Corporate hospitals cash in on govt health insurance plans; reach hinterland sans branches 

A patient who has had a heart attack or is in need of urgent specialist medical care in Malda, a district 325 km north of Kolkata, has little choice but to travel to the West Bengal capital for treatment. The journey takes eight hours.

The poorly equipped and thinly staffed government medical college and hospital in Malda doesn’t inspire confidence in local residents so they make the arduous journey by road to Kolkata. In many cases, they don’t make it alive to a tertiary care hospital.

People lack sufficient paying capacity and specialist doctors are reluctant to serve in small-town India, which in turn means that timely secondary and tertiary healthcare is inaccessible to the majority of the residents across the country.

So how do millions of people living in districts like Malda access quality healthcare in the most vulnerable moments of their lives? An option that did not seem even remotely possible some years ago has appeared on the horizon.

Big corporate healthcare providers are turning their attention towards small towns, forging alliances with local partners through innovative models—teleconsultation for specialist care and by setting up virtually run critical and emergency care facilities -- without the need to build brick and mortar structures.

Private-private partnerships  

In September 2018, the Narendra Modi government launched its flagship health insurance programme Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), billed as the largest such public initiative in the world.

Its aim was to cover 100 million poor and vulnerable families in the country with cashless hospitalisation insurance of up to Rs 5 lakh.

In the past, the government’s focus was on providing services, building hospitals, staffing them with human resources and installing equipment. Under PMJAY, the approach has changed. Now, it has started paying healthcare providers based on service delivery to the people who needed advanced care.

Of the 25,000 hospitals empanelled under the scheme, nearly 10,500 are private facilities, many of them small ones with 20-50 beds each.

Several of these small hospitals have joined hands with major multi-speciality chains from the big cities and are catering to people needing secondary and tertiary care through facilities like e-ICUs and teleconsultation, a concept that has existed for two decades but has been popularised only over the last few years.

While there has been no dearth of demand for quality healthcare services in the country, the problem has always been lack of funds, said Ayanabh DebGupta, member of the health services committee at the Federation of Indian Chambers of Commerce and Industry (FICCI).

“Earlier in small towns and rural areas, people were not able to afford the specialized medical care, but now schemes like AB-PMJAY, Swasthya Sathi in West Bengal and other state health insurance schemes are taking care of financing,” said DebGupta, co-founder and joint managing director of the Medica group of hospitals.

Swasthya Sathi, a health scheme that guarantees cashless secondary and tertiary care treatment of up to Rs 5 lakh at empanelled hospitals every year—similar to AB-PMJAY-- was launched in West Bengal in 2016.

DebGupta’s chain of hospitals, which has 10 branches in Bihar and Jharkhand apart from West Bengal in cities like Patna, Kolkata, Ranchi and Siliguri, is now seeking a footprint in every district of these states through local partners.

“It’s like a supply chain concept and people recall your name,” he explains.

“How COVID-19 pandemic has helped is that tele-consultation has become a reality. Earlier, seeing a doctor in front of you was a very important thing, but a lot of people have started using teleconsultation; that has helped bridge a barrier,” DebGupta adds.

The Manipal hospital group, for instance, was remotely monitoring the health of COVID-19 patients, including Intensive Care Unit inmates, in 16 districts of Karnataka during the pandemic’s first wave in 2020. It was an initiative formally approved by the state government.

  Hub and spoke model 

Healing Touch hospital in Bhagalpur, Bihar, was established in 2001 by Dr Sanjay Kumar Singh, a surgeon trained in Dubai, UK and Singapore, and his wife, obstetrician-gynaecologist Dr Pratibha Singh.

“I come from a family of doctors and wanted to serve back my society and people and set up the hospital to offer services and facilities that were not here earlier,” he said.

Always aspiring to do something better and bigger, he tied up with Medica in 2018 to set up a nine-bed e-ICU. The hospital group has entered into such collaborations with several local hospitals in towns like Munger, Gaya and Deoghar in Bihar alone.

Similar collaborations are being undertaken by other healthcare groups such as Narayana, Apollo and Manipal, said DebGupta, adding that more than 100 such tie-ups would have taken place over the last 3-4 years.

Mutual benefits  

Such collaborations work this way. A hospital with basic facilities ties up with a major hospital chain from the cities and sends its MBBS doctors to the latter for a training programme of nearly three months. At Manipal, these professionals are then called “master medics”. These doctors, on their return, know what basic protocols to follow for patients in need of critical and emergency care and then hook up with specialists in the cities for real-time monitoring using technology and virtual treatment methods.

What’s more, the big hospital chains are also helping their local partners in improving basic hygiene and health standards—which in a few cases has led to them receiving accreditation by the National Accreditation Board for Hospitals & Healthcare Providers (NABH).

“That’s bringing a phenomenal amount of change in bringing tertiary care to people in small cities,” said a Confederation of Indian Industry (CII) member who is associated with a leading hospital chain in North India.

Karthik Rajagopal, the co-chair of the FICCI Health services committee and chief operating officer of Manipal Hospitals, said the group was working on innovative methods to take its medical capabilities to small towns.

“We are partnering with hospitals in secondary cities to offer outpatient consultations, like in oncology, cardiac or orthopaedics,” he told Moneycontrol.

Dr Singh explained that for every patient so treated and managed, the larger group-in his case Medica-receives a fixed sum. It also gets the advantage of strengthening the group’s brand and recall value in the hinterland.

Infrastructure, innovation but is it benefitting the last man in the line?

Dr Shankar Narang, COO of Paras Healthcare, stresses that it is critical to put in place a strong medical infrastructure and to be innovative to ensure that quality healthcare reaches the masses at an affordable cost.

He has a point- given that rural India gets just one-third of total hospital beds, or, in other words, 28 per cent of the population in urban parts gets 75 per cent of the medical infrastructure available in the country.

But can the task of taking medical expertise and quality and timely healthcare beyond the big cities be left entirely to the private sector alone?

Antony Kollanur, a public health activist who is also an independent monitor of the Centre’s National Health Mission, says that if Five Star hospitals run collaborative nursing homes in Tier-3 towns, that could be a financially efficient model of extending tertiary care, especially e-ICUs and coronary care units; they will mainly benefit the upper-middle class and the rich.

“But what about the poor who cannot afford it? Will the government upgrade the services in the district hospitals for a matching quality of services,” he asks, adding that if not, it was akin to abdicating its core responsibility to common citizens.

“On the other hand, if you purchase such services through empanelment under the AB-PMJAY scheme of newly mushroomed private hospitals, it is a hidden sale. It is akin to siphoning out of public funds for the betterment of the private sector, not aimed at the welfare of the common man.”