Containing Health Care Cost, What is our role as a Physician? by Dr. Chandrika Kambam @Ckambam




Indian health care is at an inflection point. Today governments’ spending on healthcare needs is one of the lowest amongst the Developing countries [1]. India spends about 5% of the total expenditure on Health which is around 1.7% of the GDP. Public healthcare growth has slowed down over years. In 1998 about 43% of population was served by Public Hospitals and today only 30% use the Public health care system. [2] That means almost 70% of the health care needs are serviced by Private players, trust hospitals and non-profit institutions. This has led to the rapid growth of Private players who are growing at the rate of CAGR 16.5% year on year [3]. The costs of procedures or hospitalization has increased anywhere from 83% to 263% in 10 yrs. i.e. 2004 to 2014. There is also a wide variation of the cost for the same procedure in different hospitals [4]. It is also noted that 86% of rural Indian patients and 82% of urban Indian patients do not have access to any form of employer-provided or state-funded insurance.

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Software Product For Hospital Industry by Girish Koppar @KopparGirish



Before we talk about software product for hospital industry lets understand how the Hospitals are broadly classified

- Based on the legal entity ( Private , Trust or Corporate)
- Based on specialty ( Super specialty, Multi-specialty, Single specialty)
- Based on bed strength ( Larger hospitals and Nursing Homes)

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A Data Scientist’s Experience in Decoding Chest Imaging by Vidya MS



The Chest Imaging Update 2018 held by the Narayana Health group, brought together over 150 radiologists, pulmonologists and doctors gathered to update and improve their knowledge in the reporting of Chest Imaging, both X-ray and CT. As a data scientist with keen interest in medical imaging, my aim was to get an inside look into the daily practice of medical professionals in detection and diagnosis of pulmonary diseases.
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PregBuddy’s year with Google Launchpad by Sivareena S. L. @SarikaSivareena




We’re all aware about the Google Launchpad accelerator which selects pre-series A startups across the globe every year to assist them scale their business. Along with this, Google Launchpad has few more offerings where they have extremely well structured programs for various stages of startups. Pregbuddy has benefited from couple of these programs as we grew our product.

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Almighty Data or Hype? By INDERJITH DAVALUR @INDERDAVALUR

DIGITAL TRANSFORMATION AND THE PLACE FOR DATA

Mea Culpa, I am one of those who is guilty of getting on and staying on the Big Data wagon for the wrong reasons. “Data is the new oil” is an oft-repeated phrase. I am about to commit a “virtual” suicide by proclaiming that it is not so. Data has its place and it is not at the top of the digital food chain. I feel that we have crowned the half-naked prince, Emperor in haste.

For the sake of clarity, when I say data, I will be referring to digital data throughout this piece. Data is a by-product of any activity. Therefore, creating data is as natural as breathing. So we have data. A lot of data. So what? Accumulating data, structuring it, storing it, analyzing it are a natural progression from that point onwards. How and what we do with the data is more important. Software. 

The magic that is software, to me, is more transfixing. Consider the prospect of a language written in a semantic that is alien to our natural human language. A cryptic command, logic, condition, trigger – anything at all – that is magically read, understood and acted upon by silicon. Hardware that contains baked-in code that can parse and carry out complex instructions at blazing speeds. Pieces of such chips soldered on a board and communicating through ‘roadways’ of circuits laid out on a board. The miracle of hardware coupled with the magic that is software is what gets my adrenalin pumping. How can such a marvel not be exciting?

Even the awesomeness of hardware pales in comparison to software. Hardware is more or less static. It is confined to physical and functional dimensions. Software, however, is supreme. It can use the same hardware (with some limitations of course) and carry out simple tasks, entertain with games, or perform wildly complex calculations at very very high rates of speed, accurately all the time. And it can do this million million times with alacrity. This is just the beginning of what software can do. But wait, there’s more!

Consider intelligence in software. It suddenly becomes a living, breathing, dynamic being. Almost. Software can learn and teach itself. Crunching data and spitting out patterns and actionable analysis suddenly becomes mundane, banal almost pedestrian. No. I am not against data or big data. By itself, big data is just that. A monstrosity. Sometimes, big data actually gets in the way. Misleads us in making decisions quickly. Software breathes life into data. 

Take any software language or tool. Examine it. Study its flow, the eloquence, the nuance and its brilliance. Brevity in software coding is revered by programming perfectionists. There is elegance in a well-written piece of code that executes beautifully, perfectly, every time. Anyone that can find literary melody in Shakespeare or Milton can certainly begin to enjoy the harmony in a beautifully crafted software application code. So, my appeal goes out to all those who are worshipping big data to take a moment to reflect upon the joy that software brings to our daily lives. After all, the future is software!

