REVIEW OF RECENT TRENDS AND STAKEHOLDERS IN THE INDIAN HEALTHCARE SECTOR
Mrs. Vijaya Jain
Assistant Professor, Rewa Gurjar Bal Niketan College Sanawad Dr. Paras Jain
Assistant Professor, Rewa Gurjar Bal Niketan College Sanawad
Abstract - The idea behind this was to advance academic research on healthcare stakeholders, particularly in the Indian setting. The healthcare system is intricate. Multiple parties pursue various interests, and this complexity is exacerbated in the setting of emerging economies where there are severe resource limitations (Nicolini et al., 2008).
The healthcare industry in India is evolving quickly. Particularly in light of the government's announcement of the Ayushman Bharat and Pradhan Mantri Jan Arogya Yojana (PM-JAY) healthcare affordability programmes and the growing use of technology in the way information is accessed, stored, and shared (Angell et al., 2019; Gupta et al., 2020;
Prinja et al., 2017). The intricate interrelationships between stakeholders in the Indian healthcare industry have changed as a result of these factors and a number of others, including shifting demographics, improving medical technology, and regulatory changes like the dissolution of the Indian Medical Council (IMC). The special issue was inspired by the need for a thorough investigation into how stakeholders' responsibilities are altering as a result of these quick and significant changes.
It seems sense that a single special issue would fall short of capturing the complexity associated with the numerous players in the Indian healthcare industry; yet, this issue serves as a foundation for ongoing discussion of these issues. We provide a summary of the contributions made by the papers included in this special issue and engage in a discussion of how those contributions relate to the stakeholders in the Indian healthcare industry.
These studies address problems involving several stakeholders and offer perceptions that improve our comprehension of market dynamics. We also make recommendations for future research paths that might further the discussion.
Keywords: Demographics, Intricate, Affordability, Medical Technology, Exacerbated.
1 INTRODUCTION
Alignment between different stakeholders, including local communities, the scientific community across various disciplines, public healthcare, private healthcare, regulatory authorities, executive, and even legal authorities, is crucial for dealing with epidemics, as evidenced by the actions taken by the government in dealing with the current pandemic.
Even before the pandemic hit, there have been a number of developments to the Indian healthcare industry over the past 20 years that have the potential to significantly alter stakeholder dynamics. The National Rural Health Mission (NRHM), which was launched in 2005–2006, sought to transform the structure of the healthcare industry, particularly in rural areas, by increasing community involvement in the delivery of healthcare through the involvement of Panchayati Raj Institutions (PRI) and developing a sizable workforce of Accredited Social Health Professionals.
As a result, the NRHM changed the community's function from that of a mere recipient of healthcare services to that of a significant stakeholder who can influence the planning and delivery of services locally (Husain, 2011).
The corporatization and privatisation of the healthcare industry, with several huge corporate hospital chains accounting for more than 60% of the nation's bed capacity, is a significant secular trend that has evolved (Srinivasan & Chandwani, 2014). The majority of these businesses concentrate on offering tertiary treatment in metropolitan settings. These factors have also changed the structure of the healthcare industry in India, shifting the position of physicians from owners to workers and increasing the influence of the business community, financiers, investors, and managers in designing healthcare services in India (Srinivasan & Chandwani, 2014). The government's role has changed from that of a healthcare provider through the public sector to that of a regulator and funder as a result of increased privatisation (more than 80%) and a commensurate decline in the involvement of
the public sector in healthcare (Bali & Ramesh, 2021). The Pradhan Mantri-Jan Arogya Yojana (PM-JAY), a welfare programme that provided health insurance to 110 million of India's poorest households, was introduced by the Indian government in 2018. (Angell et al., 2019; Gupta et al., 2020). The PM-JAY, the largest health insurance scheme in the world, adds significantly to the complexity of the healthcare system by combining both public and commercial healthcare providers with third-party administrators (TPAs) (Bali &
Ramesh, 2021). More hospitals are pursuing certification from the National Accreditation Board for Hospitals as a result of government laws including the Clinical Establishment Act and PM-JAY (NABH).
