mHealth can Reduce India's Healthcare Expenditure and Increase Public Wellness

Developing countries lack infrastructure, they are set to benefit more from mHealth than developed countries which have a legacy system and worker-base to deal with

Mohammad Chowdhury
Published: 24, Jun 2014

Mohammad Chowdhury is PwC's Telecom, Media and Technology consulting leader across Australia, SE Asia and New Zealand. Until recently he built the practice in India where he became one of the most quoted industry experts in the country. Mohammad has served as an adviser to telecom sector reform in Saudi Arabia, Zimbabwe, Ethiopia, Slovakia, Poland and Slovenia and during 2015 as national telecommunications adviser to the Government of Myanmar. Previously in his career he has conducted significant strategic roles at Vodafone and IBM. He is quoted regularly by the Financial Times, Wall Street Journal, BBC, CNBC, TV-18 and NDTV. Mohammad has worked in 83 countries, lived in 7 and speaks 6 languages. He has a BA in Politics, Philosophy and Economics from Oxford University, an MPhil in Economics from Cambridge University, and strategy training from Harvard Business School. He was born in London, has family origins in Bangladesh, and is married with two sons.

mHealth

India has one of the biggest healthcare burdens in the world, due to a limited endowment of doctors per capita, a high rural population which cannot easily access specialists, and a significant communicable disease burden. Addressing the demand for healthcare by building more and more public health facilities exposes the sector to a continued trail of major development projects, and with it a prolonged and bigger fiscal headache for the exchequer. As the new Union Minister of Health and Family Welfare settles in office, it would be worthwhile to note how much mobile health could help attain some of the goals set forth by the health ministry, in lieu of brick-and-mortar investment, and with it lighten the public finance burden on the finance minister.

As the chart shows, in contrast to many other developing countries, a large chunk of India's urban population suffers from chronic diseases which compels people to regularly go for health check-ups and clinic visits. Diabetes is the most obvious example of this, with India being touted as the diabetes capital of the world.

As the new Union minister reviews India’s health policy, there are 3 themes that he can pay attention to, which render mHealth increasingly relevant for India:

  1. Convergence of mobile phones, traditional computers and tablets which are increasingly working together with back-end technology support to enhance healthcare delivery as well as lower operating costs and, huge potential savings to capital expenditure in building more and more hospitals and clinics. Smartphone uptake will surpass 200 million within a couple of years, and the general public’s usage of data on mobile devices is shooting up.
  2. mHealth is reducing readmission rates in chronic patients (eg those with Type II diabetes) through better monitoring and higher compliance rates for prescribed care. Regular check-ups can be easily industrialised through remote monitoring using mobile, interpreted by data analytics at the health clinic.
  3. mHealth provides the potential to generate invaluable societal data, provided there is a common and acceptable framework to host and share the data responsibly.  For public health policy development in India, the benefits of a programme to collect information more systematically through mobile are immeasurable.

However, the health minister's trump card on mHealth could be how the public purse is set to benefit. A recent analysis PwC found that Brazil could save Rs 90,000 crore ($14 billion) of public healthcare expenditure in 2017 alone from the uptake of mHealth. It reckons that in India, savings from public health care spends would be similar. This is because mHealth in India could be used to substitute a portion of future physical infrastructure (of hospitals and clinics) through remote diagnosis, monitoring and care.

patients

Because developing countries lack infrastructure, they are set to benefit more from mHealth than developed countries which have a legacy system and worker-base to deal with. Europe's public health infrastructure is a source of huge employment, and mHealth is seen by many as a distraction or a threat. North America and Australia are somewhat different, as they are large territories with dispersed populations which can benefit from some degree of remote care, but in their cities the same obstacles that apply to Europe also exist.

For mHealth to scale up in India, the government needs to create an mHealth policy and create a strong public push for its adoption. Healthcare is too regulated a sector for mobile solutions to achieve scale just through successful private sector pilots and initiatives. The National Telecom Policy (NTP) 2011 refers to mHealth and the government has undertaken some projects already, but so far it has not shown any real seriousness about mHealth, and no service has scaled up in India.

Aside from policy adoption, what else needs to be done? First, healthcare practitioners need to be encouraged, trained and ultimately mandated to adopt mHealth as a part of their methods for diagnosis, and staying in touch with, patients. Second, a number of regulatory gaps need to be closed to enable mHealth to scale up faster. These include defining what can and cannot be prescribed by a medical practitioner via remote diagnosis, and where the liability lies for healthcare provisions when an ecosystem of health workers, doctors, telcos, data analysts, device manufacturers and IT service providers are involved in the cycle of service delivery.

We should be optimistic about India because patients in developing countries are ready to pay for better access to affordable healthcare. A recent survey found that 20 percent of developing country respondents are willing to pay $5 per annum for subscribing to a mobile healthcare service. The figure is only 10 percent in developed markets. The propensity to pay for mHealth in poorer countries is higher because the cost of standard healthcare relative to earnings is higher. To attend a specialist in a medium-sized town that is 200 km away from the village, a patient may have to spend Rs 500 on the appointment, but as much as another Rs 2,000 on travel, lodging for a night, food, and foregone income. Prohibitive economics such as this dissuade millions from seeking guidance at all, until it is a medical emergency.

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