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Healthcare goes domestic – but is it a home run for patients?

Home healthcare Copyright: <a href=''>Krisdog / 123RF Stock Photo</a>The home healthcare industry is on the rise in India – and it has the capital to prove it. But is it a safe bet for patients as well as investors?

Increased interest from investors

Home healthcare services are witnessing increased interest from investors, says The Hindu Business Line. It puts this down to “a rise in chronic illness, coupled with hospitals’ inability to deal with the rising volumes.” The report says the industry could be worth $8.4 billion by 2020.

A number of recent cases illustrate this. HealthCare at Home (HCAH) – an offshoot of the UK-based service with the same name – raised Rs 250 crore ($40 million) from Quadria Capital, a private equity firm which specialises in healthcare, in April. HCAH is Quadria’s first investment into home healthcare – with the firm seeing “huge potential” in home healthcare, according to its director Sunil Thakur.

The investment comes as HCAH plans to expand into 25 cities in the coming years, growing its workforce from 800 at present to 15,000 by 2020. It looks to reach Rs 1,000 crore (US$154.76 million) in revenues by that year.

Medwell Ventures – which employs more than 1,000 medical professionals to draw up care plans for a range of chronic conditions – enjoyed a similar boost. It raised $21 million in its series B round of funding in April, the lion’s share of which came from Mahindra Partners. This marks the multinational company’s first investment into healthcare.

Business Today quotes Vishal Bali, Medwell’s chairman, as saying the funding will be used to “expand its base of technology and also expand the portfolio of service offering in more clinical specialties and build presence in segments like oncology, arthritis and expand in pulmonology.” The company plans to be a “pan-Indian player”, as it expands across the country. It plans to support one million patients in the coming years, the article adds.

The home healthcare industry is growing at a rate of 20 percent annually, according to VCCircle. “The booming sector has caught the attention of entrepreneurs and investors, alike, and is evolving as an organised, technology-led industry with standards and protocols” the magazine says.

All it’s cracked up?

This aside: is home healthcare all it’s cracked up to be?

The growth of the sector arguably stems from deficiencies in India’s public healthcare system. Healthcare is principally a state responsibility. However, Central Government spending on healthcare has been too low for too long, hovering around 1.2 percent of GDP – though the Modi government hiked the health budget 23 percent earlier this year.

Public hospitals are still ill-equipped to cope with the increasing strain non-communicable diseases (NCDs) are placing on the country, as lifestyle-related conditions are on the rise. Staffing levels in India’s hospitals – with one doctor for every 1,681 patients – also contributes to the shortfall.

Home healthcare aims to compensate for these shortfalls, but some suggest there are risks in putting patients’ well-being in their own hands, or the hands of caregivers. This is partially to due to the patients themselves. The Economic Times raises the point “awareness of safety standards is…feeble” in India, particularly with regard to medical devices.

“Being voluntarily vigilant about quality and safety certifications is unfortunately not the tendency of majority of the population”, the ET notes. Therefore, “most people who purchase these devices do not necessarily check for the requisite marks to ensure that the device is certified as safe and accurate for use by a recognized laboratory.”

The ET also describes technical proficiency as an issue. It suggests “many types of home healthcare equipment are often too complex for safe and accurate use by most patients and caregivers.” This problem can be exacerbated by “outdated or ungrounded electrical wiring systems…insufficient ventilation, temperature and humidity control systems” and incompatibility with other household devices.”

Copyright: <a href=''>rixie / 123RF Stock Photo</a>
Some suggest home healthcare devices, such as blood pressure monitors, are not reliable.

Devices themselves can be problematic. Blood pressure monitors, for example, are prone to give out inaccurate readings, with the margin of error anywhere between five and fifteen percent. This could lead to patients not taking the correct dose of medication, if they believe their blood pressure is higher or lower than it actually is.

Home healthcare providers are outside the ambit of any regulatory framework. This could leave patients on the receiving end of substandard care, especially as more providers enter the market in the next few years. Addressing this is the remit of the government – and players in the home healthcare sector are advocating for the appropriate guidelines to be established, to ensure patients receive the proper quality of care.

Another issue is that home healthcare is seldom covered by patients’ health insurance, forcing them to go further out of pocket for medical care than they already do. Some companies are acknowledging and addressing this. Medwell is reportedly “in talks with two insurance companies to cover home healthcare services.”

Home healthcare has the potential to make up for some of the weaknesses of India’s public health system. For those with reduced mobility – such as the elderly and people with disabilities – and chronic conditions, it could be a boon. It is clear, however, that work must be done in order to strengthen and regulate the sector so that patients are protected and capable of managing their own care to a large degree.

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