India has actually always believed in a disease prevention model of healthcare — the Ayurveda system, which relies heavily on keeping one’s body and mind in balance and thus, disease-free. In it, disease treatment also focuses on the root causes and was not based on addressing symptoms alone. By writing about Ayurveda, I do not mean to single it out, for other methods of medicine also do have a strong aspect of preventive medicine. The objective here is to simply point out that this model of preventive medicine is not new to our country.
At the beginning of the 20th century, healthcare was centered around acute care — if you got sick, you called a doctor. As the century progressed, infectious diseases gave way to chronic diseases as the most common cause of death. However, healthcare never evolved beyond the acute, treatment-based model that had existed for over 100 years. Today, lifestyle-related chronic diseases account for 81% of all hospital admissions, 76% of all physician visits, and worldwide, USD 1.5 trillion is spent on healthcare each year.
I would like to take you back once more. This time only to back up and revisit what preventive health really means. Disease prevention has a few hallmark features — prevention is holistic, yet pragmatic (i.e. medication only when needed), prevention looks at a person as an individual and not as a body. This means understanding the person’s physical, lifestyle, emotional, medical, cognitive, social and even spiritual needs. Before you think that I am too far out, put any one of these aspects out of balance, and you will find the person quickly turns into a patient that needs intervention.
For this individual, a focus on prevention would mean less trips to the doctor for interventional care and the shift would be to periodic, predetermined visits. At these, the healthcare provider and the patient work together to shed light on potential future issues, and discuss how to get ahead of them before they become a problem. This can be in the form of discussion, laboratory and imaging studies and often questionnaires. Patients will find that this sort of visit will lead to a healthier and longer lifespan – and as an added benefit – these visits will be easier on the pocket.
Thanks to the current Covid pandemic, we are witnessing a faster move from the larger hospital setups that are providing interventional care, to smaller clinics or even, as the second covid wave is showing us, the patient’s home. This will open up all kinds of avenues for the healthcare industry to provide value-added services. For example, in just the last few weeks, we have witnessed our patients getting more ambulatory care delivered to their homes — from oxygen cylinders and x-rays, to BiPAP machines and IV medications. This trend is not likely to slow down in any way in the near future. We foresee that in the next wave, we will witness technology-led solutions following the path that Covid-19 has paved. These innovations may be in the form of IoT devices, to specialized instruments for telemedicine, to data analytics, all vying for the same space – the patient’s home – all geared (we hope) towards a focus on disease prevention and early intervention.
Such forms of health technology penetration into people’s homes can also help the rural underserved areas of our country. This could dove-tail in well with the current Ayushman Bharat scheme to allow innovative private enterprises to move the country towards a prevention focused model.
Speaking of the government initiatives, the focus of Public Private Partnership (PPP) should tilt more towards prevention, rather than intervention, as this is the way to cut long-term healthcare costs, as is evident from outcomes in many Western nations. The dream of universal health coverage can be made a reality sooner only if we ride the current focus on prevention rather than costly interventions.
This sort of patient-centric, prevention-focused solution could help the insurance industry to have a better handle on efficiency and managing claims. This sort of data-exchange and communication can be a win-win for both the patient as well as the insurance company.
What is trending in patient’s homes will then be mimicked in corporations. Corporations that are providing health benefits and employee wellness programs will find that having a focus of such programs on preventive diseases, the productivity and illness related loss in labor-hours will drop. This will then be followed by similar technology penetration as will start in people’s homes.
In a well publicised study, the Associated Chambers of Commerce of India, reported that INR 1 spent on employee disease prevention saves INR 133 in absenteeism costs and INR 6.62 in healthcare costs. No one can argue against that kind cost-benefit ratio of preventing diseases amongst employees! The same study found that 83% of employees are willing to contribute towards a company sponsored wellness program.
Covid has brought some more thinking home; and literally so! During these multiple lockdowns, people started educating themselves about Covid and in doing that, have come across many strategies that are geared towards prevention. Once this concept of keeping a healthy body-weight, avoiding lifestyle diseases has sunk in, they are having a second look at this cost-effective method. At Circee Health, we have noticed an uptick in the kind of questions that are being asked – typically, revolving around disease prevention. By that I do mean disease prevention in general, not only Covid prevention.
While in total numbers, India might produce an impressive number of physicians, nurses and other healthcare workers, it pales when we look at our per-capita ratio. A focus therefore on disease prevention takes a lot of the burden off the system in terms of manpower requirement.
Another, not so obvious reason for the move towards prevention (and cutting out most medication) is the issue of non-adherence to prescribed treatment regimen. In a recent paper by Dr. Pooja Singh from All India Institute of Medical Sciences (AIIMS), reported as little as 50% or fewer adherences to prescription medications. Needless to say, this dismal rate can lead to further aggravation and cost of handling the disease burden.
Shifting gears and thinking outside of medicine, we are predicting that large pieces of this disease prevention market will be yoga and fitness centers and even healthy meal delivery companies.
It is time that we in the Indian healthcare system, make lemonade with the very sour lemons Covid has served up, and push for a faster move in the direction of prevention and away from acute treatment-focused care.
The elephant in the room that we are ignoring (since Covid has taken over most of the conversation), are non-communicable diseases (NCD). These NCDs have a hallmark of taking a toll over the patient’s lifetime in terms of health and financial cost to the patient, and to the system as a whole. However, the good news is that preventive medicine can handle this elephant with aplomb! NCDs don’t just appear. They start with tell-tale signs that any good prevention-focused healthcare provider can identify, and given appropriate tools, reverse the disease condition. With NCD numbers in India climbing at an alarming rate, shouldn’t it be a wakeup call that it is time for preventive medicine to claim its rightful place in our healthcare system?
By: Dr. Jennifer Prabhu
Co-Founder & CEO, Circee Health- a disease-reversal platform
MD, MT (ASCP), FAAP, FACP
Dr. Prabhu is also a double board-certified doctor in Internal Medicine and in Pediatrics