Role of Diagnostic Centres in achieving Universal Healthcare Coverage (UHC)

(Hony) Brig. Dr. Arvind Lal Padma Shri Chairman & Managing Director Hony. Physician to the President of India

Health Ecosystem

Health Ecosystem is defined by the interaction between organisms and their environment in specific, limited spaces.

Concept of Ecosystem & importance of Health

For any interaction to happen in ecosystem, health is the foremost requirement. Humans are the most evolved species on planet earth Jaan hai; Jahan Hai Pehla Sukh Nirogi Kaya The greatest wealth is Health

Indian Healthcare Industry

Current industry size ~ US $ 40-55 bn (Rs 200,000 - 275,000 cr); expected to touch US $ 100 (500,000 cr) by 2015 ~ 1.5 mn beds - Projected addition in beds to the extent of 750,000 over the next 5 years Private players account for almost 80% of the healthcare delivery market Entry of Corporates with large growth plans increase in M&A based consolidation activities
Growth Drivers Changing Lifestyles incidence of NCDs Growing per capita incomes/ literacy levels Healthcare awareness demand for quality / reliable services Increase in Government Spending Penetration of Life and Health Insurance

The Indian Healthcare industry is projected to grow by 13% pa till 2012CII-Mckinsey

Indian Healthcare Industry

No. of beds in India only 0.9 per 1,000 pop Only 25% Indoor/Patient Admission facilities available Communicable diseases take heavy toll (Malaria, Dengue, Typhoid etc) Incidence of Non Communicable Diseases increasing at alarming rate!
v India has 61.3 million people living with diabetes (only next to China) The Asian Age, 2nd Nov 2012 v India being referred to as Diabetic Capital of the world

NCD - Coronary Artery Disease (CAD)

Coronary Artery Disease (CAD) is the most common noninfectious disease in India Likely to affect over 6.5 crore Indians by 2015- Dr. Thomas Alexander, British Heart Journal Dramatic rise in incidence, 3-4% in Rural areas, 8-10% in Urban areas 1.8 crores productive years of life expected to be lost due to CAD in working age group (35-65 yrs) by 2030, seriously affecting Indias growing work-force & economy

NCD - Cancer worldwide & in India

Of the 10 million new cancer cases seen each year worldwide, nearly 5.5 million are in 3rd world countries Cancer is 2nd most common cause of death in the developed & developing world Cancer prevalence in India: App 28 lakh cases with 10 lakh new cases & 5.5 lakh deaths occurring each year More than 70% of the cases report for diagnostic & treatment services in the advanced stages of the disease, which has lead to a poor survival and high mortality rate

Indian Pathology Industry

The Indian pathology market is estimated at app. 1.5 Bn USD (Rs. 6,300 cr) Over the last 5 years, the domestic pathology market has grown at an estimated CAGR 20 % Pathology services are offered by Government and private hospitals, independent pathology laboratories and blood banks Highly fragmented industry with 50,000 100,00 path labs in the country; ~ 2,000 in Delhi / NCR Increase in activities of the organized sector consolidation and inorganic growth on the upswing
Independent Labs 52%

Market share by service providers

Blood Banks 5%

Hospitals 43%

Role of Labs/Diagnostic Centres

70% of Clinical decisions are based on lab tests
e.g: Causes of fever, Indications for surgery, Patient admission/discharge etc.

Faster diagnosis resulting in reduced hospital stay esp. with acute bed shortage in India Scientific management of disease Huge cost saving 3% of Indians slip BPL yearly because of health problems

Role of Diagnostic Centres

Prevention of diseases and Complications Early changes can be detected with diagnostic tests Mainstream medicine would be way different if they focused on prevention even half as much as they focused on intervention~Edward Stanley

Role of Diagnostic Centres

Clinical Trials are not possible without Diagnostics India has immense opportunity boosting R&D; playing major role in drug development Lesser healthcare expenses with early and pin-pointed diagnosis thus reducing expense on drugs & health management

Challenges

Accessibility

Affordability

Quality

Challenges
Accessibility
600,000 villages have practically no health infrastructure i.e. PHCs, Labs or collection centres Almost nil infrastructural support in form of roads, electricity, water, schools

Challenges
Affordability
Diagnostic Tests are expensive 77% or 83 cr Indians earning below Rs 20 per day Vicious Cycle starts with nonaffordability; causing more disease that causes loss of man hours and productivity

