First of all a grand salute to all the healthcare workers including doctors, nurses, GDA, housekeeping staff and support staff who have worked day in and day out to treat the Covid-19 patients without caring about their safety. This is what is called selfless service to society and that is why doctors are having the stature just next to God.
Corona Virus has left the entire economy reeling. When the economic history of the world would be written then the Corona Lockdown of the world would be a significant milestone. The effect of the coronavirus lockdown on the world economy would be devastating. However, I would like to look at the repercussions of Covid 19 on Indian healthcare, especially hospitals. The effect would not be uniform across the country and therefore I would like to go into these effects separately for Tier 1 and 2 cities.
Indian Healthcare Pre-Covid 19
Private hospitals in India account for almost 9 lac beds and also employ almost 80% of the doctors. Before the coronavirus pandemic, private hospitals were doing an estimated revenue of 2.4 lac crores per annum with an EBIDTA or operational profit of about 13% on average. However, things are not going to be the same for private hospitals both in Tier I and Tier II cities after the opening of the Lockdown. Hospitals were already feeling squeezed with capping on most of the consumables like implants and even medicines. To make things even worse they were having huge outstandings to be collected from the government for the credit services given to CGHS, ECHS and ESI patients. Let’s look at the challenges that the hospitals are going to face during the coronavirus era in Tier I and Tier II cities.
Hospitals in Tier–I Cities
Hospitals in Tier 1 cities are going to be under the effect of coronavirus for a long time. Most of the big hospitals in Tier 1 cities like Fortis, Max, Medanta, Artemis, Nanavati, Global etc were operating at an average occupancy of 60-75% before corona. Most of these big hospitals need at least 50-60% occupancy to achieve operational breakeven. If we look deeper we would understand that these hospitals were largely dependent upon international patients for the big ticket surgeries.
Practically international patients have been a distant dream for these hospitals for some time now. Maintaining the same revenue post-corona is going to be an uphill task for them. They will have to rework their marketing strategies to survive. We are already seeing pay cuts in some of these hospitals though at this point it is at the senior level. As per Dr Ankur Garg, Senior Liver Transplant and HPB surgeon at Nanavati Hospital, Mumbai, “Big hospitals are going to feel the heat for a long time. This is going to be harsher for hospitals that are doing super-speciality work and have lots of dependence on international patients. Surgeries like liver transplants, kidney transplants, major cancer surgeries etc are going to dry up for a long time. This is because of the global financial meltdown as well as curbs on travel. Personally, many of my patients have got transplants done at hospitals near to their homes as surgery could not wait and we were not accessible because of lockdown.”
Apart from international patients even Indian patients who need elective surgeries would be very sceptical to get the surgeries done in the hospitals. Most of the patients who were planned for the surgery will wait for things to get better. However, emergency procedures would be done as usual. As per Dr Priyanjana Sharma leading ENT surgeon in Gurugram, “Corona has thrown healthcare in India out of gear. Patients are still not very comfortable visiting hospitals for consultation. They insist on having a video consult rather than an OPD consult. The number of covid positive patients is still rising and we are far from flattening the curve. This is only going to prolong the road to normalcy. To protect healthcare staff from the infection the COVID test will have to be done for every patient who is getting admitted to the hospital but this would add significant costs to the treatment as the test results take a long time in coming.”
As per Dr Sumita Singh very senior breast specialist in Gurugram,” Corona has changed the healthcare not only for the patients but also for the doctors. As a surgeon, I am still preferring to do video consults and stay home. I am just performing emergency surgeries and that too after proper precautions. I expect people to be more conscious towards their health and hygiene. Even we as a surgeon will have to be careful as the infection in this case spreads through aerosols.”
The biggest sufferers would be the under-construction hospitals which were planning to start operations in the year 2020. They were hit earlier due to a National Green Tribunal order due to which construction work was stopped in winter owing to the increase in pollution levels. The construction had barely started when the lockdown stopped everything in its tracks. Now relaxations have been given but the labour force is on the way back home and this would put a spanner in the works. The economic package which has been in the talks for the last several days is still an elusive dream and it is not clear whether healthcare would have any benefits in this package whenever it comes.
Healthcare is highly capital intensive and the burden of EMI would make several projects nonviable even before commencement. It is also not clear what role would be played by private healthcare in the treatment of COVID-19 patients. In Gurgaon, almost 7-8 renowned private hospitals have been acquired by the government as COVID-19-ready hospitals. The good thing that has happened in this case is that the staff’s remuneration will also be paid by the government apart from a fixed rental or fee to these hospitals.
Hospitals in Tier II Cities
Hospitals in Tier 2 cities in India were having a fairly good run before corona. Most of the services apart from the super speciality like cancer or major neurosurgery were being taken care of in the city itself. Very few brand-conscious patients would move to metropolitan cities like Delhi or Gurugram for such services. However, corona most of these hospitals are facing a difficult time as OPD numbers are very low and most of the cases that are coming are through emergency only. Post corona things would be slightly better for hospitals in tier 2 cities. These hospitals hardly get any international patients so that factor won’t have any impact on their revenues. However post corona they are already facing big challenges, one of them being the testing of patients who are coming for admission. As per Dr Anurag Mehrotra leading cardiologist and chairman of Siddh Hospital Moradabad, “We are not post corona, we are in mid of that. Post relaxations we are expecting cases to go up. The biggest problem is rapid testing which is not available and we have to wait for reports for 3-5 days. As a cardiologist biggest issue that I face with cases coming to the emergency with MI (heart attack) or other cardiac conditions is to differentiate them from corona as they both present with very similar symptoms. We have started performing CT Thorax for these patients as the test results would show the changes in the lungs which are typical of corona infection.”
Apart from that the elective surgeries are still not coming. We need to understand that the patient in a tier 2 city is very price-conscious and an addition of INR 4500 for corona testing is going to have a big impact on the budget. With the use of PPE kits compulsory, even insurance patients are going to feel the pinch as the cost of PPE kits would be counted as disposable items or non-payable items. The cost for the same will have to be borne by the patient.
Availability of doctors is also going to be an issue for private hospitals both in tier I and tier II cities. Most of the doctors from government medical colleges used to join private hospitals because of the unavailability of the latest technology and infrastructure at government setups. Government hospitals have upgraded their infrastructure to combat the coronavirus pandemic making it exciting for these doctors to stay and learn in these government hospitals as well as medical colleges.
Hospitals in Tier 1 cities should look at this scenario as a blessing in disguise. Till now the big hospitals that were focused on getting more and more international patients lost touch with the domestic market. They need to revise their strategies and make plans to reach the domestic segments through direct marketing, branding, online marketing and doing educational meets. The cost of getting an international patient ranges between 25 to 50% of the revenue generated through that patient which is exorbitant. The same applies to tier 2 cities, they also need to focus on direct marketing and online marketing.
People say when supply is limited then wastage should be avoided. Most of the hospitals would agree that they don’t even know how much revenue they are losing from their hospital premises just because of lack of training of the staff. Hospitals need to be aggressive in the direct marketing and training of their staff to ensure the highest level of patient satisfaction. This might not have been possible because of the high patient volumes in normal days but with low patient volume right training to the staff can make the patient go back delighted and don’t forget that there is no better marketing than word of mouth.