When a Facebook, Uber, or Airbnb of health care looks elusive

Okay, I used these big names in the headline to grab some attention. That said, few would disagree that there’s dire need for such unicorns to emerge in health care so that the benefits of network conditions make health care less expensive, more effective, and above all, participatory in managing chronic illnesses.

One could argue I am hallucinating:  A tech-led revolution in a country where most medium and big hospitals have their basic ABCD broken? That’s a neat acronym I learnt from Swami Swaminathan, chairman of Manipal Integrated Services, where A stands for Admission and Appointment, B for Billings, C for Clinical records and D for Discharge. But only when the system is so utterly broken that radical ideas emerge. And as Dr Paul Salins of Mazumdar-Shaw Cancer Hospital says, the real solution lies in moving away from hospital-centric models of healthcare.

That’s the premise with which Axilor Ventures, and its founders, two of them being Infosys co-founders, SD Shibulal and Kris Gopalakrishnan, have started Healiate. It’s a guided innovation challenge to draw entrepreneurs, existing and wannabe, to gaping health care problems. The metaphor couldn’t be more appropriate – Healthcare needs healing, big time.

Moderating a panel discussion and listening to a bunch of passionate and brilliant entrepreneurs, I was clear about one thing: Only preventive and,  to borrow Dr Salins’ term, “Interceptive”, healthcare can save India from looming health care catastrophes. To cite an example of “interceptive”, Dr Chittaranjan Yajnik, a diabetologist from Pune, has shown that under-nutrition (and/or low birth weight) during pregnancy is linked to adult diabetes among Indians and it can surface as early as four years of age. Can something be done at a population level to correct that?

The larger question though is, unlike medicine which falls under the realm of science, health care is business and hence one needs to ask if preventative care is to be given, who is going to pay for it? At what stage, and how, will people make sacrifices for preventive health care?

Courtesy: www.glasbergen.com

Doctor, specialist and hapless patient

One of the entrepreneurs, Siddhant Jena, spoke about his experience of 2009 when he was using phone-based sensors to screen for oral cancer in Karnataka. He found, “People just did not want to know about their cancer”. If individuals are not interested, then who is? Insurance penetration is so sparse that to assume insurers will be happy paying for preventive care so that their customers don’t need to go to the hospital is nothing but woolly thinking.

Can entrepreneurs then work with hospitals to provide such care – to keep people healthy, proactive in keeping their, say, blood sugar or pressure under control – in out-sourced manner?

Screening, counseling and diagnosis-driven preventive care is one where even the locally-developed medical technologies can find a life and business model. Forus Health has found it the hard way and iBreastExam is adopting it from the start. I’ve earlier argued, quite comprehensively if I may add, that diagnostics can be our savior against antibiotic resistance menace too.

There’s another advantage, too. Very few clinicians in this country undertake research — they are either too busy treating patients (in public hospitals) or too focused prescribing battery of tests in the name of evidence-based medicine. Consequently, they either haven’t figured where to apply emerging technologies or they do not understand the underlying biology enough to “intercept”. In such an environment, entrepreneur-driven diagnostics and devices companies can gather a lot of valuable data which can then lead to further intervention. As Forus found in its screening of a couple thousand drivers that nearly 9 percent of them had colour blindness. Guess how they they managed to navigate traffic signals? By looking at the position of the three lights, not at their colour.

While inaugurating the event yesterday Shibulal said one of the ambitions he has for Axilor and Healiate is to make it the go-to-place for health tech, just as Koramangala in south-east Bengaluru was for IT, nearly two decades ago. At the end of the day I was wondering how apt the Koramangala analogy was.

Just as the IT product companies missed not having a market place – for merger and acquisition– for the first decade or so, medtech entrepreneurs are groping for one today. Big enough healthcare companies to hunt-and-partner to innovate are missing. Private hospitals do not want or cannot absorb many of these technologies (for various reasons and it’s another story for another day), government hospitals have no money, nor any effective public procurement system.

Perhaps going directly to consumers, showing outcomes, and winning their confidence could be one way forward for preventive care.

(Yes, I say this while fully agreeing with economist Kenneth Arrow’s landmark paper and its premise which, in nutshell is, — free market can’t cure healthcare. Have discussed this earlier here.)



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