Author
Inder Davalur
Inderjith Davalur is a healthcare technology specialist, speaker, writer and utopian dreamer.
Inder works with hospitals committed to transforming the healthcare paradigm with the aid of new innovative technologies. His primary area of interest lies in using data analytics and technologies such as Deep Learning to shift the current physician-driven healthcare model to a patient-driven market dynamic.
Inder focuses on the manifold ways in which data crunching and machine learning can lead to better diagnoses that can not only be made at the time of illness, but predicted way before any symptoms surface. The path ahead in the sector, he believes, lies in the deployment of evolving technologies that immensely influence both diagnostic and therapeutic aspects of healthcare, delivering real patient-driven, data-enabled, informed healthcare.
Inder currently works as the Group CIO at KIMS Hospitals Private Limited, Hyderabad and has previously assumed leadership roles at leading hospitals and companies, in India and the United States of America.
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Simplifying Health Economics by Dr. Karan Sharma

After hearing about India's New Health Insurance Program, I thought it is good idea to share about Health Economics, so here I am

Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. 
Alan William Plumbing Diagram about Health Economics
I am using Alan Williams “Plumbing Diagram” to comprehensively understand Healthcare Economics. He has divided scope of healthcare economics into eight distinct topics (explained in the documents) which are:
·        What is health and what is its value?
·        What influences health? (other than healthcare)
·        The demand for healthcare
·        The supply of healthcare
·        Micro-economic evaluation at treatment level
·        Market equilibrium
·        Evaluation at whole system level
·        Planning, budgeting and monitoring mechanisms.
There are interlinkages between each topic, which make it possible to see Health Economics as an integrated whole – more than an Ad-hoc assemblage of topics. According to understanding – The first five boxes
(A) Health and its values,
(B) Influencers to health,
(C) Demand for healthcare,
(D) Supply of healthcare and
(E) Market equilibrium factors are the analytical “Engine” of health economics.