Challenges Quality
Lack of skilled medical personnel Lack of Governmental regulations & quality enforcement Causes unrestricted proliferation of substandard diagnostic centres

Current Model
Hub and spoke model Samples collected, transported using cold chain & tests performed at larger Quality Centres Goverment Model Private Players Model

Govt- Hub & Spoke Model

CHC PHC CHC DH DH PHC

CENTRAL LABORATORY

PHC CHC

DH

DH CHC

PHC

Government Model Challenges

Eternal demand & supply problem Restricted test menu, equipments, trained manpower etc. Unmonitored quality Lack of cold chain maintenance

Private Players Model

CC1

CC2

Lab

CC3

CC4

How LPL is Helping Ecosystem ?

Accessibility:
High-tech Hub & Spoke Model Satellite - VSAT, Fiber optic cable Regional Centers Reference Centers Largest test Menu 3,000+ tests

LPL Hub & Spoke Business Model

Types of Units -Reference Lab -Metro Lab -Satellite Lab -Collection Centers Delhi Product Portfolio - > 3,000 Tests - 600 Tests - 400 Tests -App. ALL Activity - High End Testing - High End & Routine Testing - Routine Testing

Metro Mini Metro Other towns

Sample Collection

ICT NATIONAL PATHOLOGY GRID

Collection Center

Dr Lal PathLabs

Doctors PC

Hospital with Lab

prop. interface

INSAT-3C enabled bi-directional interface

REMOTE LAB

REMOTE LAB

REMOTE LAB

2800 km ISDN AGARTALA Doctors PC

2 X 128K

REMOTE LAB

REMOTE LAB

NEW DELHI Location of Server

REMOTE LAB

Frankston

Collection Center Collection Center

REMOTE LAB

Collection Center

Hospital with HL7 Interface

Collection Center

Hospital with Lab

Remote Lab

Collection Centre

Dr.'s PC

Current National Pathology Grid

cc1

Mumbai

CENTRAL LAB

Delhi

cc2

LAB 1

cc3

cc4

Bangalore
cc1

Kolkata
cc1

cc2

LAB 2

cc3

cc2

LAB 3

cc3

cc4

cc4

Hub: Reference Lab, Rohini

Largest lab. in Asia ~ 85,000 sq. ft. State-of-the art design and implementation of best-practices Consolidation of operations with Clinical Trials labs Central Hub Pathology education (Fellowship / Diploma National Board; MLTs) Outsourcing (Global Accreditations) Location in Sector 18, Rohini, North West Delhi

Rohini Lab

How LPL is Helping Ecosystem?

2. Affordability

Reasonably priced CGHS ECHS Govt PSUs Camps CSR activities

How LPL is Helping Ecosystem?

Quality & Laboratory Accreditations

Dr Lal PathLabs Introduction

Highest No. of patients tested (~ 30,000 per day) Widest test menu 3,000+ tests & panels 125 labs, 2,000 collection centers, being run presently largest in the country Rohini Reference Lab biggest lab in Asia, 85,000 sq. ft.

Dr Lal PathLabs Introduction

135 Pathologists i.e. largest pool of pathologists with any Pathology provider 25 Ph.D & M.Sc - senior research scientists 500 Medical Laboratory Technologists 6 full time Chartered Accountants 250 well qualified sales & marketing personnel with 30 MBAs 200 Couriers & Pick-up boys

QUALITY

Accreditation in India
q Accreditation in India is under the aegis of NABL (National Accreditation Board for Testing and Calibration Laboratories), Department of Science and Technology, Govt. of India qNearly 400 labs currently accredited in India

INTERNATIONAL ACCREDITATION College of American Pathologists (CAP)

qConsidered an international stamp of Quality (equivalent to JCI, USA) q40 CAP accredited labs in India qPractically, all US labs are CAP accredited; should not all Indian labs be NABL accredited?

Suggestions

Tighter Governmental regulation & accreditation of Diagnostics Industry Increased scaling-up and training of medical/paramedical lab personnel Hub and Spoke model to be strengthened by technical & infrastructural support

Suggestions Public Private Partnerships (PPP) both in operating labs and training personnel Greater adoption of IT: Tele-Pathology and Tele-Radiology More R&D in academia & industry Greater Health insurance diagnostics to be included

Thank You

arvind.lal@lalpathlabs.com