Dr Harish Pillai

Unit 3: Public Health CEO - Aster Medcity &

Head – Kerala, Aster DM Healthcare
TATA INSTITUTE OF SOCIAL SCIENCES
Aster Medcity | Aster MIMS - Calicut |
Aster MIMS - Kottakkal | DM WIMS
 Unit Objective

At the end of this Unit, you will be able to:

• Understand public health challenges and cost concerns

• Understand innovative healthcare financial models
• Narrate Healthcare as a GDP driver
Shrink the Earth’s Population to 100, there

will be:

57 Asians
21 Europeans
14 North, Central and
South Americans
8 Africans
South Asia developing fast and creating
more unhealthy population.

60% of world’s diseases burden

born by 17 % of global
population in the region.
 India: The Prima Donna of South Asia

S. No Type of Expense %

1 Total expenditure on health as percentage of gross domestic product 3.9

2 Private expenditure on health as percentage of total expenditure on health 69

3 General government expenditure on health as % of total government expenditure 31

4 Social security expenditure on health as % of general government expenditure on 16

health
5 Out-of-pocket expenditure as percentage of private expenditure on health 86

6 Private prepaid plans as percentage of private expenditure on health 4.7

7 Per capita total expenditure on health at average exchange rate $ 59.1

 Public Health Challenges in India

Demand for healthcare manpower has outpaced its supply

0.9 million doctors are required to meet the global

average of 14.1 doctor per 10,000 people

2.4 million nurses are required to meet the global

average of 2.5:1000 patients (Currently 1.7:1000)

Require new 550 medical colleges to meet the global

average of doctors by 2030

India need to focus not only on increasing the

educational institutes, but also the quality of
education
 Human resource challenge for Indian healthcare

Around 50,000 medical students graduates every year whereas the number of PG
seats are only approximate 15,000 in MD, MS courses.

Lesser density of healthcare workers in rural sector due to poor infrastructure, non
availability of the basic healthcare requirements, medicines and equipment

India’s system healthcare is mostly driven by contract based or Allied Health

Professional (AHP), i.e 56 per cent and there also exist a scarcity of 1.88 lakh AHPs
only in public health organisations
India’s share in global disease burden vs share of global health care

infrastructure
 Discrepancy within

South Indian States Vs. BIMARU States

Infant Mortality Rate (2011)- South Infant Mortality Rate (2011)- BIMARU
Indian States States

Kerala 12 Bihar 44

Tamil Nadu 22 Madhya Pradhesh 59

Karnataka 35 Rajasthan 52

Andhra Pradesh 43 Uttar Pradesh 57

0 20 40 60 0 20 40 60 80
 Discrepancy within

South Indian States Vs. BIMARU States

Life expectancy at birth (2011)- Life expectancy at birth (2011)-

South Indian States BIMARU States

Kerala 76.8 Bihar 66

Tamil Nadu 72.4 Madhya Pradhesh 65

Karnataka 70.9 Rajasthan 68.5

Andhra Pradesh 70 Uttar Pradesh 65.6

65 70 75 80 62 64 66 68 70
 Growing burden of NCDs
DALY(YLL (Years of Life Lost)+ YLD(Years
Lived with Disability)) In India
Injuries
13%
Communica
ble,
Maternal, DALY of Major NCDs in INDIA
Perinatal
and
Nutritional
44%
Non
communicab
le diseases
43%
Source: Data portal India( data.gov.in)

40 million diabetics,- ‘diabetes capital’ of the world

Death of 80% diabetics can be attributed to CAD

50 to 60 million Indians suffer from heart disease

Every 10th Indian suffers with either CAD or diabetes

Economic Burden due to NCDs
The mounting disease burden, coupled with low government focus on healthcare

has acted as one of the prime factors accounting for low labour productivity in India
 Issues in Fiscal Federalism

Vertical imbalance- between the powers of the states and the Centre to raise revenue through taxes and duties
in comparison to their expenditure requirements

Horizontal imbalance - limited ability of some of the states to mobilize adequate resources from within their
state economies in comparison to others
Abysmally low focus on preventive care

Poor insurance penetration

Ageing and related issues

Way forward…
Way forward…
 Way forward…

Asset Light Model

• Capital Investment, profit/loss by owner

Model I • Management co. gets annual fees –fixed /% of
Both cases ↑ Brand gross/net
Visibility, market
access,
No land or Building Asset Light Model- use existing infrastructure; rapid
expansion, ROCE high if land/bldg subtracted, payback↓
owned Returns @ 18-20% on Capital

• Management Co. identify property, refurbish

it & manage
Model II • Profit/loss to Mgmt Co.
• Owner gets fixed leased rentals
Way forward…

Day care model

Way forward…

Implant Vs non implant model

 Way forward…

Promote Cost Containment

cost cutting
x
The Focus …
cost efficiency
Innovation-based healthcare landscape
Thank you