The majority of Indians must pay out of pocket (OOP) costs for healthcare services, whether they are received in public or private institutions. OOP in public hospitals often refers to the lack of supplies of drugs or diagnostic tools (Ellis et al., 2000). The Central Government Health Scheme (CGHS), Employees State Insurance Scheme (ESIS), other employer-managed welfare programmes for employees, insurance coverage provided by public and private healthcare insurance companies, state-sponsored healthcare schemes (such as Kalaignar in Tamil Nadu), and other employer-managed welfare programmes are just a few of the other state and private mechanisms for financing healthcare in India aside from the PM-JAY (Angell et al., 2019; Gupta et al., 2020; Prinja et al., 2017). Despite these measures, less than 20% of Indians have health insurance (Singh, 2016). The government's concentration on healthcare funding as opposed to healthcare supply, however, is projected to cause the healthcare insurance industry to expand quickly. Additionally, the current epidemic has brought attention to the importance of having health insurance.
Another trend in healthcare delivery that has been noticed globally and in India is the growing importance of information technology (IT), which includes the use of electronic medical records (EMR), empowering community and peripheral healthcare providers, connecting patients through online patient support groups, making healthcare information available online, and more. IT has affected both the delivery of healthcare as well as how patients and caregivers seek out healthcare. As a result, IT and the businesses operating at the interface of IT and healthcare have emerged as key players in the Indian healthcare system.
The discussion above provides an overview of the fast-evolving healthcare system in India and the associated complexity of the players involved. The following section describes how the articles in this special edition emphasise particular problems involving particular stakeholders.
2 STAKEHOLDERS DISCUSSED IN THIS SPECIAL ISSUE
The impact of technology in altering the conventional healthcare delivery system by affecting stakeholders' behaviour is covered in two articles in this issue. Panda and Mohapatra (2021) do a study of the literature on the Indian online healthcare market to determine the pertinent stakeholders and their associated dynamics throughout various lifecycle phases. The authors specifically stress the participation of many stakeholders, including IT developers and managers, medical professionals, nurses, patients, and carers, in various stages of the open health connect (OHC) platform's lifecycle from inception onward (Young, 2013). In administering an OHC platform, they emphasise the importance of technical factors like adequate interface design, user-friendly GUI, and technical support as well as informational factors like information credibility. The conclusions reached have significance for facilitating appropriate information flow throughout the current epidemic.
The governments have been greatly hindered in their efforts to provide individuals with accurate information that might enable proper behavioural modifications for managing the pandemic because of panic and inaccurate information.
The reasons why people interact with their physicians on Facebook are examined by Mishra (2021). Instead than using the typical techno-utopian perspective, the author chooses a critical lens to undertake an in-depth investigation of the phenomena (Lupton, 2013). Patients connect with their doctors for a variety of reasons, including receiving health information, looking for social support from other patients in the community, and rating doctors. This is in addition to the desire to communicate with their doctors. Through these stories, Mishra (2021) emphasises how gaining access to a doctor's Facebook page
paves the way for neoliberal practises and subjectivities, expanding the Foucauldian idea of neoliberal governmentality to the field of digital health.
For the expanding significance of digital health and telemedicine, it would be crucial to comprehend the dynamics of IT in healthcare delivery and healthcare seeking. As telemedicine has become increasingly prevalent—post-COVID—these studies in particular become more pertinent. In March 2020, the Indian government formalised new telemedicine norms, advancing digital health (IANS, 2020). The bulk of the population in India still uses conventional methods to acquire healthcare, despite the fact that technology is progressively permeating the industry, particularly in light of the current epidemic.
