Dr Mark Britnell, Chairman and Partner of the Global Health Practice of international consultancy firm KPMG, considers his recent visit to India, his 22th, the most exciting one for a single reason - the announcement of Modi government's National Health Protection Scheme (NHPS). In an interview with Business Today's Joe C Mathew, Britnell, who authored the book "In Search of the Perfect Health System" some years ago, says that the budget announcement of NHPS is historic. Prime Minister Modi has embarked on a marathon race, he says
How do you see Modi government's health insurance plan?
In my book, there is a chapter on how countries can build universal health systems. The number one requirement that I point out there is political will. Then you need managerial skills, and thirdly, you need time and money. I believe Prime Minister Modi and finance minster Arun Jaitley are serious about their announcements. It shows the political will. You can't hide a promise that is made to India and to the rest of the world to provide insurance to 100 million families and 500 million people. That is an enormous promise, one of the biggest political promises I have ever seen in my life around the world. Therefore I believe that there is a political commitment because to break it will be political suicide. Secondly, your economy is growing 6 percent per annum, and with a spend of 1.5 % of GDP on healthcare India is way behind its BRICS counterparts, who spent between 4 and 8 % on health. A growing economy, political will and GST and other taxes as well, you have the means and sources of funding.
How about the implementation?
I am not sure about India's managerial skills. I say this for three reasons. KPMG is helping countries build universal healthcare systems in Africa, South America and Asia. The biggest common challenge that we find is incompetence, collusion and corruption. We know there is not enough money at the first place. You need sufficient amount of money to begin with. The journey to universal healthcare is a marathon not a sprint. The country that did it most quickly is South Korea and it did it in 12 years. Most countries take three decades. If Prime Minister Modi is embarking on this mission, it has to be a marathon race. So you need time. The other problem with the announcement is that it concentrates on hospitals (tertiary and secondary) while 90 percent of the care and 10 percent of the cost globally happens in the primary care platform. And we don't have a good primary care platform. In most developed countries, if you have a good primary healthcare system, 90 of the patient contacts take place in the primary care, which accounts for only 10 percent of the cost. India also has a problem with absorbing capacity. Some of the money has gone bad, some misappropriated through corruption or collusion. I am here with our global team, meeting various ministers to explain that they have got political will, they have got money, now it is time to be realistic about your managerial capability and capacity. You can't be passive fund allocator. You need to be an active payer. You need to reshape the health system. We need to encourage the private sector to set up new low cost points of care, we need to think about the finer mechanism that allows the Union and states to construct and roll out universal healthcare for its successful implementation.
Any similarities with Obamacare?
Superficially, both are similar, because both end with the word care. It is similar because Obama wanted to deliver universal healthcare to Americans and Modi wants to do it for Indians. They are similar in the sense both economies are growing and they could afford it. Both are trying to bring the costs down. But they are also completely different. Firstly, America spends 18% of its GDP on healthcare. America has a well established primary healthcare, India has none. Also it took Obama four years before his ideas became a law. So Modi has to think about how it should work. There is no clarity on details at the moment. Modi has to negotiate with the states also. So he has to prepare for a long game.
Let us assume that the insurance will take care of tertiary and secondary care. But is the budgetary allocation sufficient enough to take care of primary care?
What the government needs to do is to ask the private healthcare players to change their model of care. There has to be lot of public private partnerships. Centralized diagnostic imaging capability, operating capability, emergency patients care capability, tele-health, there is a lot that can be shared. We are going to see business models and care models change in both public and private sectors. That is the only way you can build affordable, high quality low cost care for the masses. I think it is a clever policy. It is time to think disruptive, innovative and differently. If Indian private healthcare providers do not want to change their model, many of the private healthcare service provides in other parts of the world will be meeting Prime Minister Modi. Perhaps, they should meet him.
Will there be more pressure on hospitals like the scrutiny on overcharging that is happening now?
Of course. They are being asked to change their business model. Most hospitals don't want to do that because they have comfortable profits and margins. PM Modi with this declaration is giving all existing players a chance to re-imagine themselves. It is a one in a generation opportunity. If they choose to ignore it, I don't think the government and people will forgive them.
What will be your advice to the private hospitals?
I would respect the Prime Minister's declaration and try and make the government and the serve the people in a different way by developing low cost, high quality care and diagnostic centres. Also partner with the public sector. You have seen this work in other countries. I have been coming here for the last 22 years. I can tell that there has been a trust deficit among private sector and government. You have to put that behind you. The government now needs to spend more time to think how to design the scheme and motivate various stakeholders. You need to do it if people around the world are to take you seriously as an economic powerhouse. You need to make your people healthier and live longer for that. All this has been possible because of this declaration though there seems to be no grand master plan behind it.