Malcolm Grant in Mumbai on Tuesday. Malcolm Grant in Mumbai on Tuesday.

Malcolm Grant is the chairman of United Kingdom’s National Health Service (NHS), a seven-decade-old free health service for not just UK’s population but even its non-residents. In India for a four-day trade mission, Grant talks about the necessity of technology and innovation to cut healthcare costs and the difficulty India faces in providing health cover to its population, a week after the Budget announcement by Finance Minister Arun Jaitley. On Tuesday, Grant hit back at US President Donald Trump for tweeting that NHS was “broke and not working”. “In America major cause of bankruptcy is healthcare costs,” Grant said, adding in its seven decades, the NHS has fulfilled its purpose. Excerpts from an interview with The Indian Express:

Last week’s Budget talks about Ayushman Bharat, where a National Health Protection Scheme hopes to cover 10 crore families and provide Rs 5 lakh insurance cover annually. What are the difficulties the Indian government will face in its implementation?

Firstly, it will take a long time to achieve this. Secondly, it would be wise to ensure that a significant amount of investment goes into primary care and not into more shiny hospitals. Some of the healthcare problems are at a much earlier stage in the life-course of individuals and the NHS has been founded on primary care. There is a system of triage, where specialists are referred to by general physicians who treat most of the illnesses in society. It is very tempting when looking at healthcare to see it through the lens of smart new hospitals but what we need to do is roll out simple diagnostics across the country, specially rural areas.

What are the issues when we deal with healthcare through the private sector? Government hospitals lack in infrastructure and human resource.

The question is where do you want to invest so that it reaches most people for whom it is intended. The mechanism can be private or public. In the NHS, it is public. We do have a small number of private hospitals for specialist work. But for emergencies, patients are taken to NHS hospitals. It is modeled on the ‘Beveridge model’, which is the nation provides universal healthcare funded out of taxation. The American model is medium market model, where government is regulating and it is a mixed market, modeled around the ideology of private pay of choice. There are variants across the world. France, Germany are insurance markets with tight regulation by government. Sweden and New Zealand have health insurance of smaller proportion. So the point is, every nation has to devise a system based on history and current requirement.

What, then, for India could be a good cocktail of insurance schemes?

Two things we see in India: Bulk of acute healthcare is provided by private hospitals and secondly, 60-68 per cent healthcare expenditure is out-of-pocket which is not even covered by insurance, which means people have to shell out large sums out of their pocket. So if I had to start, I would think how to address these two issues. I don’t have objections with the private sector providing acute care provided everyone is getting access to it. We need to ask — what works for patients, not what works for providers? I think access to high quality acute care happens but only in the private sector. There are public hospitals, but they are rundown and crowded because demand exceeds supply. In the age of technology, primary care is possible. High penetration of smartphones can be built upon. Patients can conduct consultation on smartphones. The consultation stays on ‘cloud’ so we can review it.

Can India afford technological advancement? Private healthcare is heading in that direction, but public sector is yet to pick up pace.

Yes, technological advancement can reduce cost. Do you need someone who has trained in medical college for six years, trained for another four years and worked for 20 years to take your blood pressure? You can do it by training a workforce in a completely different way with support of technology that ensures we get greater accuracy.

But there is also an issue of massive doctor-patient gap. Indian doctors prefer to work abroad for higher pay.

This is a global market. In the NHS, we have 50,000 Indian doctors. They are proud of their Indian origin. But obviously, if there is a richer country and poor country, the flow will tend to be towards the richer country. Some doctors do come back after getting trained in the NHS.

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