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The smart way of providing affordable health care

Ubiquitous smartphones and 3G data can create a low-cost platform for delivering efficient medical services in India

Unitus Seed Fund
Published: 18, Jun 2015

Unitus Seed Fund is a venture seed fund supporting startups innovating for the masses in India. Unitus invests in healthcare, education, mobile commerce & value-added services, marketplaces & e-commerce, retail & distribution, agriculture, and water & energy sectors. Founded in 2012, Unitus Seed Fund is part of the Unitus Group, a financial services group operating in India and other emerging markets since 2000. Unitus Seed Fund is based in Bangalore and Seattle.

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Affordable quality health care diagnostics must be available to both rural and urban areas (Photo: Amit Verma)

As India’s masses increase in affluence and awareness, they are demanding access to better health care. But the supply of conventionally-delivered health care services cannot hope to keep up with the ever-increasing demand. The clamour for specialists able to address issues beyond what often poorly-trained general practitioners can handle is getting especially loud. To understand the scope of the issue, here are the statistics for selected health care specialists in India vs the US. healthcare

The US is widely considered to have a shortage of specialists, as well as a shortage of primary care physicians in rural areas. It has suffered from such shortages for decades. By comparison, India has a super-shortage of specialists, with less than 1 specialist per 1 lakh people. The US vs India ratio in this case ranges from 5x to 25x. While these per capita gaps will narrow over time, it will take many years.

So how are the crores of Indians, who have no access to a specialist, going to get help in the next 10 years? Providing new means of affordable access is no small task. We see five factors that must be addressed: First, services of specialists must not only accessible, but also affordable to both urban and rural India. Indians have a high willingness to pay for quality health care diagnostics that are reasonably affordable. There is growing health care consumer awareness in India, so demand will continue to grow if care is affordable and accessible.

Second, services must be from a trustworthy source. Because of all the quacks and healers here, Indians are generally sceptical unless they can find genuine medical credentials. This is even true of “branded” health care services. People want “board certified” or the equivalent along with references.

Third, convenience is a major factor for consumers. People lead busy lives. If you want to visit a specialist, appointments are hard to get and then you end up waiting in a queue. For many people, this means complicated logistics with family, cost of transport to a specialist facility, and lost income. Getting treated for the simplest of maladies, too, is an expensive investment.

Fourth, providing consultation needs to be convenient for specialists. Most specialists are busy, so to take on new clients, they need a solution which enables them to get more services done in the same time, and/or to make better use of their time when they are between patients or in transit.

Fifth, specialists need to earn money. While motivations vary for specialists, it is fair and right that they get paid for additional services delivered based on the time invested. Ensuring fair remuneration also helps ensure that they pay attention to quality. It must also be reasonably easy for a specialist to reliably receive payment.

Enter the new smart mobile platforms, which are soon going to be ubiquitous. The cost of a basic Android smartphone is now Rs 2,500 and falling. In not too many years, it won’t be possible to purchase a new mobile phone that isn’t a smartphone. India has the cheapest mobile services on the planet. 3G is already available across much of India; there will continue to be a ferocious price war to capitalise on the 3G and 4G spectrum purchased by the mobile carriers. This is all good news for consumers and health care providers. Why? Because, the combo of ubiquitous smartphones and 3G data creates a massive low-cost platform for delivering health care services–the foundation of Telemedicine 3.0.

Mobile platforms are changing the game for diagnostics, creating opportunities for Telemedicine 3.0. Here’s the formula for the future of diagnostics by many specialists: Smartphones, tablets and laptops (bring your own) at health clinic. Connected non-invasive diagnostic devices capture diagnostic and patient info. Phones/tablets connect securely via 3G/4G data to cloud-based apps. Cloud services connect to a network of specialists using smartphones/tablets, ready to provide fast responses.

Here are some of the diagnostic services ready for disruptive growth:

Ophthalmology: Eye screening for disease and refraction issues can now be done by a technician using new low-cost devices such as Forus’ 3netra, routed via mobile networks to ophthalmologists working in their homes, in the back seat of a taxi, or waiting for a flight and diagnosed with a tap on their smartphone. In fact, one of our portfolio companies does exactly this.

Radiology: CT scans, X-rays, ultrasounds can be captured by a technician. The remote radiologists can then view these images along with other relevant patient data wherever they are on their smartphones, tablets or laptops and provide diagnosis. Numerous companies provide this technology today in developed markets, and numerous startups are looking to create low-cost versions of the same in India.

Cardiac care: Today, ECG monitoring devices are primarily sold to health facilities that have a cardiologist in near proximity. If you could easily transmit an ECG image via a smartphone to a group of on-demand cardiologists, you could suddenly put ECG devices in a 100 more places.

Dermatology: Eighty-five percent of skin issues can be fully diagnosed by a dermatologist with a photo taken by a smartphone. From the embarrassing STDs and acne to rashes that don’t go away and other skin issues, there is a huge efficiency to the consumer and the doctor in managing the interactions through a mobile platform.

