Hi-tech, yet affordable

Then, a CT (computed tomography) scanner, and that too just a head scanner, was the biggest thing in medical technology, says Dr Prathap C. Reddy, Chairman, Apollo Hospitals Group, reminiscing about the time he launched India's first "corporate" hospital, Apollo Hospital, in 1983. Apollo, he says, went a step ahead and was the first to bring to India a whole body scanner.

Now, plain CT scanners are dime a dozen and Apollo has upgraded to a 320-slice CT scanner, typically for the heart and brain. It is a very powerful machine in its class and can even measure subtle changes in blood flow or minute blockages in the blood vessels.

Fast forward to January 2010: Roughly 50,000 villagers in 50 villages near Nagpur in Maharashtra will have primary healthcare services delivered to them through handheld devices. Under the project, started by CARE Hospitals' CARE Foundation, Hyderabad, a healthcare worker will be able to prescribe medicines for simple ailments like a fever or a tummy upset using software programmed by experienced doctors and specialists.

And ambitions all around are huge. "Since inception, we have treated 19 million people and in the next 10 years should double that number," says Reddy. In tune with its efforts to reach out to more people, he says, while Apollo's tagline is "Touching Lives", the vision now is to "Touch a Billion Lives".

The Decade of Technology
Over the last decade, there has been a big leap in medical technology and the spread of cashless health insurance has made it more affordable and accessible. Gone are the days when healthcare was provided mainly by charitable and trust hospitals: Apollo was followed by a host of corporate players, and all are now expanding their reach and thinking of health cities of giant hospitals.

Hospital surgery has been revolutionised by technology: From hesitant beginnings with keyhole jobs in the last century, the past few years have seen everything from laparoscopic gastrointestinal surgery to interventional radiology. Dr B. Soma Raju, Chairman, CARE Hospitals, points out that minimal invasive surgeries allow patients to go home in a day, in cardiac care there is patient-awake surgery, where the procedure does away with general anaesthesia, a heart-lung machine and ventilator. All this reduces cost.

"India also has robotic surgeries being done now, not just for heart operations, but even in the case of cancer treatment," Soma Raju says.

If technology has transformed medical practice, outsourcing is helping the government sector. Thus, Chiranjeevi Yojana in Gujarat provides healthcare to pregnant women; the government pays for services rendered by the obstetrician in private practice.

The Andhra Pradesh government funds Health Management and Research Institute (HMRI), a unique public-private initiative founded by B. Ramalinga Raju, the tainted Founder of Satyam Computer Services. HMRI has a helpline (104) for tele-advice and another that has 475 vans complete with nurses, lab technicians, pharmacists and computer operators for delivery of drugs and services to the people of the state.

Next: Outreach and Costs
By 2020, Indians in the remotest village should be able to get advice over broadband from specialists in metros or even foreign hospitals. Already, there are some small projects that combine mobile telephony, broadband connectivity and satellite links to shrink distances.

Pranay Lal, Technical Advisor (Policy), International Union Against Tuberculosis and Lung Disease, says: "Over the past year or so, technology, particularly SMS text messaging and community radio services, has been used to alert people to stick to their treatments regimens and to avoid drop outs."

Insurance, too, is slowly increasing its coverage. Dr Rana Mehta, Vice President (Healthcare) at consultants Technopak Advisors, says: "Community Health Insurance schemes are slowly penetrating the rural markets with more than 25 schemes, covering over 10 million lives all over India." A McKinsey and Co. report, India Pharma 2015, released in 2007, noted: "We expect insurance coverage to double from current levels to cover around 20 per cent of the population by 2015." According to Suresh Gurumani, CEO, SKS Microfinance, universal coverage through health insurance will gather more momentum if health insurance is backed by a cashless health service delivery infrastructure—a paradigm shift that's in its early days.

Still, while technology combined with insurance can improve access and affordability, the process can be aided further by playing the volume game—large volumes that lower unit costs. This path is already being chalked out by Dr Devi Prasad Shetty, Chairman, Narayana Hrudayalaya.

Shetty says: "The cost of a heart surgery today (Rs 3-5 lakh) will soon fall and you will see operations at Rs 50,000-60,000 in the next 5-7 years." But this can happen only if the size of the average hospital is raised to 2,000-5,000 beds, against 50-70 today. "We need to do 25 lakh and not just one lakh heart operations in a year," he adds. Few will disagree.