The Indian healthcare industry consists of hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The industry is growing at a tremendous pace due to its strengthening coverage, services and increasing investments.
The healthcare industry stands on four pillars – Services and staffing (health services), Pharmaceuticals, Health Financials and Devices. Hospitals staffed with doctors and nurses provide the central location for patient care and interventions. Pharmaceuticals provide drugs that help in curing patients. Health financials like Mediclaim provide support to patients and families in managing expensive treatment and surgeries. Devices support both diagnostics and surgeries.
Materiality or the context for CSR is incredibly complex in healthcare, because of the nature of the industry. While the industry sells solutions to illness, thoughts and actions of healthcare players whether in pharma or managed healthcare need to be for the betterment of human health and wellbeing. Since the industry is intrinsically committed to doing public good, society has many expectations of a healthcare firm other than managing environmental impact like any other business.
What do consumers expect of the healthcare industry? They expect effective, high quality medicines, attention and care at hospitals, absence of spurious drugs, ethical dealings and honesty. But is that all? As important as all the other aspects, customers also expect affordable health products and services.
Unlike other businesses where price is set by the ability to pay, for the healthcare industry, price at times is subservient to public good. In a country like India where income disparities are large, social insurance limited and an increasingly polluted environment, public good comprising of access to medicines and care, affordability and ethical marketing rests at the heart of a healthcare company’s CSR strategy.
Key Questions – How can we maintain a profitable business while contributing to society?
Collaborating for disease prevention and management
Diseases like Diabetes, Cancer, HIV-AIDS, TB, Swine Flu and many such others are on the rise. The burden of disease specially for low income/underprivileged segments, who can’t afford expensive medicines and long treatment is extraordinary.
Key Questions – How can healthcare companies collaborate to develop pricing frameworks targeting priority diseases that cover a holistic approach; where Medicines, Treatments, Care and Devices are all accessible ?
Patient Safety in clinical trials
India has a diverse demography with history of multiplicity of diseases. This paves the way for companies to conduct clinical trials. Ensuring patient safety is an essential requirement of clinical trials. Little seems to have been done in this space over the years.
Key Questions – Can healthcare companies identify safer way of doing clinical trials and transparently disclose information in reports annually?
Pharma and Medical device companies market their drugs, devices to doctors, hospitals and consumers through various modes. Consumer level marketing is done through TV advertisements, which needs monitoring. Pharma companies state that they follow their self-regulatory code while marketing to doctors/hospitals. However there have been many instances where companies have violated the code. This has lead the government recently to ban freebies, cruise tickets, paid vacations and sponsorships to educational conferences and seminars etc.
Similarly, many doctors are being accused of over treating patients and undertaking needless surgeries to fulfil corporate / personal targets. Where generic drugs are sufficient, doctors are also being accused of prescribing expensive / branded ones.
Key Questions – How can we lead the way with ethical sales and marketing? How can we put the patient first?
In the pharma industry, packaging is still emerging as a sustainability issue. There are many opportunities for pharma companies to explore sustainable packaging like Bio Plastics, Bio-based PET. Some companies are looking at replacement of PVC blister packs for tablets to eliminate the use of PVC. With growing usage of over the counter products there is a real need for companies to use sustainable, recyclable packaging materials.
Key Questions – How can we shift from the traditional packaging to make it more sustainable?
Product safety and quality
The World Health Organization (WHO) estimates that one in five drugs made in India is spurious and that counterfeit pharmaceuticals are a $75 billion dollar global industry. A 2010 survey of New Delhi pharmacies found that 12 percent of sampled drugs were spurious. In 2014 The Central Drugs Standards Control Organization (CDSCO) lead by central government has started a whistleblower reward scheme for government employees and general public who get rewarded when fake, spurious drugs, medical devices and cosmetics are reported.
Pharma companies also need to do more to educate the chemists to enable them to dispense medicines correctly. Often chemists sell substitute medicines wrongly leading to prolonged treatments or visits to emergency rooms.
Key Questions – What initiatives can healthcare companies take to address product safety and quality?
Patient Privacy & Electronic Records
There has been a increase in number of doctors/health care providers using social media and other platforms to showcase their skills. However, many times online disclosure violates patient privacy. Many doctors use online platforms to brainstorm about specific cases with fellow practitioners.
Doctors/hospitals also use modern technology and gadgets to record surgeries/treatments and post treatment results, but many times patient data gets leaked into the market and customers are assailed with calls.
The privacy issues also apply to the health insurance companies who are given access to all information by patient/hospital as they were treated during a claim process. Healthcare records are often not made available to patients simply because insurance companies demand and retain the original records. There is a clear need for hospitals to provide the patient complete set of their medical records.
There is also a need to create a comprehensive database of patients. Currently each hospital keeps its own records. If they were to share records among themselves doctors would have access to greater information on patients and a better treatment plan.
Key Questions – Do healthcare providers/health insurance companies follow guidelines.If violated what measures/actions are taken? Can hospitals embrace cooperation to increase patient welfare?
Managing waste, water and energy
The Indian pharmaceutical industry is ranked third largest in volume terms and 10th largest in value terms with about 24,000 players. India exports pharmaceutical products to more than 200 countries. The process of manufacturing these products uses large quantities of water and energy. Also, large quantities of waste is also generated.
Management of medical waste and usage of large quantities of water is also a key issue for hospitals, clinics and labs. When it comes to the managed healthcare industry, a city like New Delhi with about 40000 beds generates about 60 metric tons of hospital waste per day that needs to be treated and managed with care and caution. Smaller hospitals often lack both capability and resources to manage this waste.
Key Questions – How can we establish robust waste. water and energy management practices?
Article coauthored with Utkarsh Majmudar and originally published in Economic Times.