking is getting
inducted in 60% of population which is below – for them this paradigm needs to be
inculcated through education. This new paradigm should originate from nutrition to
exercises to preventive healthcare to healthcare. It should be proactive rather than
reactive in terms of its reforms.
 As quick as possible health must become a priority issue for government of India. It
means department of pharmaceuticals, FSS, Ayush and related bodies should be
appropriately part of ministry of health and family welfare or in other suitable
ministry.Government is taken up HIV, TB and Tobacco through massive government
 Overall, India needs to reform its healthcare system through policies, medical
infrastructure, education and realization of right nutrition to lifestyle management.
Acute diseases overtime will be at reactive end of the reforms.
– Published in Pharmabiz