The global population is increasing. A UN projection from last year cites an estimate of 9.6 billion people on our planet by 2050. Although some say that this is a conservative estimate, there’s no denying the fact that, as more and more people inhabit this planet of ours, we need to provide them with appropriate health care and ensure they live a trouble-free and happy life. This includes concerns over pregnancy, newborns and motherhood at one end of the health care spectrum. And, on the other, it includes the overwhelmingly worrying issue of aging populations in countries like USA, China, Japan, Australia and possibly the entire continent of Europe.
In their health care sector website titled 2014 Global Health Care Outlook, professional services and management consultancy firm Deloitte shares some of these concerns: “Among drivers for growth in the global health care sector are an aging population, rising incidence of chronic diseases, increasing access to care; technological advancements and product innovation; and emerging market growth. Yet health care organizations also must address major issues in 2014 like navigating the impact of health care reforms in many countries; rising costs; quality issues; lack of infrastructure in many parts of the world; workforce issues; and safety and privacy concerns. The challenges and opportunities emanating from each of these areas can be both global and market-specific.”
As much as there are concerns regarding our ability to provide quality health care to each and every person on our planet in tandem with the growing global population, there is a growing preparedness among us to address these ever-increasing demands and challenges for health care. The good news is, both globally and within countries, health care sector stakeholders are coming together to find solutions through global and local government re-thinking, collaboration and co-operation, corporatisation of services and offerings, technology development and transfer, entrepreneurship, innovation and investment. In this blog post, we take a broad look at the global health care sector and find challenges which open up opportunities within the sector.
The Deloitte 2014 Global Health Care Outlook (PDF) report offers a summary of what the global health care sector is experiencing today. And, though the challenges seem overwhelming at times, the report also highlights opportunities which spring forth as a response to these challenges to grow the health care sector globally and within countries (a handful of countries are selected as examples in the report). Here are excerpts from the report:
“The outlook for global health care sector growth over the next few years is generally positive. Emerging markets including China, India, Indonesia, Russia, and Mexico are expected to see spending increase quickly over the next five years, due to population growth, increasing consumer wealth, and government programs to expand access to health care.
The concept of glocalization — thinking globally but acting locally — will move to the forefront in 2014 and beyond. In the face of change and innovation, the ability to reach into global jurisdictions to learn and mitigate the risk of local change will be invaluable. Conversely, trying to apply global solutions to local markets without factoring in local dynamics could be disastrous.”
The Deloitte 2014 Global Health Care Outlook (PDF) also suggests that,
“Bolstering the number of professional medical, nursing, and other health care professionals is not the only staffing challenge facing hospitals and health systems in 2014 and beyond: Organizations will need to source, recruit, and retain staff, such as advanced nurse practitioners and telemedicine technicians, who are trained to meet the needs of new 21st-century health care models.
Workforce shortages are a major contributor to health care access problems around the world; patient location can be another deterrent to care. In India, for example, about 80 percent of the population lives in rural areas. Many of these rural areas lack good hospitals when compared to urban parts of India; some rural areas even lack a dispensary. Finding innovative solutions to provide health care outside of the traditional hospital setting is going to be critical for industry stakeholders.”
The two issues mentioned above – i.e. the need for (a) health care professionals and (b) equitable access to health care – already pose serious challenges to health care delivery globally.
On exploring these issues further, we find that, as far as medical or health care occupations go, no longer is health care limited to the traditional view of doctors, nurses, clinics, hospitals, pathology labs, pharma companies, chemists or medical insurance firms. The sector has opened up to include thousands of specialist skills and practices – e.g. respiratory therapists, diabetes educator, genetic counsellors, nuclear medicine technologists, to name a few – apart from the traditional list of medical and health care professionals and staff (as documented by e.g. the Indian Ministry of Labour & Employment or the Ministry of Health & Family Welfare under health care occupations) who are in constant demand by patients and hospitals across the globe.
In fact, globally, the shortage for such skills and a skilled health care workforce is quite alarming. Of course, the workforce issue is not new; it has dogged us from time immemorial. But, with the growing global population, the need for a skilled health care workforce in sheer numbers has intensified over the last 50 years. Last November, the World Health Organization (WHO) published a report titled A universal truth: No health without a workforce addressing this demand for a global skilled health care workforce. How alarming is this issue for our growing population? On the WHO website, a news release titled Global health workforce shortage to reach 12.9 million in coming decades states,
“The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million.”
“The foundations for a strong and effective health workforce for the future are being corroded in front of our very eyes by failing to match today’s supply of professionals with the demands of tomorrow’s populations,” says Dr. Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation. “To prevent this happening, we must rethink and improve how we teach, train, deploy and pay health workers so that their impact can widen.”
“Training of health professionals must be aligned with the health needs of the country,” adds Dr. Etienne.
In the Foreword of the (PDF) report titled A universal truth: No health without a workforce, Dr. Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation writes,
“As world leaders embrace the aspiration for universal health coverage, it is clearer than ever that this ambition cannot be realized without a health workforce that is fit for purpose and fit to practice. This report was commissioned to provide a cutting-edge analysis of the status of human resources for health and to sketch an agenda looking ahead to the next 15–20 years.
Gearing up the health workforce to meet the challenge of universal health coverage is no simple task, and continuing with the status quo in the development of human resources for health will not necessarily yield the expected results: looking back at the past 10 years, a clear lesson learned is the need to move away from piecemeal approaches and short-term solutions; only long-term action, backed up by political commitment and adequate investments, will lead to the transformative changes required to attain sustainable results in developing the health workforce.