“Diagnostics as a service”: Disrupting and serving

In the next few years, the traditional model of selling diagnostic devices is going to be replaced with selling “diagnostics as a service”. Rather than paying for a diagnostic device upfront, a health centre will get a no- or-low-cost device installed and a technician trained. This device will be integrated through 3G/4G with a group of quality specialists who can deliver opinions on patient diagnostics within minutes. And the business model will be revenue sharing. This “diagnostics as a service” has the potential to increase the diagnostic device market size in India in magnitude, connect under-utilised specialists with previously-neglected populations, and usher in a much-needed realisation of the long-held vision of telemedicine.

- By Dave Richards, co-founder and managing partner, Unitus Seed Fund

  • Kishore Reddy

    We have been experiencing Telemedicine projects in this new Millenium launched first by Apollo and later Narayana, private hospital network. Later GOI supported through ISRP Telemedicine Network funded and supported as communication technologies were expensive in the first decade of this century. Unfortunately after this, in spite of government specially allotted fund for the 12th Plan did not show effective results. PPP models need to be simplified and too much of official jargon has to be reduced and public awareness on its role to be projected as the top most priority and fixed time bound PPP based Telemedicine models need to be taken on war footing basis. Unless and until the governments do take stringent steps, it is impossible to meet the demand and supply gap in healthcare needs for the rural areas and any kind of other means would only be a waste. We are fortunate that the present decade has seen huge change in the broadband networks and mHealth and Mobile vehicle based services would the golden opportunity for the rural health development for all primary care and secondary care accessing the speciality care services through Telemedicine/Telehealth. Medical devices have been very cost effective to see preventive care. As we see alarming population growth, environmental hazards are advancing into most critical healthcare issues, Governments (both Central and States)need to adapt and bring a significant change in healthcare delivery.

    on Feb 20, 2016
  • Deepshikha M

    Nice article http://www.jiyopalpal.com/

    on Jan 24, 2016
  • Dr Sanjay Kumar

    Our current conventional health care ecosystem is acute care management and hence every time patient has to take consultation with specialist. This ecosystem will have to be changed to continuous care management where accredited health care professional rather than specialist will be the primary level of contact. They will provide wellness services to healthy individual, disease management service to person suffering with chronic illness and can present patient history in more elaborate way to specialist when required. New gadgets and online application like EMR, Remote sensing device, tele-consultaion with specialist will further add value into this chain. With this model specialist will be effectively utilized, Quakes will be eliminated and more jobs will be created in health care industry.

    on Nov 15, 2015
  • The smart way of providing Affordable Healthcare – Unitus Seed Fund

    [...] Read the complete blog here > [...]

    on Oct 14, 2015
  • Health Insurance Basics India | INSURANCE

    [...] The smart way of providing affordable health care – There is growing health care consumer awareness in India, so demand will continue to grow if care … Enter the new smart mobile platforms, which are soon going to be ubiquitous. The cost of a basic Android smartphone is now Rs 2,500 and falling. [...]

    on Sep 24, 2015
  • Dhanalakshmi

    I agree with this. But no need to worry. ASHA+ - a hand held health monitoring device with smart phone app will be a great solution for these issues. Coming soon.

    on Sep 15, 2015
  • Cameron Powell

    Dave, I couldn't have said it better myself. As it happens, my co-founders and I (mostly my co-founders, genius Indians) have built the solution to the problems you pose. How do you remedy an insufficient supply of high-end medical expertise? By disruption, in one way of looking at it. That is, by creating a free, mobile app that performs differential diagnosis and appropriate workup strategy at the level of a team of specialists - in fact, I call it a team of specialists in the palm of your hand. It is just what Vinod Khosla has written about, except that our final product is beyond even his vision in efficacy and utility. Again, like Google, it's free. We aim to do for medical information what Google did for information generally: to democratize it and make it easily and conveniently available to every person on the planet, regardless of race or religion, location or income. The fully-featured apps are coming out in a few weeks, while the web app -- see http://beta.physiciancognition.com - has been earning rave reviews from clinicians since March. If you know of providers who could benefit from having a bunch of doctors in a box, so to speak, please pass it on! Namaste, Cameron Powell CEO Physician Cognition

    on Sep 9, 2015
  • Manish Srivastava (Pravartan Technologies)

    Dear Dave, I fully agree that, new delivery mechanism & models need to be put in place to increase the access on quality healthcare. That needs to happen by moving away from traditional model, interaction & relationship of Hospital, Doctor and Pharmacy & Patient. To my mind new Healthcare system approach should look at three pillars of Healthcare delivery Device, Medicine & Doctors and various models are needed to increase the availability of doctors, reach to medicine & affordable devices & platforms. I'm glad to see the details of Cardiac Care innovation in your blog. It’s a great morale booster and validation of our effort and probably acknowledgement of our start-up by virtue of being a finalist in Unitus Seed Fund's StarHealth Competition.

