What will Indian healthcare look like in 2047? Robotics, AI, biotech will shape the future

Indian healthcare has been making steady progress since independence. Our life expectancy is much higher, we are the pharmacy and vaccine provider to the world and our healthcare industry has some of the best capabilities available anywhere in the world (and a medical tourism destination). In the pioneering Arvind Eye system, we also have a high quality, low-cost, high- volume care model. In Yoga and AYUSH India has a holistic approach to health and wellbeing.

While these are achievements to be proud of, India needs to make giant strides in providing universal, affordable, and high-quality healthcare, as envisioned in the National Health Policy (NHP) 2017). India will also witness demographic, epidemiologic, and economic transitions by 2047, when India is likely to:

• Have substantial numbers of both young (~25% less than 14 years) and old with (~14%) with their distinct health needs (e.g. geriatric, palliative care)
• Have both communicable (amplified by Covid & increasing antibiotic resistant strains) and non-communicable disease prevalence
• Need care for mental health (due to increased urbanisation, services orientation & awareness) as much as physical well being
• Have double the share of middle-class population (from ~30% to ~60%) with higher education attainment and expectation of better service quality

Technology will advance too, with much higher maturity and usage of robotics (in surgery), nano tech, biotech (in precision and personalised medicines/ treatment), AI/ ML (in image recognition & diagnosis), augmented reality (in better visualisation & training), tele-medicine and wearables. These will lead to a few broad trends and shape the Indian healthcare of 2047.

Shift to increasingly public and insurance funded model from the current OOP (out of pocket) dependance:
In India today about 60% of health spend is out of pocket (OOP), a higher share when compared to economies like China (~30%) & Brazil (~25%). Government is committed to enhance its budgetary allocations from about 1% of GDP to about 2.5% by 2025 and has launched Ayushman Bharath scheme. Private health insurance will continue to grow (the anticipated opening of health insurance to life players will aid expansion). This shift will push for more organisation of the industry and accelerate the share of organised chains in the ecosystem.

Future healthcare business model will look substantially different from the current, shaped by technology and India specific needs:
Better telecom connectivity, easy availability of home diagnostic devices (e.g., pulse oximeter, blood pressure monitor etc.), increasing comfort with tele- consultation (of both doctors and patients, aided by Covid) and India’s geographic spread will pivot primary care to towards remote/ tele delivery - experts opine that upto 85% of primary care can move to tele- consultations. This shift will help India address its chronic challenges of doctor availability in remote and rural locations. The HWC expansion under the NHP in combination with tele- consultation will transform primary care as we know it.

Tertiary care will witness alternate business models emerge. Today’s tertiary care is characterised by large multi-specialty hospitals due to high fixed cost (on equipment, beds, rooms, etc.) and availability of doctors. With improvements in precision surgery many procedures will shift to day care. Advancement in robotics and VR/ AR will enable remote robotic procedure changing the nature of tertiary health facilities. We will see more and more distributed therapy/ condition focused centers instead of large multi-specialty tertiary facilities of today. Emergence of remote, robotic centers will take tertiary care closer to citizens.

Pharma industry will need to prepare for the shift from mass chemistry to personalised biology- based treatments.

India is a leader in pharma exports today and has deep chemistry skills. India has also made a start in biosimilars and which can rapidly scale up in the coming years. With rapid advances in bio-tech (CRISPR, etc.) and nano tech, we would see treatments move increasingly to precision, personalised approaches. India's pharma industry will need to develop smaller batch, individual treatment-protocol based manufacturing in addition to its deep capability in large batch standardised manufacturing today.

Diagnostics & monitoring as we know, will undergo a transformation:
Covid has taught us self-testing. Wearables and point of care diagnostics are advancing rapidly with increasing ability to monitor larger numbers of body parameters. India’s Digital Health Mission will enhance adoption of EHR (electronic health records) and enable availability of vital data in digitised form. This in combination with better image recognition/ analytics algorithms will assist Doctors interpret conditions and help in diagnosis. These technologies changes in combination with tele-consultation will change in the diagnostic & medical devices industry. Diagnostic labs will increasingly focus on specialised and complicated tests, impacting their business model (getting more centralised/ consolidated, from the current distributed). Diagnostics equipment and medical devices players will need to pivot from primary focus on hospitals (B2B) to end users/ patients (B2C) as well. Their product development and service delivery model will have to evolve to keep pace with this shift.

India will have a larger wellness focus from the current illness centric approach to healthcare:
Advances in nutrition science and enhanced societal awareness will enable an enhanced focus on eating right, exercising right, meditating right, and living better. Higher penetration of insurance will enable an increased focus on healthier habits and earlier screening of conditions. These changes will accelerate the wellness focus. India, already home to Yoga - a holistic approach to mental and physical health, will see increasing and wider adoption of its principles in the society.

Healthcare of 2047 will be substantially different from today. All ecosystem players will be impacted by these changes and will need to be prepared to embrace emerging trends and pivot their business models as appropriate. For consumers, these trends will lead to easier access, better quality, improved service level and affordable healthcare for all.

Kaushika Madhavan is Managing Partner & Country Head, Kearney India. Deepak Sharma and Prabhu Dhev are Managers, Kearney India. The authors would like to thank Avinash Nayak, Principal, Kearney India, for his inputs.