Godrej Memorial Hospital CEO Pravin Swamy: Prevention is key to curb healthcare cost

Godrej Memorial Hospital (GMH) is a multi-speciality hospital based out of Mumbai, which prides itself on its  accreditation and facilities; and speaks of a proactive approach to healthcare and patient care. Pravin Swamy, CEO of the hospital, has had a long career in the healthcare sector, specifically in operations across different hospitals. He talks about emerging trends in the sector, in a chat with Pankaj Joshi and Jescilia K.

Edited excerpts:

What is the relevance of technological advancement in modern medicine and how does it impact an organisation like yours?
The positive impact of technology is definitely visible to all. But there is also a flip side. With rapid technological developments, the tech support from the vendor’s side is now much lesser. Earlier we had support agreements across 12-15 years, which are now curtailed to seven-eight years. Beyond that period, they would not support those models which are now old for them due to rapid technological changes.

For us this is a troublesome aspect of technological advancement, because maintenance is crucial for equipments. Effectively we also need to upgrade our equipment faster, which means costs go up and ROI on the investment declines. On the staff training part, generally we are comfortable with the support provided from the vendor’s side.

Our hospital spends Rs 4-5 crore annually on new equipment and on upgradation. We cannot doubt the benefits of technology, but what we as users request, is that upgrades should happen at software level from the vendor’s side. The hardware which is in place should be leveraged as is, and not regularly replaced. This will serve the purpose, and also not impact the ROI of our investment negatively.

How do you view health insurance?
Health insurance is a major succour for the patients. India as a whole is under insured, because coverage today extends to only 20 per cent of the population. We estimate that 60 per cent of our patients have some form of insurance cover. We have partnered with 28 health insurance providers.

The hindrance to speedier growth of health insurance lies in the implementation. Insurance cover can, sadly, be used both for genuine purposes and also for money making. Then you have the situation where claims get rejected or reduced. Effectively what the patient thought was cashless treatment is no longer cashless.

Also the insurance agents and providers do not educate the patience that all expenses cannot be covered. This therefore leads to a sense of dissatisfaction. Then it becomes our duty to step in and educate the patients. For them, we become a resource and our workload goes up.

We have created a third-party administrator (TPAs) cell, which does document collation, understands the case, communicates and gets approvals from insurers and keeps the patient updated about what needs to be done. In this process both medical and insurance-savvy people have to be deployed.

Insurance companies themselves need to modify their approach, both in premium structure and claim scrutiny. Pre-insurance medical check-ups should be compulsory for a greater number of applications. Data now can be easily collected and filtered across a greater number of parameters, which then can help set different benchmarks of premium for individuals with different health, fitness and lifestyle patterns.

Secondly in future there will be procedures which do not need overnight stay. Hospitals will increasingly operate like a daycare facility. Insurance should take this aspect into account while looking at claims which will also then be smaller in size.

Another area to look into is broadening the definition of mental illnesses to include conditions like depression. For such cases, authorised counsellors are available and such counselling should be accepted as therapy. Such counselling can save on other medical costs later on.

One huge challenge to the healthcare system is that of skill sets. Our education system at the base needs to focus on skills, and not just processing of information. The curriculum quality needs to improve, and we have to emphasise more on practical work. Training institutions are needed in more quantity.

How do you define your operations and growth areas?
We are a medical organisation run on non-corporate principles. Our focus is always on improving and increasing range of services while keeping patient charges under control. We are, contrary to general perception, accessible to all public and not just the Godrej group.

One area of attention for us, beyond lifestyle related ailments, is that, as lifespan increases, age related problems will also increase. We understand that quality of life is very important in old age. We do a lot of work in that area, through counselling, focussing on preventive measures, training, providing OPD service benefits and so on. We are active in sessions for building awareness at corporates and resident societies.

We are in the process of setting up a yoga and meditation centre within the hospital, which will help in both prevention and management of ailments related to age and lifestyle. For us, our hyperbaric oxygen treatment centre is a great growth initiative. We have invested around Rs.1.50 crore in the project and the treatment benefits extend across a variety of ailments.

Other hospitals too are sending their patients to us for this treatment. Our centre has the capability to handle 8-10 sessions of six patients at a time, on a daily basis. So far as our expansion plans go, we are looking at the option of a satellite centre in Vikhroli West.

As I said, we are constantly looking at expanding our range of activities. We have already initiated home sample collections and home care services in areas within a decent radius from our hospital.

How do you look at the Ayushman Bharat scheme?
It is a very good concept because India surely needs social health security. However, they have missed out an important partnership in the healthcare ecosystem, which is that of the private hospitals. In government hospitals, equipment by and large would be there, but their maintenance will not be up to the mark, and there would be issues on quality of manpower.

Private healthcare players would be ready to participate in Ayushman Bharat activity, but the reimbursement rates need to be revised upwards because even marginal costs cannot be recovered from the currently prescribed rates. Secondly, if the authorities are looking at healthcare as a whole, then preventive healthcare should also be on the agenda. Preventive healthcare helps cut down on future medical costs.

Godrej Memorial Hospital CEO Pravin Swamy: Prevention is key to curb healthcare cost
Godrej Memorial Hospital CEO Pravin Swamy: Prevention is key to curb healthcare cost

When you look at India with a huge population, increasing life expectancy and lifestyle issues, healthcare can be a massive potential problem unless it is handled proactively. Preventive care is any day better than curative. Putting health check-ups in the ambit of medical insurance coverage can help a lot.

People would then be more keen on regular check-ups. Early diagnosis of potential problems and subsequent action can eliminate a lot of health problems down the line.One issue in policy matters is that stakeholders of the healthcare ecosystem operate in silos.

While making policies, all stakeholder inputs—doctors, hospitals, insurers, TPAs—need to be considered. Getting simultaneous understanding and acceptance from all the parties will ensure fulfilment of the objectives.

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