Care of human health has intrigued the social, scientific and economic intellect of mankind since time immemorial. Indian healthcare has leveraged the scientific and technological developments of the West and adapted them to the social and economic fabric of this diverse country. In the next 10 years, I assume the situation will not change much; the dynamics, however, may, depending on the shift in the priorities of state and society.
The Indian state has historically concentrated on preventive healthcare and has seen a mixed bag of successes, eradicating diseases like smallpox and polio, but unable to make much headway in aspects like clean drinking water and sanitation. There have been attempts at delivery of curative care too. In 10 years, I see a conscious effort by the state to utilize the infrastructure of private healthcare organizations. This would mean reaching a larger population with state-sponsored schemes of treatment and much larger health insurance coverage in some form or the other. On the ground, it may mean the reversal of the percentage of insured to non-insured patients to about 80:20. This may induce both investment in technology deployment and clean up the costs of healthcare delivery. The involvement of organized players will also ensure the appropriateness of costs, though it may not necessarily bring down costs. I think this would lead to the distribution of reasonable tertiary healthcare to the taluka-level, piggybacking on communication technologies and platforms.
Disease and treatment
The country has been swinging between the dominance of communicable and non-communicable diseases in a cyclical manner. I believe there will not be any change in the existing ratio of communicable and non-communicable diseases; however, the absolute numbers may increase radically. A vast number of non-communicable diseases will be diagnosed due to the reach of advanced diagnostics and the increasing incidence of lifestyle-related origination. It is feared communicable and infectious diseases will increase in view of ever-evolving bugs and narrowing options of antibiotic development. The respective counters to these threats can be predicted by looking at the direction of current global research.
I foresee that in 10 years, treatment based on genetics will evolve to a reasonable extent to treat non-communicable diseases, aided by early detection and advanced diagnosis. Meanwhile, the immunization spectrum will increase in quantity and level to challenge the threat posed by communicable diseases. This will be separate from modified ways of diagnosis and treatment, where there may be some radical breakthroughs in addition to the four basic elements of diagnostics and treatment—mechanical interventions, chemicals, waves and rays. Stem cells may be the dark horse.
Business of Delivery
In India, we will see a radical consolidation in the healthcare industry owing to these scenarios. Mega-corporations will have the advantage over mom-and-pop shows. I assume that apart from the government, three-four large players, some of them international giants, will dominate 80% of the market. The sheer size of our country will attract investment in healthcare infrastructure, divided between increasing the reach and deployment of technology. High-end communication technologies, devices and platforms will form the backbone of effective reach. Analytics and big data will be the direction setters for the way patients are treated, medically or otherwise. I am reasonably sure that the practices of medical professionals will be largely institutionalized owing to super-specialization. The design of current set-ups like hospitals will see a sea change. In all probability, they will become diagnostic and treatment stations, while recuperation will be shifted to homes.
The future Shock
The obsolescence of treatments, drugs and technologies is very high in healthcare. So is the accuracy of directions, predictions and designs of the future. Therefore, the prophecies are based more on current desires and wishes. The predictions also assume the continuum of normalcy. Human health and existence have historically been influenced by quite a few black swan events. The colour of future healthcare could change radically with any such event.
Not only what we will be after 10 years, but also what we should be after 10 years, can be a part of the current discourse. India is ill-prepared for disaster management. I hope that our thinking for the future will include planning for outlier contingencies like chemical and nuclear warfare, lethal disease outbreaks, natural disasters, etc.
A decade from now, with the current economic vision and pace of growth, I believe India will be leading the world in creating the vehicles for that reach. I am not sure if it will remain a healthcare destination for foreigners, as it is now, but I am sure that it will evolve some disruptive processes for the benefit of people. It certainly has the potential of being quoted positively across the globe—if we plan meticulously for the challenges of the future.
Zahabiya Khorakiwala is managing director, Wockhardt Hospitals
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