The majority of patients and their caretakers rely on recommendations from family, friends, or acquaintances to choose hospitals and physicians, even if Facebook posts and Google reviews play a significant role in doctor selection (Mishra, 2021). In fact, word-of- mouth (WOM) marketing continues to play a significant role in deciding which hospital or doctor a patient would ultimately choose (Dobele & Lindgreen, 2011). In their work, Mehra and Mishra (2021) make an effort to investigate the origins of patient recommendations for doctors. They specifically look at if and how the doctor's communication abilities affect patient WOM marketing. They contend that during in-person contacts between doctors and patients, patients form opinions about doctors based on the social interaction hypothesis (Lockie et al., 2015).
They used a quantitative method and surveyed 626 patients to demonstrate that good doctor-patient communication did, in fact, result in favourable recommendations.
They discovered that the aforesaid link was mediated by patient satisfaction and perceived influence, highlighting the route of this association.
The development of health insurance companies has significantly altered the Indian healthcare landscape. The government's emphasis on affordability and the rising cost of healthcare have accelerated the expansion of the health insurance business, which reached US $6.06 billion in FY 2020. The cost of the therapy has been progressively increasing even while the premium paid has been growing at a healthy rate of roughly 14% annually. These conditions present a significant challenge for private insurance companies because they must strike a balance between two competing demands to maintain profitability: provide quality service, which necessitates giving their clients the best possible coverage, and keep premiums low to survive the competition. The principles of the literature on the resource- based perspective of the company (Barney, 1995; Rumelt, 1991) and on competitive strategy (Porter, 1985) are drawn upon by Kumar and Duggirala (2021) to emphasise the crucial success elements for the enterprises in this fiercely competitive industry. They use a grounded theory method to conduct in-depth interviews with professionals in healthcare and health insurance to identify five strategic options that health insurance companies may take advantage of to prosper and obtain a competitive edge. The article's observations lay out the future course for India's expanding health insurance industry, particularly for private sector businesses.
As discussed in the introduction, the Indian health care system has become highly privatized and corporatized, with the market or commercial logic playing an important role in determining the stake holders’ behaviours. However, with health being a socially sensitive subject, the government is attempting to ensure quality, affordability and accessibility through regulations such as Clinical Establishments (Registration and Regulation) Act 2010, PM-JAY and the national medical commission (NMC). However, can market dynamics, albeit controlled and regulated, provide access to healthcare for everyone? Or is there some specific population that is crowded out?
Pingali and Das (2021) underline how market processes based on commercial rationale exclude uncommon diseases from the goal of finding innovative treatment modalities through R&D as well as for delivering a cure or care for these illnesses. Due to low volume, market-driven stakeholders avoid devoting resources to these disorders since the sustainability of such endeavours from an economic standpoint is debatable. Even with investments, the extremely low volumes lead to higher costs per patient, creating still another huge access barrier. Governments seek to direct resources toward diseases that are more common and afflict more people, which crowds out diseases that are uncommon or less noticeable. Patients have frequently gone to the courts to request access to the therapies. The courts have often ordered the governments to fund therapy. While India has
taken a forward step in developing a strategy, National Policy for Rare Illnesses 2020, to help patients with rare diseases, Pingali and Das (2021) argue that the policy is mainly quiet on resource and funding distribution. They offer a number of recommendations to improve financing for rare disease research, development, and healthcare provision in India.
The next section presents some of the directions forfuture research emerging from the articles included intheissue.
While this issue focuses on particular issues relating to some of the players in the Indian healthcare industry, the papers also present a number of potential directions for further study. This issue's articles include topics including the health insurance industry, the government's role in rare illnesses, and presenting patients as stakeholders who use technology and evaluate doctors. Alignment with a number of different ecosystem players might be difficult. To deepen their understanding of one another, future researchers might concentrate on various stakeholders, including NGOs, CBOs, hospitals in the public and private sectors, TPAs, and so on. All of the papers in this issue focus on ways to bring these stakeholders together for improved healthcare delivery. In dyadic connections between two stakeholders, such as between community level workers and those in the formal system, alignment can be difficult. The effects of NRHM and the growing application of technology in healthcare foster intimate relationships between informal community actors and formal systems. The current pandemic's reaction, which placed a strong priority on behavioural changes, exposed the disconnect between official and informal institutions, as well as the absence of communication and cooperation between them. Future studies can examine the elements that help or hinder the interaction of these connected but varied parties.
