One of the most contentious topics in the 2008 US presidential elections has been healthcare policy, with Barack Obama pushing aggressively for universal healthcare.
As I delved into the topic from the perspective of India and tried to outline a business plan for a sustainable, for-profit venture–not a non-profit, nor a government agency–Doctor For Sure emerged. Thus, I want to state upfront that this is not the be-all and end-all solution for healthcare in India. It is, however, a venture that made healthcare viable for a much larger population of people than was previously possible.
Doctor For Sure, of course, is a medical insurance provider. We have been working closely with Doctor At Hand and Doctor On Wire, and we share certain common philosophies, the most important of which is: Prevention is better than cure. As a result, we have created a program for primary care for all our clients whereby they are consistently checked, tested, and treated with preventive care.
We maintain a comprehensive database of all our clients and their health-related information. These records are shared with both our partners, Doctor At Hand and Doctor On Wire, and with The Gates Foundation. Our partnership with Gates is to support vaccination and other preventive medicine grants that they have made available to the large-scale Indian population and that Doctor At Hand administers, primarily through their pharmacists.
One of the issues that we found appalling about the US healthcare system, and that we tried to avoid, was the staggering administrative cost. In 2007, the US spent about $2.26 trillion on health care, or $7,439 per person. I read somewhere that the US system spent $1,000 per year per person in administrative costs that year. About 45.7 million people in the US were uninsured in 2007, out of a population of slightly over 300 million, which had put the administrative cost of the system at over $250 billion. This jaw-dropping number stared at me like a bottomless sewage pit of wasted resources.
From the outset, therefore, we worked to keep administrative costs low by using fewer providers, and using technology extensively so that claims filing, processing, validating, and reimbursing were all low overhead activities. For example, Doctor At Hand pharmacists would administer a vaccine and immediately log the procedure through their handheld into the main database. Validations were done through text messaging. Co-payments were accepted through mobile phones, as were policy payments.
In addition, we were providing corporate insurance for the entire manufacturing sector, as well as the mining sector. Farmers and many other small businesses bought their own insurance through us, and we also created a generous and welcoming individual coverage offering.
Aside from these, we were the primary administrator of a number of government programs that insured the least privileged of the population.
We made extensive use of mobile phones and mobile micropayment technologies to keep this system running as efficiently as possible.
Of course, the basic coverage for primary care was not adequate in many cases, and it would be a misrepresentation to say that we could bring universal healthcare of the highest quality to everyone in India. But we did succeed in offering primary care to almost 100 million patients, particularly in rural and small town India where access to quality healthcare was in an abysmal state before we and our partners came into existence.
Yes, some of the more expensive treatments were still only affordable for people of greater financial means, who could pay for the more expensive policies, deductibles and co-payments. However, we did manage to solve the issue of access, by covering treatments by Doctor On Wire centers. These facilities were already an order of magnitude improvement over what rural/small-town India had to offer in a prior generation. Thus, if you work in a rural/small-town setting, at least you no longer have to travel a very long distance to access care.
We hope that over time, we will be able to get further in bringing affordable healthcare to a broader population and not have to deny care to anyone. Meanwhile, we have done what we could, and in 2020, we are a $2 billion profitable enterprise – which gives us the wherewithal to take on more.
This segment is a part in the series : Vision India 2020