About the authors

Sandipan Gangopadhyay is the President and COO of GalaxE and plays a key role in GalaxE’s continued worldwide expansion and operational success Prior to this, Mr. Gangopadhyay spent over a decade in high profile roles in both Pharmaceutical and Information Technology companies around the globe and instrumental in setting up one of India’s first private Software Technology Parks. He has a Bachelor’s degree in Computer Engineering from Bombay University, is a member of the Indian Institute of Chemical Engineers, and is certified in the Governance of Enterprise IT.

Dheeraj Misra is the Chief Technical Officer and Senior Executive Vice President of GalaxE and has over 15 years of experience in the design, development, testing, porting and maintenance of application and system software for the healthcare industry. Prior to this, he spent a number of years in high profile roles at HCL Technologies, Context Integration, Eforce Global, and as a Research Specialist in Parallel Processing. He has a B.E. in Computer Engineering from REC, Allahabad.

Vijayaraj Chakravarthy, Senior Vice President of Delivery and Head of Strategic Business Unit, is a member of the GalaxE’s executive leadership team, responsible for organization growth and innovation through predictive analytics platform aiming to discover new cost reduction opportunities in the Healthcare ecosystem of the United States. He serves as a subject matter expert on various AI/ML-based platforms and frameworks. He is passionate about solving industry problems with automation methods and agile execution. His leadership style focuses on developing a positive environment, teamwork, passionate culture, and an entrepreneurial mindset. He has B.E in Electrical and Electronics from PSG College of Technology, India. He enjoys spending time with his family. He has a green thumb to nurture organic gardens. He likes to do tech-inspired research projects for Kids.

Prof. Paul Lillrank (moderator) presented his keynote by giving insights of his ideas and implementations in the organization for which he is the chairman (Aalto Health Platform). Explained how the world famous, ARAVIND EYE CARE model was chosen and implemented by his student in Finland who studied ARVIND EYE CARE in Tamil Nadu. Stressed on technology circulation instead of technology transfer, as the later is only one directional flow. He felt India is the most innovative place in the world with the land full of opportunities.

Molshree Pandey, currently working on communicable diseases and finding ways to collaborate stakeholders in a much more efficient way. Conducts and concentrate on boot camps, road shows in Denmark, presentations to many companies; connecting and opening pathway to better delivery of care in India as well as Denmark. Insisted on modification of products according to the country.

Ankit Bahl compared the way of delivering care and implementing in 2 countries Estonia of 1.2 million populations with India of 1.2 billion populations. Estonian healthcare developments:

-Have S.E.Z for Pharmaceuticals, diagnostic companies in Estonia
-Worlds first biobank which Is commercialized too!
-97% of their patient prescriptions are made online for better access for both patients as well as stakeholder handling it.

Only three things can’t be made online in Estonia 1.marriage 2. Divorce 3. Trade property. Haha!! Introduced E ambulance in Estonia! They call E-Estonia and are also working towards to achieve it!

Iris Ohrn, A kind of matchmaker and identifies companies, investors which would benefit mutually. She observed similar challenges in India as well as Sweden in terms of the cost of healthcare.

K Gopalan, Works for the betterment of healthcare ecosystem of underprivileged. India is a big corridor for the scope of solutions. The focus needs to be on Primary health care, an example is vatsalya which is trying to provide subsidized private care. Promoted SANKALP, which is a form of the network of healthcare stakeholders.

Identification of right partners and right market recognition is required. IPR (very important) during technology transfer is at-most concerned.

As GDPR in EU, likewise, we need in India too. Shared her views on DISHA Act
DISHA:
– Setting up central and state organizations
– Ensuring trust in the system
– Recognition of ‘RIGHT TO RECTIFY’ by the patients is becoming important
Differences in DISHA and GDPR should be studied,
Example: right to forget/Erase isn’t there in DISHA

GST a loan waited game changer is now about to become a reality for Indian economy. Talking about the world’s second largest population and huge health care market, the GST is going to make or mar the industry. With positive move of One Indian One Tax, the rates and procedure is going to ultimately decide the result of GST.

Introduction to Indian Taxation System

The Indian Taxation system is one of its own types in the world with numerous taxes and complex compliance system. And perhaps very few in the country actually understand the complete taxation system. While the entity has to collect and pay huge amount of taxes, what is more difficult is the compliance system of the country. The continuous efforts of various government for years has been to make the system simple and industry friendly has ultimately resulted in implementation of GST.

