T K Arun
The business model of healthcare must shift from paying hospitals to treat people if they fall ill, to paying healthcare providers to keep people healthy and treat them if they do fall ill.
If you still think that the advances in healthcare that can shield humanity from the next pandemic can safely be left to the rich world’s good intentions, technological savvy and business acumen, you might as well also believe in the tooth fairy. India bears a special responsibility to equip the world, particularly its developing parts, to take care of its health.
Two distinct areas of advances offer themselves up for Indian companies and state agencies to make their mark . One is the area of biotechnology and genomic medicine. The other is making use of the millions of data points increasingly generated for a growing population of wearers of devices that constantly measure assorted bodily parameters, ranging from rudimentary step counters to sophisticated watches that also serve as electrocardiograms.
Biotech is Big Tech
Why is it particularly India’s responsibility or opportunity to make good on these promises of technology? India happens to have the largest demographic of those who can be trained in science, technology, engineering and maths.
Armies of Indians work in the world’s best biotechnology labs in universities and pharmaceutical companies. The cost of research and development in India is a fraction of what it is in the developed world. And Indians are good at solving problems if only someone would set them the problems that need to be solved.
The new breed of messenger RNA vaccines come from a new branch of research to find cancer cures. BioNTech, the small German biotechnology company whose product Pfizer has developed and marketed for its coronavirus vaccine, had cancer in its sights. So did Mo derna, and Novavax. Some companies already offer tailor-made genetic therapies for cancer. The only problem with these cures is that they cost a bomb.
One fallout of Covid has been renewed interest in studying viruses. The common perception is that all viruses are malign creatures that offer gratuitous harm. But that is not the case. Scientists know that certain viruses can be used to eat up specific bacteria.
Such bacteriophages (eater of bacteria in plain English) can be used to kill multidrug-resistant bacteria. Phages were a research interest before the advent of the first antibiotic, penicillin. After its arrival, research funding and the focus shifted to newer and newer antibiotics. But, now, fresh antibiotics have been hard to find or synthesise. So, interest in phages has come back.
India is ideally placed to take synthetic biology forward. Indians don’t worry about playing god: which god, in any case? It has the manpower, biodiversity and different agroclimatic conditions for all kinds of interventions in animal, including human, and plant biological systems. The central government has the responsibility to come up with appropriate and enabling regulation, to set ethical standards and norms of propriety. Editing genes can lead to piquant choices that people who have only trained in medicine and biochemistry will struggle with.
Those who have clarity in ethics and the law will have to come to their aid. After that, it is up to universities, state governments and businesses to help startups set up and get going.
Every smartphone counts the number of steps its owner takes a day. Smart bands and watches measure not just physical activity but also blood pressure, blood flow, temperature, sleep patterns, regularity of heartbeats, temperature and, increasingly, oxygen saturation of the blood.
Where does all this data go? Right now, into the wearable device owner’s bragging rights. That is about it. India is the world’s capital not just for young people but also for diabetics, those who suffer from tuberculosis, high blood pressure and heart disease. The data captured by wearable devices are vital inputs to preventive healthcare, particularly in the case of non-communicable diseases such as diabetes, hypertension and heart disease.
But to make use of this data, we need a health system in which someone is paid to take care of a citizen’s health. The focus of the healthcare system we have is on treating someone when she or he falls ill. The healthcare system makes its money from treating the ill. Keeping people healthy will actually depress their revenue and sink their business.
The problem is not with the healthcare providers but with the business model. The business model must shift from paying hospitals to treat people if they fall ill, to paying healthcare providers to keep people healthy and treat them if they do fall ill. In such a model, the care provider is paid upfront, and has an incentive to keep their charges in good health, so as to minimise the outgo on treatment.
These care providers would make use of the vital parameters collected by wearable devices.
Ideally, state and private providers should both take on this job. Regulation and the fear of reputational damage will ensure good behaviour. In India, two states are probably best placed to try out such a model of healthcare: Kerala and Tamil Nadu. Their levels of literacy and democratic agency are relatively high, and the government machinery works.
Views expressed are author’s own.
This article first appeared in The Economic Times: View: Covid crisis offers new healthcare opportunities for India on 23 June 2021.
About the Author
T K Arun, is a ET consulting editor.