India features a mixed-market health system where chronically low investment in public health systems has led to the proliferation of private care providers. They occupy a wide spectrum – from traditional healers to corporate owned multi-specialty hospitals – and provide primary, secondary and tertiary services paralleling the three-tier public health system. But without a governing steward, they don’t provide a coordinated continuum of care. A patient often zigzags between multiple providers with unclear referral pathways, and ends up receiving questionable quality of care that is typically neither safe nor affordable.
The global experience suggests that health systems organised around primary healthcare provide a sustainable care continuum and better health outcomes. For this, we need to establish primary care linkages and organise the primary healthcare sector under a single umbrella. While the government is working to develop an integrated digital health infrastructure in India, a new breed of technology platforms has emerged as an alternative, fuelled by innovative technology, market strategies and venture capital.
Technology platforms in India launched a decade ago as online portals that aggregated provider information, scheduled appointments and, after the coming of smartphones and high-speed internet, entered the service provision space by creating health records and facilitating remote consultations. Today, these platforms bring providers together on a common platform, attract consumers, facilitate and secure transactions, and provide end-to-end support for a seamless experience. Embracing a demand-driven approach, these platforms allow consumers to expect standard prices and quality plus a marketplace to search, select and compare available services.
The consumer can log in to a platform through their phone or computer, log their symptoms, connect with a provider and receive a prescription. The platform keeps a record of this interaction as well as past medical records. Some platforms also provide online diagnostics services, with sample collection at home and online report generation, and drug delivery services with reminders and automatic refills. Continuous interaction on a platform generates data to better understand consumers’ health needs and creates opportunities to streamline the care continuum.
Being a sunshine sector, it attracts many players who develop different business models and diversify revenue streams. Companies like Practo, mFine, DocsApp and AskApollo already enable millions of consumers to consult physicians and specialists in real-time via mobile apps. Portea, CallHealth and Zoctr provide home services. Services like SigTuple, KlinicApp, 5C Network and Qure.ai provide direct-to-consumer laboratory tests. Then there are online medicine-ordering services like 1mg, Netmeds and PharmEasy.
These platforms have the potential to alter the fabric of Indian healthcare markets – but also have their own challenges. IT-related disruptions – non-scheduling of appointments, payment issues, delays in drug and diagnostics delivery – often lead to dissatisfied patients and providers. Other common issues include compliance difficulties, growth pressure and business sustainability.
But despite these troubles, many platforms have created a huge demand for personalised treatment. The platform economy has trained consumers to expect transparent pricing, standard quality and the ability to do business with a provider of their choice. With countrywide lockdown due to COVID-19 pandemic, these aggregator platforms proved to be lifelines for lakhs of patients and providers.
To emerge as a winner in this highly competitive market, online platforms will have to harness scale, develop a revenue model that justifies their valuations and grow at a dramatic pace while keeping the patient experience at a high. Engagement with other market players will provide for a sustainable and potentially profitable strategy by uniting clinical expertise and supply chain excellence with the cultures of innovation, competitiveness, and price transparency.
With an optimistic outlook, they present an opportunity to create models for improving health outcomes and patient experiences at a systems-level, and in organising a virtual retail-based health hub where providers forge partnerships and are more amenable to monitoring and regulation.
The author acknowledges Rajeev Sadanandan, Dr Devadasan and Dr Rahul Reddy for their valuable feedback and comments.
Vivek Panwar is a fellow at the Health Systems Transformation Platform, ISID Campus, New Delhi.