The 10th NATHEALTH Arogya Bharat Summit 2024, with the theme “India's journey towards health for all & the crucial role of private sector”, is poised to address a critical imperative at the intersection of health, human capital development and economic growth. Against a backdrop of evolving healthcare challenges and opportunities, the summit seeks to explore how India can transition towards a comprehensive healthcare framework that embraces the principles of accessibility, value-based healthcare and quality for all while removing equity barriers. Moreover, the role of private healthcare players in achieving Universal Health Coverage (UHC) in India remains a defining question that needs a forward-looking perspective.

Good Health equals Good Economy, Good Human Development

India stands at a pivotal juncture, grappling with a healthcare landscape marked by significant challenges and opportunities. The World Health Organization (WHO) reports that non-communicable diseases (NCDs) account for nearly 60% of all mortalities in the country, with NCDs contributing to 40% of hospital stays and 35% of recorded Out-Patient Department (OPD) visits. The burden of maternal and infant mortality further underscores the urgent need for a robust healthcare system.

India bears approximately 20% of the global disease burden, yet the existing healthcare infrastructure remains inadequate. With only 0.7 doctors and 0.9 hospital beds per 1,000 people, the nation falls significantly short when compared to global benchmarks, such as the United States with 2.7 doctors and 3.1 hospital beds per 1,000 people. These statistics highlight the pressing need for a comprehensive and inclusive healthcare strategy.

The Global Burden of Disease Report 2017 ranked India at 154 out of 195 countries in terms of accessibility to healthcare. Less than 15% of the population receives some form of health expenditure support from government or privately funded insurance schemes. Shockingly, millions plunge into poverty annually due to catastrophic health expenditures. It is evident that the current state of healthcare accessibility in India is an area that requires steadfast political commitment and commensurate investments, emphasizing the urgency for transformative interventions.

India is positioned as a destination for medical value travel, offering high quality healthcare at 1/10th of US costs. However, the disparities in healthcare accessibility within the country remain stark, necessitating a comprehensive and collaborative approach to address the multifaceted challenges.

The remarkable strides in India's business and innovation landscape are intricately linked to the nation's commitment to healthcare development. Over the past five years, India catapulted from the 142nd position in 2014 to an impressive 63rd in the Ease of Doing Business ranking in 2019. This upward trajectory not only signifies a conducive business environment but also underscores the role of a healthy workforce in fostering economic growth and attracting global investments.

In tandem with its economic achievements, India has emerged as a beacon of innovation, ranking first in the Central and South Asian region in the Global Innovation Index. The jump from 81st globally in 2015 to 48th in 2020 reflects India's prowess in fostering a culture of creativity and technological advancement. A healthy population is a catalyst for innovation, driving the nation towards higher echelons of global competitiveness.

Furthermore, the healthcare sector itself has become a magnet for foreign direct investment (FDI), reflecting its pivotal role in economic development. FDI inflows into the health sector surged from USD 2.5 billion in 2000-01 to USD 50 billion in 2019-20. The liberalization of FDI norms, allowing up to 100% investment in various healthcare sectors, has fueled growth, with pharmaceuticals attracting approximately two-thirds of total health-related FDI. This infusion of capital has not only bolstered the healthcare industry but also stimulated job creation and technological advancements, propelling India's economic narrative forward.

WHO’s High-Level Commission on Health Employment and Economic Growth (2016) found that each dollar spent in the health sector results in an additional USD 0.77 contribution to economic growth as a result of indirect and induced effects.

International Growth Centre (2017) highlights evidence around health as an integral component of economic growth.

• Health affects growth by augmenting worker productivity, increasing average life expectancy and subsequent human capital accumulation, and reducing burden of disease.
• In the Indian context, the main source of increases in worker productivity has come from improving nutrition.

World Bank Systematic Country Diagnostic for India in 2018 highlighted the role of inclusive growth, which involves investments into healthcare and human capital.

Healthcare is a linchpin in the overall development of a nation, exerting a profound influence on both the Human Development Index (HDI) and economic prosperity. A robust healthcare system not only contributes to increased life expectancy but also enhances the quality of life for citizens. By addressing maternal and infant mortality, combating non-communicable diseases, and ensuring access to essential healthcare services, a nation can significantly elevate its HDI.

Economically, a healthy population is a driving force behind productivity and economic growth. A workforce that is physically and mentally well contributes to increased labor efficiency, reduced absenteeism, and heightened innovation. Consequently, a nation with a thriving healthcare system stands poised for sustainable economic development, making investments in healthcare a strategic imperative for both societal well-being and economic advancement.

