Changing Trends Of Healthcare In Mumbai

On my last visit to Mumbai from the UK, where I have been residing for the past two years, I socially interacted with a couple of senior doctors running nursing homes in the city. Listening to their conversations, I got the impression that both of them were thinking of winding up their practice and nursing homes due to changes in the way healthcare services were being delivered, keeping up was more and more demanding with lesser returns. Curious, I dug deeper using open source intelligence and realised that the healthcare delivery in Mumbai and probably most Indian metros were undergoing transition at a rapid pace. When I was growing up in the city, private practitioners and hundreds of nursing homes located all across the city and suburbs catered to healthcare for the large middle class. These nursing homes, although small in size, have catered to the healthcare needs of the people for decades. Although what they lacked in terms of infrastructure, patient comfort, aesthetics, trained and courteous staff, it was offset by competent doctors, reasonable expenses and satisfactory outcomes. The corporate hospitals took care of the well-heeled. Medical insurance was not commonplace and people generally paid directly for treatment. The state government and municipal corporation run public hospitals and various healthcare institutions; many of those hospitals have attached medical colleges with high demand for seats from top medical aspirants. However, the middle class never favoured the government and municipal corporation-run hospitals for quality healthcare and instead opted for private nursing homes. These institutions ended up catering to the economically weak sections. Over the decades, they never managed to up their game in terms of budgets, overcrowding, compromised infrastructure, and nursing care, despite having doctors with good clinical exposure. As a result, more than 70% of healthcare is delivered by the private sector. This trend is now gradually changing. Medical insurance has entered with a bang and the large middle class has embraced it with open arms. Cashless insurance is becoming the norm with third-party operators managing the logistics. This has allowed large numbers to access better facilities in larger private medical institutions. Smaller nursing homes are giving way to larger facilities that are also attuned to other patient needs, as well as medical treatments. Architects and interior designers are being roped in to design the setups. Along with great clinical treatment, doctors now want the latest state-of-the-art equipment, trained and courteous staff, elegant and comfortable facilities, aiming for patient delight. Funding for promising practices to scale up had become corporatised and easier to access. Dr Ashish Joshi, a medical oncologist who manages dozens of daycare centres for cancer reatment under the brand MOC (Mumbai Oncocare Centre), says that patient experience of well-being and comfort during difficult treatment is of paramount importance without any compromises, and our centres go the extra mile for not only the patient but also the accompanying family. His company, MOC, was funded by TATA Capital a vertical of the esteemed TATA Group to the tune of 10 million USD to scale up the cancer treatment across various cities of India. The traditional nursing homes are finding it difficult to adapt and are losing the better-off patients and trained staff to the new institutions. The regulations are also becoming more stringent over the years. The National Accreditation Board of Health (NABH) has come into force with various levels of compliance which the nursing homes are finding increasingly difficult to adhere to. Dr Kartik Bhagat, a senior OB-GYN running a nursing home for more than three decades, says I would no longer advise a new doctor to start a nursing home given the challenges regarding managing and retaining staff, regulatory approvals, accreditations, insurance compliance, economic weaker patient base, etc. The healthcare delivery in Mumbai is changing very fast with a lot of positives but all is not hunky dory. The expenses keep mounting and with time, it will become almost impossible to access quality healthcare without insurance. For better or for worse, for the citizens of this large megapolis, the story of healthcare has rewritten itself.