View: India needs an integrated healthcare circuit | Economic Times

Last week, PharmEasy acquired diagnostic chain Thyrocare to become a more integrated healthcare service provider. Apollo Hospitals unveiled its integrated digital health platform Apollo HealthCo. The emergence of such integrated healthtech platforms promises the world to the patients. A one-stop, seamless interface to provide information, facilitate consultation, conduct testing, and make treatment available to patients conveniently and at low costs.They promise to address the three basic pain points of India’s healthcare ecosystem: accessibility, affordability and availability. Widespread penetration of such omnichannel platforms has the potential of improving health delivery outcomes over a long term.They also have the potential to enable patients to consider the options to fund their treatment — through medical insurance, financial loan or crowdfunding. What more could Indian patients ask for?The integrated healthcare model started in the 1980s, and has been one of the World Health Organisation’s (WHO) recommendations. But the evolution of technology-backed integration has opened a plethora of possibilities that disrupts traditional healthcare in many ways.The modern integrated healthcare models — online or offline — mask a fundamental concern. The same forprofit entity arranges doctor consultations, offers diagnostic services, dispenses the prescribed medicines, as well as collects patient information. In the process, it practically places the patients, their records and their choices all under one roof, increasing the risks of medical malpractices, compromising patient safety and consent, and antitrust issues.To be fair, for a technology platform to work effectively at lower costs, it is important to have forward and backward integration of all the related services. While the price points are kept lower to attract more patients, the business earns higher volumes by pitching a variety of health products, tests and services to a greater number of patients through user-friendly tech interface. However, in extreme scenarios, the services, often cross-sold, can get pitched to patients who may not need them at all.The recent growth of evidencebased medicine reinforces the practice of treating patients after seeking evidence from their diagnostic test results. The downside of this trend appears in the form of excessive or unnecessary testing. The integrated care models further increase the ethical obligations of doctors towards their patients. They also presume that patients in India are aware of their rights as consumers, and assert it by saying no to unnecessary medication or tests. Unfortunately, most patients are not health-literate and are unempowered.The quality and provision of healthcare services has been quite skewed across different states, and even in different regions within a state.Integrated models do not necessarily end up correcting this skewness. For instance, they remain ineffective in areas where basic services like a doctor, dispensary or chemist are missing. They typically work well in urban settings with adequate healthcare services. Here, too, their growth poses risk to the survival of small stand-alone healthcare service providers who may find it difficult to operate profitably, and may be compelled to join one healthtech network or the other.In a country where data protection compliance is still at a nascent stage, and where an exclusive personal data protection law is still awaited, fastevolving tech platforms dealing with sensitive personal medical records needs to be watched with cautious optimism.With the overall focus on health shifting from illness to wellness, per-capita discretionary spending on healthcare is set to rise. And, with it, practices such as self-medication, self-diagnosis, preventive diagnosis and consumption of wellness products and services. Healthcare is the second-largest consumption basket in India, and outpatient care is emerging to be a fast-growing profit pool for businesses to tap. Little wonder then that digital healthcare, since the Covid pandemic, has become a large and attractive opportunity to tap.The emergence of healthtech platforms now calls for the integration of the role of doctors, service providers, drugs- and device-makers, regulators as well as patients as envisaged under the National Digital Health Mission.Efforts need to be undertaken towards increasing patients’ awareness of their rights, autonomy and safety; an increasing focus on medical ethics and patient rights; developing a competitive market of verified digital service providers; and strict enforcement of data protection and privacy laws. The idea is to strike the right balance between profit-making and patient welfare.