The Road to Universal Health Coverage (UHC) & the Role of Private Healthcare Stakeholders

The path to universal health is dependent on bringing in the complementary strengths of the government and mirroring them with the private sector. In real essence, a public private partnership (PPP) can be successful if there is alignment between public and private stakeholders along goals, competencies, and core strategic mindset.

The government’s focus on women’s health, child’s health, and overall national health index should match with the private sector’s focus on professionalism, pragmatism, and preservation instincts. Only when complementary principals will be brought on the same table, can India really start walking the path towards UHC.

It is time to come on common grounds regarding financing, care provisioning and governance to drive better solutions and last mile care delivery.

The need for convergence

With less than 15% of the vulnerable population having health insurance pooling, the role of private healthcare players becomes pivotal but challenging in expanding coverage. The private sector's expertise, innovation and resources can complement the government's efforts to establish a robust healthcare system that caters to the diverse needs of the population.

Healthcare providers, MedTech, Diagnostics, Academia, Skilling & Allied sector, Digital Health players, Pharma, and the Government constitute a diverse ecosystem that can significantly contribute to bridging the existing gaps.

Several factors are driving the demand for healthcare in India, contributing to the urgency of achieving UHC and a placeholder for the private sector to be a key player. The growing population, expected to reach 1.5 billion by 2050, coupled with an aging demographic requiring geriatric care, underscores the need for an expanded and efficient healthcare system.

Higher disposable income and increased awareness of health issues are pushing 73 million households into the middle-class category over the next decade, further intensifying the demand for healthcare services. The increased penetration of health insurance, with a 30% rise in coverage since 2014, is an encouraging sign but necessitates a corresponding increase in healthcare infrastructure to meet the growing needs.

The Government of India's Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) plays a crucial role in aligning public and private efforts towards UHC. By providing financial protection to 400 million vulnerable families and covering secondary and tertiary hospitalization expenses, PMJAY creates opportunities for private healthcare players to actively contribute to the mission of UHC. Parallelly, the government has also committed to grow healthcare spends from 1.4% to 2.5 % of GDP by 2025. This serves as an opportunity for the private sector to join hands with the government to transform healthcare in India.

Enabling the private enterprises

The private sector's integral role in Indian healthcare is evident, with 80% of service delivery supported by private business models. The private health-tech domain has also witnessed a surge, with over 4,300 officially registered start-ups. The influx of private equity and venture capital investments, totaling USD 1,275 million since 2010, underscores the confidence in the healthcare delivery space. Merger and acquisition deals in hospitals also surged recently by a record 155%, reaching INR 7,615 crore (USD 1.09 Billion) in FY19. These investments not only drive healthcare accessibility, but also contribute significantly to employment generation, technological innovation, and overall economic development.

It is essential to support the private sector by providing conducive environments for them to scale up the healthcare system.

For instance, ensuring regulatory clarity is essential for the successful integration of private healthcare players into the UHC ecosystem. The summit underscores the need for a clear and effective regulatory architecture tied to a long-term vision. This involves building quality technical capacity to enforce regulations, ensuring that they promote both innovation and accountability.

Private medical education holds the key to fostering a healthcare workforce equipped to address the evolving needs of the population. There is a need to revolutionize medical education and enable private enterprise in strategic areas where private participation aligns with the government’s policy priorities.

Digital technologies are another facet poised to play a transformative role in leapfrogging healthcare. From integrating public and private sectors to connecting urban and rural areas, patients to care, and physical to remote services, the effective use of technology can streamline healthcare delivery.

The right fundamental blocks are required for the private sector to play an essential role.

The Arogya Bharat Summit 2024 aims to catalyze effective collaboration on the UHC agenda, envisioning a healthcare ecosystem where both the public and private sectors fulfill their responsibilities while meeting key obligations to stakeholders. This collaboration involves not only addressing the challenges but also innovating to scale hyper-efficient models of care delivery.

The Role of Summit – harmonizing convergence towards key design principles

NATHEALTH’s role through the 10th NATHEALTH Arogya Bharat Summit 2024 is to bring all the pieces of the puzzle together. To create a platform for all stakeholders to work in unison and work towards key design principles.

The event will explore and facilitate dialogue on the crucial role of private healthcare players in advancing the government's agenda of achieving UHC in India. By addressing the impact of healthcare on human development and economic growth, emphasizing the importance of accessible healthcare for all, and exploring the collaborative potential with the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, the summit aims to chart a path toward a healthier and more prosperous India. The integration of technology further amplifies the transformative possibilities, ensuring that the healthcare sector evolves to meet the evolving needs of the nation.

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