GST History

It all started with establishment of empowered committee headed by Asim Dasgupta in the year 2000 by the Vajpayee Government. The UPA1 and UPA2 government took it forward and finally after a very long time in 2016 again NDA government is going to implement the same.

General Expectation from GST

While manufacturers are quite optimistic about the new tax law. Commoners are not sure how it is going to impact their lives as yet. The expectation form GST is to simplify and streamline the tax structure in India.

The industry in general feels that this is a milestone for Indian economic development and will provide a huge fillip to manufacturing. This step is also expected to accelerate prime minister’s ‘Make in India’ initiative and lower prices for the consumers. The immediate impact of GST may also increase the cost of finished products in some sectors. However in the long term this would prove beneficial to the industry and consumers, and augur well for our overall economic development.

Indian Healthcare Industry

The emerging economy of India is one of the largest producers of generics. And also experiencing a boom in medical tourism which generates additional returns for the healthcare industry. Globally India’s pharmaceutical industry currently is ranking in the top 5 in terms of volume and top 15 in terms of value. To provide the required healthcare facility to the growing population of the country, the government has raised the FDI cap for Brownfield Pharmaceutical investments to 74% in June. Eventually, 100% FDI is allowed in Greenfield Pharmaceutical investments and beyond 74% under government approval in Brownfield Pharmaceutical investments. This step is expected to develop more qualified personnel and provide state-of-the-art facilities and technologies to patients.

Though the rates of GST are recently notified and item wise list is pending. It is expected to have a positive effect on the pharmaceutical sector in an overall sense. The GST is expected to simplify the tax structure, since eight different taxes are levied at state, central and municipal level in the pharmaceutical industry at the moment. GST, by

consolidating all these into one tax would increase the ease of doing business. As well as mitigate the cascading effects of multiple taxes applied on one product. Apart from this, GST will also result in operational efficiency by streamlining the supply chain which can alone add 2% to India’s pharmaceutical market size.

The pharmaceutical companies need to move to a hub-and-spoke model with primary and secondary hubs across states, besides overhauling the process of the companies used to select their warehousing network with cities like Chandigarh, Lucknow, Guwahati, and Nagpur emerging as primary hubs in addition to the metros.

GST implementation will also envisage a seamless flow of tax credit, account for improvement in overall compliance and is also expected to create a level-playing field for pharmaceutical companies in India. A big advantage for companies will be the reduction in transaction costs with the discontinuance of Central Sales Tax (CST). GST is expected to bring down the manufacturing cost. Even a 2% reduction in production or distribution cost is believed to add over 20% to profits. GST, if its rate is below the current total tax rate, will eventually help consumers by making healthcare and drugs more affordable which already is a big goal for the Indian Government.

Although, the new tax legislation is believed to bring down the manufacturing cost. It cannot be said with certainty as to how the ultimate consumer will be benefited through this as most of the medicines are available at the MRP which is inclusive of the taxes, how is the end consumer going to benefit from that? It will be ultimately the industry’s call whether to share their profit margin with their customers or not.

India’s healthcare industry is worried that the implementation of the goods and services tax (GST) may lead to higher taxes that could erode its profits, even as it hopes that the new regime will help streamline the supply chain.

GST will help companies rationalize their supply chain. However, if the overall tax cost goes up above 12% there won’t be any savings as such.

GST, once implemented, would put various sectors under the purview of service tax. The list of exempted services presently includes healthcare sector. It is expected to continue after the GST regime at least for initial period until basic cost of healthcare sector becomes affordable to the common man of the country. It is believed that levying service tax on healthcare services and facilities will be a retrograde step. An it will certainly push back the agenda to provide best in class healthcare.

Overall, the effects of GST implementation on the healthcare and pharmaceutical sector are still uncertain. However, industry experts believe that GST will set industry players and consumers in a win-win situation. In case the tax rate is set at an efficient level. The healthcare industry will benefit as GST certainly reduces complexities and removes many hurdles to the industry’s growth. The industry is on a path of promising growth and increased productivity.

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About 72.6 percent of the rural population in India do not have access to basic oral health. Unfortunately, in our prevalent war against diabetes, cardiac issues, HIV/AIDS, et al, we ignore the seemingly less-important battles – like oral health, for instance – that can actually strengthen our chances of success. Enhancing access to affordable dental care is important in its own right, but is unlikely to be a sufficient strategy for reducing the burden of disease. The innovation that India needs today is an integration of public health solutions for oral diseases with those for chronic diseases and with the national public health programmes.