The remaining three (F) Microeconomic evaluations, (G) Planning, budgeting and monitoring and (H) Evaluation of system are main area of Applied Economics. 
Let us understand each topic and its relationships:
CORE ENGINE
A.    Health 
Health can be defined as physical, mental, and social wellbeing, and as a resource for living a full life. It refers not only to the absence of disease, but the ability to recover and bounce back from illness and other problems.
Health generally evaluated through its value and perceived attributes, which are like:
1.     Productivity of individual healthy days
2.     Value of life
3.     Expenses caused by diseases and etc.
Health can be treated both as consumption and an investment good, Consumption: health makes people feel better, Investment: it increases the number of healthy days to work and to earn income.
Health does have characteristics that more conventional goods have; it can be manufactured; it is wanted and people are willing to pay for improvements in it; and it is scarce relative to people’s wants for it. It is less tangible than most other goods, cannot be traded and cannot be passed from one person to another, although obviously some diseases can.
B.     Influencers
According to WHO, many factors combine together to affect the health of individuals and communities. The few factors which affect health include:
1.     Income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.
2.     Education – low education levels are linked with poor health, more stress and lower self-confidence.
3.     Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions
4.   Social support networks – greater support from families, friends and communities is linked to better health. Culture - customs and traditions, and the beliefs of the family and community all affect health.
5.     Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behavior and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.
6.     Health services - access and use of services that prevent and treat disease influences health
7.     Gender - men and women suffer from different types of diseases at different ages.
There are evidences available of other examples which has been documented which are like: Transport, Food and Agriculture, Housing, Waste, Energy, Industry, Urbanization, Water, Radiation, Nutrition etc.
C.     Demand
Health demand is to achieve larger stock of Health Capital (healthy days). It is not passively purchased from market; it is produce in combining time with purchased medical inputs. Both value of Health and its influencers affect the demand. 
The demand for health is unlike most other goods because individuals allocate resources in order to both consume and produce health. There are four roles of person in health economics:
1.    Contributors
2.    Citizens
3.    Provider
4.    Consumers
 In the context of ordinary goods and services, economics distinguishes between a want, which is the desire to consume something, and effective demand, which is a want backed up by the willingness and ability to pay for it. It is effective demand that is the determinant of resource allocation in a market, rather than wants. But in the context of health care, the issue is more complicated than this, because many people believe that what matters in health care is neither wants nor demands, but needs. Health economists generally interpret a health care need as the capacity to benefit from it, thereby relating needs for health care to a need for health improvements. 
Not all wants are needs and vice versa. For example, a person may want nutrition supplements, even though these will not produce any health improvements for them; or they may not want a visit to the dentist even if it would improve their oral health.
Healthcare has its peculiarity that may mean, it is not considered as any good or service where demand can be analyzed, however that the usual assumptions about the resource allocation effects of markets do not hold meaning for healthcare. Moreover, it may well be that people wish resource allocation to be based on the demand for health or the need for health care, neither of which can be provided in a conventional market. 
D.    Supply
Supply is to achieve and fulfill the demand of health. The supply side of the market is analyzed in economics in two separate but related ways. One is related to the Resource input and Goods output model, looking at how resource use, costs and outputs are related to each other within a system.
Important influencing factors to supply are as follows:
1.     Cost of production of service
2.     Alternatives of services
3.     Substitutes of inputs
4.     Remuneration and incentives
5.     Medical equipment and pharmaceutical markets
Other way in which supply is analyzed is Market structure – how many firms are there supplying to a market and how do they behave with respect to setting prices and output and making profits. These generally managed through market equilibrium
E.     Market equilibrium 
State where economic forces like demand and supply balanced. For healthcare many believes, it is imperfectly competitive market (Nash Equilibrium) where there is strategic interdependence between two firms. The Nash equilibrium occurs when both firms are producing the outputs which maximize their own profit given the output of the other firm. The other side believes it is competitive market. Market equilibrium factors are as follows:
1.     Money (payer), investment etc.
2.     Price mechanism
3.     Time price factors
4.     Waiting list
APPLIED ECONOMICS
F.      Micro-economics evaluation
In simple words it is decision making related to allocation of resources. Major goal of microeconomics is to analyze the market mechanisms that establish relative prices among goods and services and allocate limited resources among alternative uses. It also analyzes market failure, where markets fail to produce efficient results. Few topics which would play important role in micro economics evaluation are:
1.     Cost effectiveness and cost benefit analysis of alternative treatment
2.     Cost utility analysis
3.     Opportunity costing
4.     Allocation based on phases of disease (Detection, diagnosing, treatment and after care)
5.     Market structure
Healthcare market typically which are analyzed are:
1.     Healthcare financing market
2.     Physician and Nurse services market
3.     Institutional service market
4.     Input factors market
5.     Professional education market
G.    Planning, Budgeting and Monitoring
Optimizing the system through effective instruments and tools, few are as follow:
1.     Budgeting
2.     Manpower allocation
3.     Regulation and norms
4.     Incentives structure
H.    Evaluation of system
It is to bring efficiency and equity to the system to bear on (E) Market equilibrium and (F) Micro economic factors through inter regional comparison, international comparison and benchmarking.
Efficiency - the allocation of scarce resources that maximizes the achievement of aims by Knapp.
Equity is always an important criterion for allocation of resources. However, it is observable that people attach more importance to equity in health and health care than they do to many other goods and services. It is important to distinguish equity from equality. Equity means fairness; in the health care context this means a fair distribution of health and health care between people and fairness in the burden of financing health care. Equality means an equal distribution, but it may not always be fair to be equal. 
Health economics has number of methodological limitations but it can offer us useful concepts and principles which help us think more clearly about the implications of resource decisions. An understanding of some basic economic principles is essential for all practitioners not only to understand the useful concepts the discipline can offer but to appreciate its limitations and shortcomings.
Wish to hear more from my connections on this...
The article was first published on Dr. Karan Sharma's LinkedIn pulse page here, its been re-published here with the Author's permission. 
Author
Karan Sharma
Healthcare Strategy and Customer Experience Manager, Technology Enthusiast, Innovator and Healthcare Business Leader.

Highly experienced and focused senior Executive with strong background in Healthcare strategies and business problem solving. Have managed multiple projects in different disciplines and geographies with strong track record of building great teams with exceptional results. Provide and Execute vision, strategies or idea.

He is a clinician and healthcare management professional, worked in India, Middle East and Maldives.
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Some perceived shortfalls in the proposed Indian National Health Stack by Dr. Pramod Jacob

There is ongoing work in India for a Nationwide Information Technology platform, that will support and facilitate the deployment of the Ayushman Bharat program, which is called the “National Health Stack”, the objective of which is to help achieve Continuum of Care across Primary, Secondary and Tertiary care for each of its citizens and facilitate payment for the care.


A draft of the National Health Stack (NHS) strategy and approach was put out in July 2018 for feedback and comments till July 31, following which no final draft has been published in the public domain. Hence the shortfalls brought out in this write up are based on the July 2018 draft and so these are perceived shortfalls, because the final version may have addressed these concerns. If so, request that the final document be published in the public domain. http://niti.gov.in/writereaddata/files/document_publication/NHS-Strategy-and-Approach-Document-for-consultation.pdf  

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