I was plotted on the stock audit for Sanofi Ltd in the first week of June 2021. Sanofi Ltd is a pharma giant of the country which is listed on the Indian stock exchanges. It is headquartered in Paris, France and is the fifth largest Pharma company in the world in terms of prescription sales. During the audit I was in the presence of medicines and other such supplies all the time. This made me think, how is India different than the other western countries in terms of its healthcare system.

I have listed down a few points of differences between the healthcare system of India and the United States of America: –

• The US spends over 17 percent of GDP on healthcare, with wide spending variations across geographic regions (50 states). Whereas India spends barely 4 percent of GDP on healthcare. In India, geographic variations are framed as issues of societal inequities in resource allocation and access to healthcare

• Compared to the US where government accounts for nearly half of national health expenditures, central and state governments in India account for little more than one-fourth of the total spent on healthcare. Majority of the amount is spent by the private players in the market.

• In the US, most of the population has health insurance; as a result, the fee-for-service issues deal with the volume-driven incentives of physicians and hospitals. In India, by contrast, there has been little insurance coverage until only recently; fee for service characterizes not only how providers get paid but also how most of the population pays for health services (with huge out-of-pocket expenditures).

• Finally, the hospital and insurance sectors in the US have suffered stagnating growth for the past decade; in India, by contrast, these two sectors are booming. Beyond these differences in institutional details, there are several divergences between the two countries’ healthcare systems. These divergences cover financing, delivery, and regulation.

In contrast to the US:

1. India has spent very little per capita on healthcare;

2. The Indian government (at least until recently) accounted for a decreasing share of national spending on healthcare, while out-of-pocket costs represented a rising proportion of total healthcare spending;

3. the central government has a weakly developed role in healthcare financing and regulation;

4. there are no powerful, centralized purchasers of healthcare dealing with providers;

5. there has been (at least until recently) little private or public health insurance coverage, and what coverage is provided lacks depth;

6. there are only weakly developed governance mechanisms overseeing providers’ behaviour, with resulting concerns dealing with overutilization; and

7. there is only a weakly developed system of outpatient care.

The healthcare system in India is one of the weakest in the world. There are a number of things that have to changed about the structure of the system to bring out the best that India has to offer. This will require a collective effort from all the stakeholders Viz the government, General public at large and the healthcare industry leaders.

I have listed down a few points which India can aim towards in the coming years to improve the situation of its healthcare system:

1. Quantum increase in budget allocations

The national and state budget allocations increase by at least 25% in the next year, i.e., the national health budget would receive Rs 80,000 crore (even if not accounting for purchasing power parity). However, this wouldn’t be sufficient because it contributes only to about a third of total government spending on health. A quantum increase on state government allocations to health is necessary: states increasing their allocation by 1% every year will help reach the recommended goal of 8% in four years.

2. Technology, the force multiplier

Technology will connect the dots in the health system, and bridge the gap between the public and private sector to function with a singular vision of better public health management. The creation of an ecosystem inclusive of an electronic health record system and linked health ID will make access to our medical history (including diagnostic reports and prescriptions) far simpler, and connect us remotely through tele consults with doctors, e-pharmacies and labs for doorstep delivery of services. Patients can thereby rid themselves of the complex and circuitous care- seeking pathway they must navigate at present.

3. Equitable distribution of medical facilities

While India is one of the preferred destinations for medical tourism, which implies that some our hospitals can provide world-class treatment at relatively lower costs, we also have hospitals which are understaffed, have insufficient facilities, no medicines and may not even be able to provide a bed or an ambulance to a patient. For example, rural India contains 75% of the total population but only around 30% of the country’s hospitals, hospital beds and doctors. Imagine the sheer burden put on those rural health facilities and doctors because of lack of medical facilities in rural areas of India. Our goal should be to increase the number of hospitals in smaller cities/villages so that the burden on existing medical centres in these areas is not overwhelming.

Role of an auditor in the healthcare system:

Before we talk about the significance of an auditor in the healthcare system, we need to first understand what is an auditor in the medical field and what are his/her duties. Therefore “Medical auditing” can be defined as “A systematic assessment of performance within a

healthcare organization”. Almost any element of healthcare can be audited, but most audits look at components of payer reimbursement processes to evaluate compliance with payer guidelines and federal and state regulations. By identifying errors and devising remedial actions to eliminate them, the medical audit serves a vital role in a healthcare organization’s compliance plan”

What does a medical auditor do? And how is it beneficial for the people at large. The main role of medical auditors is to conduct an internal and external review of coding accuracy and procedures of a medical provider to ensure cost-effective delivery of care to their patients.

Benefits:

1. The unnecessary billing which affects the patient at large (Extremely common in India). Medical

providers under check for any fraudulent behaviour.

2. The medical auditor can help the clinic (or other healthcare centres) to identify deficiencies in the system which would increase the quality of service provided to the patients.

3. The main objective of medical audit is to identify measure for adequate patient care practices for particular disease and to develop norms for adequate medical care for particular disease. These objectives improve the quality of services which ultimately benefits patients in the long run. By making sure that the healthcare centres adhere to these guidelines, the auditors play a crucial role in keeping the healthcare providers under check.