Healthcare service delivery in India once meant hospitalisation or consultation and treatment at a clinic or health facility. But the Covid-19 pandemic and the fast-emerging developments in digital health in the last couple of years are changing that concept for good. As the first and second waves of the pandemic threatened to overwhelm India’s healthcare system with the shortage of hospital beds, oxygen, manpower, and critical care equipment, home care emerged as a vital pillar by providing quality and safe care at home.
Before the pandemic hit home, 60-80 per cent of demand for home care used to be driven by senior citizens seeking supportive long-term care at home. But today, new avenues of care delivery are available to those in need with advanced, specialised healthcare that is available on-demand and accessible at home. It reduces the burden on hospitals and also limits the chances of hospital-acquired infection (HAI). It can also be much cheaper than hospitals since service providers use available capacity in patients’ homes. It has the potential to address the long-standing challenges of shifting disease profiles, changing the population pyramid, transitioning family structures, and the rising costs of care.
The home care ecosystem is relatively new in India, but it has grown quickly in scale to a $5.4 billion market and is projected to grow to a market size of $20 billion by 2025 at a CAGR of 19 per cent. The global home healthcare market is estimated to grow to $390 billion by 2026 from an estimated $275 billion in 2020. With India’s elderly population projected to triple in the next three decades to represent 20 per cent of the country’s population by 2050, the demand for home care can only grow.
In India, a major achievement was that an average of 60 per cent of Covid patients were treated at home with the home care system leveraging telemedicine services extensively. Several organisations were at the forefront of home and out of hospital care during the pandemic, particularly during the phase when hospitals were short on beds and critical care equipment. These providers laid the superstructure and have evolved quickly to address an entire range of needs of patients from basic care to skilled nursing to complex critical care at home. They have done remarkably well to adopt digital and virtual care technologies and integrate critical care set up at the homes of patients and set quality benchmarks in this space. During the pandemic, out of hospital care providers provided care at home or partner facilities to nearly 21 million Indians, decongesting hospitals, freeing up valuable bed capacity and offering appropriate care in settings where hospitalisation was not necessary. With lifestyle and chronic diseases on the rise in India, out-of-hospital services across preventive, promotive, chronic, acute rehabilitative, and palliative care are now a critical component of the care continuum and bridge many of the gaps in access to treatment and availability of beds that were previously unaddressed. Every hospital bed saved is a bed earned for critical and emergency patients.
Innovation to address demand-supply gaps
Innovation in home care is showing encouraging results in many countries. In the chronic and acute care category in the US, medical care expenditures per patient were 39 per cent lower with post-acute care at home under Triple Aim initiative by the Institute of Healthcare Improvement. John Hopkins’s “Hospital at Home” initiative for acute-care delivery at home has translated into 32 per cent cost reduction and 33.33 per cent reduction in the average length of stay (ALOS) realised for care at home instead of hospitalisation. Japan’s Long-Term Care Insurance (LTCI) which has been in operation since 2000, to fund newer care models to support the country’s rapidly rising geriatric population drew positive feedback for home-based care from 86 per cent of LTCI users. Adoption of home care services rose by 52 per cent in the first year and by 82 per cent in the second year. The initiative also generated 2 million jobs within the first decade of its implementation.
Home healthcare is driving value unlock across stakeholders including payer, provider, and patient. For the payer, value unlock means lower rate of complications, transparency and fraud detection, stability in costs, measurable outcomes and cost-effectiveness. For the provider, it means prevention-focused promotive care, customised services, continuity of care, convenience and comfort, and connected and integrated care. And, most importantly, for the patient, it translates into a lower rate of infections, improved outcomes, increased access, quality focus, and patient satisfaction. The sector is moving swiftly towards creating a well-differentiated, specialised yet holistic, quality-driven, outcome-focused, tech-enabled and integrated care delivery ecosystem.
Key enablers
The home care/out-of-hospital-care space is nascent and needs support to enable this segment become a highly sustainable model for providing care to a rapidly expanding elderly population and support our national agenda of ‘Ageing in Place’. Governance has a large role to play in facilitating growth in the sector which is still largely unregulated. There has to be an industry consultative transparent process for defining national licensing standards as part of the Clinical Establishments Act, 2010, or as a separate policy. Minimum standards must be established for home care providers in order to streamline and standardise care delivery and to achieve that, home care must be brought under QAI accreditation.
Additionally, medical care delivered outside institutions needs to be integrated with hospital care after the government defines care pathways and integration criteria including initiation, referral, handover and discharge. In addition, it is essential that home care needs are brought under health insurance in both public and private care spheres. This will ensure that patients need not pay the entire amount out of their pocket and the government may demarcate home care areas guided by “what can be done at home MUST be done at home”.
Industries need incentives from the government to grow and the home care sector is no different. Tax breaks to incentivise care delivery in semi-urban and rural areas and GST benefits as laid out for institutional healthcare providers can work as business financing enablers for the sector.
Way forward
The government could add to the National Commission for Allied and Healthcare Professions Act, 2021, to recognise home care workers and professionals as an allied and healthcare professional category. There has to be standardised training and curriculum guidelines for the sector along with defined homecare personnel roles with qualification criteria. There need to be conversation points around career pathways in the space to encourage students and professionals. The home care sector can also get a boost with digital infrastructure support for care delivery if the government enhances the reach and strength of this technology to support care delivery beyond Tier 1 cities and close to remote areas.
With India’s changing population dynamics, the number of people over 60 years of age is rising faster and so is the number of senior citizens in the 80-plus age bracket. Many of them are living longer but with long-term diseases. Mainstreaming home care under Elder Care, Care of the Disabled and Palliative care programmes is what will eventually count in their sunset years.
Meena Ganesh is co-founder, MD and chairperson of Portea Medical, and Vivek Srivastava is co-founder and CEO, HCAH
The opinions expressed in this article are those of the author's and do not purport to reflect the opinions or views of THE WEEK.