For instance, managing the COVID epidemic by a cooperative effort between formal and informal systems, like as in Dharavi, Mumbai, has been the subject of multiple
"success studies."
With the present epidemic, the role of technology in the healthcare sector has increased even more quickly. Many of these innovations, like as telemedicine (Chandwani &
Dwivedi, 2015) and online access to health information, are still in their infancy in India (Chandwani & Kulkarni, 2016). Platforms are now being used more often to offer healthcare and to obtain health information. The platforms comprise both official platforms developed and used by governments and healthcare providers as well as unofficial patient associations. The growing use of IT to access healthcare data and services raises a number of intriguing concerns. What behavioural differences are there between patients using Facebook, WhatsApp, and OHCs? Are the advantages they gain from these platforms different? If true, what characteristics of the particular platform cause certain behaviours?
To expand Mishra (2021), what are the precise elements of a doctor's online presence that influence a patient's decision to choose a certain doctor or facility. Furthermore, doctor- patient communication is vital in WOM referrals, as stated by Mehra and Mishra (2021).
What elements of doctor-patient contact in the internet media affect patients' perceptions of the doctors, in particular, how is this transformed in the online platforms.
Notably, IT adoption and use in healthcare are context-specific and vary by culture (Miscione, 2007). In the Indian setting, there are significant geographic, regional, and rural- urban variables that might affect the behaviour of patients and caregivers. Future research might examine how these cultural considerations affected the acceptance of in the Indian healthcare system. Communities' participation in the delivery of healthcare has frequently been stressed, particularly in light of the present epidemic. Examining the function of IT in India's rural areas can show us how to use it most effectively to improve healthcare services in remote and vulnerable places.
The research presented in this issue also examined the phenomena from the viewpoint of the patients and/or the careers. Future studies should look at how medical professionals or healthcare organisations see the phenomena. The topic of doctors' attitudes of Internet-informed patients in the Indian setting has been severely investigated in prior study (Chandwani & Kulkarni, 2016). Although their research showed that doctors were reluctant to treat these individuals, the current epidemic may have altered doctors' attitudes of how people utilise IT generally and for getting health information in particular.
Future studies can investigate how doctors see patients' adoption of IT, paying particular attention to this behaviour when the epidemic fades. Will telemedicine continue to be a top priority after the pandemic?
In addition to the above-discussed effects on individuals, such as patients, carers, and doctors, the planned technology innovations in the Indian healthcare system have the potential to drastically impact the ecology of the stakeholders. The National Health Stack (NHS), which the Indian government plans to launch, would unite all the key players—
including TPAs, hospitals, insurance, the government, and start-ups that use technology—
on a one platform. Thus, the NHS would develop into a forum where many stakeholders might unite. According to the literature, a number of other characteristics that weren't important for individual-level analysis start to matter as one transitions from an individual to a collective level. for instance, interpersonal social dynamics, community intersections, formal and informal system interfaces, and so on (Chandwani& Kumar 2018; Hitt et al., 2007). Future studies might look into how groups of stakeholders interact with one another in circumstances like those made possible by the NHS. How are business models for groups that provide healthcare collectively shaped? How do these many stakeholders change their business strategies as a result of data availability, such as by designing novel products? For instance, do insurance firms utilise data to change their prices or weed out hospitals for empanelment? extending Kumar and Duggirala's work (2021). Future scholars can investigate the tactics used by the health insurance companies in India using a variety of approaches (Ahlin et al., 2016).
In other words, the quickly evolving dynamics of the Indian healthcare industry have the potential to drastically change the behaviours of the stakeholders. These span the spectrum from the individual level (for instance, patients, caregivers, and physicians) through dyadic levels (doctor-patient, government-private sector, etc.), as well as the collective and systems level (for example incorporation of NHS at the national level). Despite the fact that the current issue only looks at a few concerns concerning certain stakeholders, it raises a number of intriguing ones for further study.
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