    on Sep 9, 2015
  • Shwetank

    Dave, Totally agree - but we also need to provide a livelihood to all the quacks and healers out there today. One approach could be- https://goo.gl/aH2blA

    on Sep 9, 2015
  • Nainesh Purohit

    I absolutely agree with this article that due to lack of healthcare resources particularly scarcity of specialist, even primery healthcare is also a big issue so how far it is possible to think about quality healthcare. But since last few years, as per my observation, concept of tele-diagnosis is growing and also having acceptance in community. When we started small project of Tele cardiac assessment project 3 years back as on-demand ECG service with online reporting in Ahmedabad, we considered it be a most chalanging. But within a few month it became most acceptable service and now we are reporting almost 150 patient every day from different corner of Gujarat every day and that too centrally with engaging only singal specialist. This type of models need to scale up for mass. I believe that if tele-diagnostic model can be designed backed with quality and efficient services it will definitely improve healthcare standard of India, particularly rural healthcare, and also get acceptance in community.

    on Aug 5, 2015
  • Dr.S.V.Kulkarni

    Dear Dave, I absolutely agree with what u are suggesting.There are still more unmet needs which can be served by a smart phone platform. I am very actively involved in advocating EHR & smart phone apps for physicians,diabetologists & family physicians.Conducted workshops,demos at many national & international conferences. The inertia is from both the sides.Now a days social media platforms are increasingly becoming popular in the medical professionals. We have a 150 family practioners group called NMDOC,ECG for ecg reporting & MadhuMitra-Friends of Diabetes for our seet patients. I am really interested in becoming a major contributor in this neglected avenue of patient care. Let us be in touch . Dr shriram V.Kulkarni- M.D.senior consulting Physician Navi Mumbai

    on Aug 2, 2015
    • Cameron Powell

      Dr. Kulkarni, our missions are completely aligned. Please examine the extraordinary algorithm conceived and designed by my Keralan co-founders and consider it for your own use - no charge: www.PhysicianCognition.com. The full mobile apps will be out soon and we'd love for you to use them for as long as you like, and pass them around. Let's save lives and money! Cameron

      on Sep 9, 2015
  • T V Raghunath

    I belong to the Rotary movement and drive many medical and education programs in Karnataka . we are keen to drive the concept of telemedicine and wish to understand how we could tie up with some well known doctors and rural health centres . looking for some leads and some advice on the subject

    on Jul 23, 2015
    • Rajan

      Can you please call me +91 99305 72246 or email me at rajan@healthnine.com

      on Aug 18, 2015
  • Elizabeth

    To my uneducated eye, this model seems to rely on primary care physicians that can take the results of a potential swath of diagnostics and make recommendations for care. Would it make sense to pair this services-based specialist model with a subscription-based primary care model?

    on Jul 23, 2015
  • Sanjay Bhardwaj

    Well articulated article , specially when it comes to specialists care in urban scenario, however what is missing is access to healthcare to over 700 million population who have little or no means to access even basic healthcare. Besides comparing India to USA will be like apple vs oranges , too contrasting and bipolar comparisons. Besides technology based solutions can carry out Screening and Triaging for much needed NCD's that are contributing heavily to the otherwise over burdened healthcare infrastructure.

    on Jul 21, 2015
  • B S Bhatia

    I was with ISRO and had initiated the Telemedicine activity. This led to providing Telemedicine facility being provided to a very large number of rural hospitals. When the activity was initiated the availability of mobile technology was limited. I have now retired from ISRO. I wonder if it would be possible to combine some of these experiences with ISRO network. One possibility is that the Telemedicine Society of India takes some initiative in this direction.

    on Jul 7, 2015
  • The smart way of providing Affordable Healthcare – Unitus Seed Fund

    [...] Read the complete blog here > [...]

    on Jul 6, 2015
  • Hospital cost of uninsured: $900 per patient, per year - World Health Portal

    [...] The smart way of providing affordable health care We see five factors that must be addressed: First, services of specialists mustn't only accessible. Also affordable to both urban and rural India. Indians have a high willingness to pay for quality health care diagnostics that are reasonably … Read more on Forbes India (blog) [...]

    on Jul 1, 2015
  • Manoj Khandelwal

    There are plenty of opportunities waiting for young entrepreneurs, who can take role of enablers in digital era. One fine example is health care due to constrain of availability of specialist and ease of treatment (flexibility). This space is going to get lot of innovative solutions.

    on Jun 26, 2015
  • Manu

    Amazing article Dave. We at Cooey has build such a platform with smartness build in. We are sure the world of health care will transform with mobile, affordable devices and remote care.

    on Jun 26, 2015
  • Skin Care Physicians Norwalk Ct | Skin Care Treatments |Skin Care Products

    [...] The smart way of providing affordable health care – To understand the scope of the issue, here are the statistics for selected health care specialists in India vs the US. The US is widely considered to have a shortage of specialists, as well as a shortage of primary care … [...]

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