When we think of innovation in healthcare, most of us tend to look for the ‘Eureka’ moments. The wonder drug that can cure cancer, the surgical procedure that can revive a brain-dead patient, the hi-tech diagnostic tool that can predict cardiac adversities. But these innovations – no matter how spectacular – are of little value without the right healthcare delivery processes.

A very interesting article that appeared in the November 2013 issue of Harvard Business Review looked at how some Indian hospitals are able to provide world-class healthcare at as much as 95 percent lower costs than those at US hospitals. The answers, the authors argue, don’t always lie in grand designs, but in smart delivery systems.

Addressing the Issue

In a recent interview, US-based surgeon and bestselling author Atul Gawande called India’s public health system one of the “most complex things” in the world. And that’s true, given the sheer magnitude of the burden of infectious diseases as well as non-communicable diseases that the country has to tackle.

Unfortunately, in our prevalent war against diabetes, cardiac issues, HIV/AIDS, et al, we ignore the seemingly less-important battles – like oral health, for instance – that can actually strengthen our chances of success. According to the WHO, the risk factors for oral diseases include an unhealthy diet, tobacco use and harmful alcohol use. These risk factors are the same for the major chronic diseases – cardiovascular ailments, cancer, respiratory diseases and diabetes.

Studies have shown that periodontal diseases (also known as gum diseases) pose a risk to general health, especially for patients with other chronic diseases. Among patients with diabetes, periodontal disease can accelerate the chances of pancreatic failure, stroke, myocardial infarction and renal failure.

Similarly, maternal periodontal disease during pregnancy is sometimes associated with increased risk of pre-term delivery and low birth weight. Yet only 50 percent of pregnant women with a dental problem visit a dentist during their pregnancy. Despite studies affirming that most dental care procedures are safe during pregnancy, myths of perceived risks still prevail even within the medical fraternity.

Integrative Approach

The innovation that India needs today is an integration of public health solutions for oral diseases with those for chronic diseases and with the national public health programmes. Say a patient is seeking treatment for HIV, it’s significant to examine his oral health condition too. Research has shown that inadequate oral healthcare can undermine the success of HIV treatment regimens.

World Health Assembly in 2005 included Oral Health with other non-communicable diseases for health promotion and disease prevention strategies. However, most of our policymakers as well as medical practitioners are still in the dark about the burden of oral diseases in the country and their impact on our overall health and wellbeing. Although there has been no nation-wide study to determine the burden of oral health conditions in India, individual studies indicate that the average prevalence of dental caries is 40-45 percent in all age-groups; periodontal diseases is 90 percent; malocclusion is 30 percent.

In 2000, the US Surgeon General identified oral disease as a “silent epidemic”, wherein a significant amount of money is spent on expensive, invasive treatments that could have been either avoided with simple preventive measures or at least treated at a lower cost and lower risk if identified earlier.

Reality Check

The biggest challenge in implementing an integrative approach vis-a-vis oral health and other diseases is the dismal dentist: population ratio (1:8,000 in urban areas and 1:50,000 in rural areas). About 72.6 percent of the rural population, says the data from Dental Council of India, do not have access to basic oral health.

Enhancing access to affordable dental care is important in its own right, but is unlikely to be a sufficient strategy for reducing the burden of disease, states a white paper on Oral Health commissioned by the National Interprofessional Initiative (Oral Health: An Essential Component of Primary Care). Sometimes, we just need to go back to the basics. Prevention is still better than cure. Primary care providers, such as general physicians, nurses and midwives, need to be trained to expand the disease prevention workforce. Children, pregnant women, diabetes and other patients who visit the hospital regularly are ideal candidates for preventive healthcare.

There are several examples of promising healthcare delivery innovations. The challenge is to ensure that they are successfully and widely adopted. And this calls for a change in the attitudes of medical practices, healthcare organisations and policymakers. We need to move away from the traditional doctor-centric healthcare setup and make it patient-centric. Thanks to the advances in information technology, it’s now possible to deliver medical care to patients at a time and place of their convenience. Telemedicine makes the remote delivery of healthcare over the phone a reality, while electronic health records facilitate easier access to expert medical opinions.

Innovations in diagnostic technology, pharmaceuticals, surgical procedures and medical devices are undoubtedly important. But what’s more important is inventive methods to deliver these services in a timely, safe and effective manner to patients. Obviously, this can’t happen overnight. But as Bill Gates so succinctly put it, “We overestimate what we can accomplish in two years, but we underestimate what we can accomplish in 10.”

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