More health workers will be required: new modelling estimates indicate a much higher global deficit than previously thought. Although these estimates serve illustrative purposes and should not be seen as a planning target, they highlight the magnitude of future challenges, implying the need to rethink the traditional models of education, deployment and management of the health workforce.
It is not all about numbers: the goal of universal health coverage requires a paradigm shift, going beyond a discourse on shortages but rather focusing more explicitly on the accessibility, acceptability, quality and productivity of the health workforce, placing equity at the centre of the agenda. Broader factors also need to be taken into account: an evolving epidemiological profile and population structure are increasing the burden of noncommunicable diseases and long-term care on health systems, and there is increased recognition that health workers can serve as change agents in society, reorienting health systems towards primary care and action on the social determinants of health. A transformative scaling up of health education will reflect such trends in determining health workers’ competencies in the 21st century.”
The health care sector has risen to the challenge. Globally and within countries, government, public and private enterprises are investing in health care education and training to manage the economics of a skilled health care workforce. Here’s the Indian example:
According to an article titled Healthcare Manpower Economics (PDF) in HealthBizIndia from January 2014, angel investor and VC Kapil Khandelwal of EquNev Capital Private Limited says, “Last week, the Cabinet Committee on Economic Affairs (CCEA) cleared a Ministry of Health and Family Welfare’s proposal to add 10,000 seats in state and central government medical colleges for the undergraduate (MBBS) level in a move aimed at reducing the nation’s disease burden. The decision comes a week after CCEA cleared a proposal to set up 58 government medical colleges with 100 seats each.” This is in addition to the 50,000 doctors and nurses who graduate from Indian medical colleges and other training institutions every year who find quick employment in the industry.
The second issue that the Deloitte 2014 Global Health Care Outlook (PDF) report mentioned – i.e. equitable access to health care – is just as challenging. It’s not enough to make quality health care available only to those who can afford to pay for it, but to ensure that, starting now, the entire projected population of 9.6 billion people in 2050 have access to quality health care and a health care professional and/or staff by being able to pay for it. As the WHO A universal truth: No health without a workforce (PDF) report says, “Access is at the core of the vision of the Global Health Workforce Alliance: “all people, everywhere, shall have access to a … health worker”.
According to the Deloitte 2014 Global Health Care Outlook (PDF) report,
“India’s primary health care infrastructure and physician base remain inadequate despite the Ministry of Health and Family Welfare (MoHFW) expanding access into tier 1 and 2 cities through the National Rural Health Mission (NHRM). Also, a high out-of-pocket-expenditure by patients (>70 percent of total health care costs) implies that many of them living in underinvested areas and either do not have access to health care or have to pay significantly more for treatment because they travel to larger cities and often get treated at a later stage of the disease. To address some of the nation’s ongoing infrastructure deficiencies, the Ministry of Health & Family Welfare has allocated $5.87 billion for near-term development.”
In an article titled Will India Witness A Boom In Health Care Sector? in BusinessInsider from June 2014, Preetam Kaushik voices similar concerns over inequitable distribution of health care across the country:
“However, one cannot deny that rural health initiatives in India have been patchy, with the urban populace grabbing the largest chunk of the healthcare pie. For instance, 28% of the urban Indians have access to nearly 66% of healthcare initiatives while the rural majority struggles to access the remaining 34% benefits.
India’s spending on healthcare is also dismal. It is just $43 (per capita) a year, compared to $85 in Sri Lanka, $240 in China and $265 in Thailand. In other words, India has been spending just 1.2% of its GDP over the past decade although it is now high time to increase the spending to at least 2.5%.
But due to its urban approach, India has grown into a coveted healthcare destination, with liberal economic policies helping the healthcare sector grow better and faster. As specialty hospitals gun for private investments and corporatisation, the entire system tends to grow more hi-tech, efficient and professionally oriented – ensuring state-of-the-art facilities, speedy recovery and great hospital stay experience. In other words, India has been working towards a complete healthcare transformation for some time now.”
In his article Healthcare Manpower Economics (PDF) in HealthBizIndia, investor Kapil Khandelwal of EquNev Capital Private Limited elaborates this point further:
“Due to overpopulation and a tremendous disease burden, along with inadequate resources and policies, there has been a perpetual demand-supply gap of medical professionals as well as health care resources in most parts of the country, especially in rural India, with demand always exceeding supply.
The majority of medical school and residency training occurs in hospital settings, where there are fewer primary care role models and a greater orientation toward specialty care. Role models and exposure are important factors in specialty choice; therefore, hospital-based training may influence medical students toward specialties. Hence there is pent up demand and premium for specialty MD seats in India with some specialties such as radiology commanding a premium of over crores of rupees.
A recent estimate reveals that as many as 40 per cent of rural posting by trained medical graduates and post graduates in different states in India are not fulfilled. There is a huge shortage of gynaecologists, cardiologists and child specialists in rural hospitals in the government sectors. Hence the government announcement to increase the supply of medical graduates may still not address the accessibility issue.”
No doubt much of the global and Indian health care sector issues are centered on human resources. But the good news for the economy is that the continuous demand for a skilled health care workforce spread across the globe assures employment for all those who are trained and proficient in their health care skill areas.