Comprehensive Health Insurance required in India

In India about 157 million households [62% of population] live with < 1 lac per year household income. The economics of these people works very different from that we can imagine. I recently saw a household maid suffering from uro-genital infection. She could have been easily treated by high-end antibiotics; total cost of treatment in private sector would be about INR 2000 whereas her monthly income is about the same. She has the option of going to a Govt run hospital, but there the cost of lost wages due to long waiting and lack of easy access to medication deter her from getting treated. There is an urgent need of a comprehensive and unifying health insurance system for the whole population, not just RSBY for BPL. This comprehensive and unifying health insurance system probably can be a PPP model between the Govt and Private sector insurance.


Currently private health insurance penetration is only about 2% in India. That too it is targeting the upper crust of 200 million population. There are no viable economic insurance solutions for the rest of the 800 million in India. What are we doing by aping the west? We need our own models.

Management paradigm in healthcare

In a recent consulting assignment to help a doctor build a new hospital, I was shocked when he said that in his plan HR has no role. He has engaged specialty consultants and each one will recruit their own staff for their own Department! He was unable to understand the basics of people, process and technology optimization.

I am just amazed at the lack of basic management skills in Healthcare. The more I find out the more it surprises me. Sometimes I wonder how I internalized these management concepts! I guess the general management program from IIMB gave me the power that others in healthcare just lack. Or maybe it came the hard way of stumbling and falling and then again getting up and learning to walk. I probably learnt part of it thru project management in IT. My enlightenment basically happened on the street. Now I intend to plough it back into improving the basic healthcare management.

Healthcare in Commonwealth countries

Healthcare systems in Commonwealth countries have a common inheritance. Therefore they carry the similar DNA though the gene expressions maybe different. Obviously they need similar solutions to common health problems. Why reinvent the wheel?

However I see very little collaboration between commonwealth countries on the healthcare front. Also I don't see businesses recognizing the commonwealth counties as a viable market segment for healthcare solutions. Are the barriers political, social, economical or emotional?

Healthcare-IT is not as simple as it seems

Healthcare-IT is not as simple as it seems. Microsoft had shut down Amalga HIS in 2010 and now Google shuts down google health. Healthcare product development and implementation projects fail when it is treated as an IT project. Microsoft and Google failed to understand this simple fact.

Many of the large HIS/EMR implementations in India are failing because they are being handled as IT projects. Now the writing is on the wall - It is high time the tech giants accept it that Healthcare-IT is not just another industry vertical. It requires deep healthcare skills and a long-term commitment.

Likewise the hospitals need to understand that IT Dept has to be driven from the top with a CIO and CMIO having deep Healthcare-IT background.

Verticalisation of IT services

Verticalisation of IT services is not a new phenomenon. IT services companies have tried to do this since 2001 or even earlier. Now there is a urgent need to do verticalisation because of market pressure. Companies called it verticalisation when they put a thin paint of domain knowledge on top of 'fungible' horizontal technical services. Fungibility was the key to use the staff in various verticals and minimize the staff that was too deep in domain knowledge and not very fungible. This approach worked in some industry verticals whereas it bombed in others like Healthcare where deep domain knowledge was the key. Healthcare customers need service partners that can advise them about the issues at hand and find solutions for them.

The second issue has been leadership of the vertical. Again fungibility in leadership has been encouraged rather than deep domain knowledge. The selection of the leader has been based on employee number indicating loyalty to the company. It is said that the Water always flows from the top. There has to be a crystal clear reservoir at the top for the rivers downstream to have water all the time. Healthcare knowledge cant be gained in a 'crash course', it takes years of education and experience to be able to guide others.

The third issue has been the '5 monkey principle'. The culture of the organisation prevents the organisation to accept anything different. Therefore radical change can't come from within. Healthcare vertical of a services company has to mimic their customers. One success story I know in Healthcare product space - a market leader in HIS/EMR calls themselves a Healthcare company rather than a software product company. They employ hundreds of doctors and nurses that work in their respective hospitals/clinics but also lead product lines.

The fourth issue has been the struggle between the verticals, geographies and horizontals for the same piece of pie. Its like 3 horses pulling the cart in 3 different directions. Atleast for Healthcare the verticalisation has to be done globally so that the skills can be cross utilized in various geographies. Human biology, Diseases and treatment protocols do not know geo-political boundaries!

Hopefully the verticalisation 2.0 will address these issues head-on. To be successful in Healthcare - the IT services companies have to build a new organisation that is completely detached from the past and is radically different from the previous.

Globally the Government funds being thrown into Healthcare have made it very hard for anyone to ignore. Everyone big-and-small, shape-and-color is clamoring to jump on the band wagon. I am watching the fun!

Different Thought process - Engineers vs Doctors

Recently during a visualisation discussion with a DW/BI engineer I realised the vastly different thought process between engineers and doctors. He was displaying the hospital data as trend lines whereas I wanted colored and vivid representation. It was so difficult for him to understand my perspective. We didn't end up in an argument because we have very high respect and regard for each other.

I think the difference in thought process stems from the fact that Engineering education is by numbers, graphs and grids. Whereas Medical education is all by colors, pictures, shapes and impressions.

I am reminded of my early days in medical school when my professor showed me pink, reddish pink, red, maroon, purple red, and purple colors during surgery. Whereas all I could see was RED-PINK. It took years of training to understand and appreciate the difference between pink, reddish pink, red, maroon, purple red and purple. I can narrate many such examples about shapes and impressions.

Engineers built the software technology, so they designed it to work with numbers, graphs and grids. The technology is yet to develop to a point where it can mimic the human brain that thinks in terms of colors, pictures, shapes and impressions.

This is such a simple fact but the realisation hit me today!

Chief Medical Informatics Officer [CMIO]

Chief Medical Informatics Officer [CMIO] is required by hospitals to complement the CIO for EHR implementation and to build the strategic IT Roadmap to support business growth. Usually the CIO comes from a non-Healthcare background and has a steep learning curve about the hospital's dynamic workflows. Whereas the CMIO should come with unique set of cross-over skills that forms a bridge between Physicians, IT and Business.


I see this as a big gap in the current hospital setup everywhere. As the Healthcare-IT product implementations increase the CMIO role will become more critical. The era of developing an HIS/EMR Application for hospitals is over. Now its all about configuring, implementing and adapting pre-developed HIS, EHR or HIE products.