The Hindu Business Line : Crystal-gazing the healthcare scene

CAN one predict the future, especially in these `turbulent' times? Perhaps not. But then, some part of how the future unfolds is in the minds of the beholder. In any case, like science fiction, business fiction too can be fun. After all, business today is all about technology, an offshoot of science.

The modern mantra in business is to build a customer base, use all the tools available for customer relationship management (CRM), build customer loyalty and cross-sell other products to existing customers. But what if the business is such that it is not in the interests of customers to be repeat customers or buy additional products? Healthcare, hospitals and, to a large extent, pharmaceutical companies fall in this category.

Needless to say, doctors, hospitals and pharma companies earn income only (or mostly) when people fall ill. Pharma companies thrive on patients suffering from chronic illnesses and having to take drugs lifelong. Thus, there is an inherent conflict of interests. True, individuals can take health insurance to mitigate their financial hardship at the time of illness. But here again, as is happening in the US healthcare market, there is a conflict of interests: Insurance companies are trying to ensure that doctors and hospitals do not over-treat or overcharge.

The idea that people should pay for remaining healthy — and not for being sick — has been sounded from time to time. Though the rudiments of `healthcare' — annual health check-ups, vaccines, immunisation and prophylactics — exist, the basic purpose of the system is to cure sickness. The change has not come about as the scientific tools for preventing ill-health, measuring and monitoring health parameters, helping the body to heal permanently through the growth of new tissues and such other technologies were not available. The new frontiers of knowledge in several, often unrelated, areas offer the unique possibility of restructuring the industry where the long-term interests of patient/customer and the industry are in harmony.

The healthcare players — hospitals, doctors, pharma companies, and so on — will resist these changes because of the large investments sunk into the system. However, the changes are inevitable given the imbalance in the equation and the technological possibility of correcting the same. Consider the following:

Genetic mapping and other research forming part of the Human Genome Project (HMG) can provide the key to understanding nearly 4,000 known genetic disorders and the innumerable diseases whose origins may be due wholly, or in part, to genetic malfunctions; remote diagnosis; remote/teleprescence surgery using robots (which combine advances in stereo imaging, telerobotics, sensory devices and video, and telecommunications) can provide full sensory experience to the surgeon; growing tissues from stem cells have the potential to be grown in-situ and repair body parts; sustained release of implanted drugs; tissue engineering (design and construction of replacement body parts from living components); material engineering, especially new-generation polymers in conjunction with tissue engineering that have the potential to create new blood vessels, skin and parts of human heart; nano technology, which attempts to build things one atom or molecule at a time with programmed nanoscopic robot arms where parts are measured in nanometer (that is, one-billionth of a metre); embedded technology that can make appliances, automobiles and other devices `intelligent' and perform various diagnostic activities; wireless communication and geo-positioning devices; and various other scientific and technological developments have the potential to diagnose, predict, collect data, communicate data online and provide the necessary inputs without direct intervention to ensure that a person is, and remains, healthy.

What then does the future hold for the healthcare system? In simple terms, the system will promote health and not be designed to cure illness. Individuals will pay the healthcare system on a regular basis to remain in the pink. The system will pay individuals when they fall ill and take insurance cover instead of them. And, insurance companies will act as clearing agents monitoring the systems.

Individuals will become members of a large medical practice that agrees to help, monitor and maintain the health conditions of the individual for a regular monthly payment. The individual's health condition, eating and exercising habits, lifestyle, and so on, would be measured and his/her genetic profiles mapped. Where genetic interventions or other implants can rectify or compensate for existing inadequacies, they would be implemented.

The health management fee would depend on the health condition of the individual as measured by the above criteria.

The medical practice would also implant various measuring devices in the body which would automatically relay data — such as blood pressure, pulse rate, blood sugar level, cholesterol, and so on — to the central monitoring station which could be located anywhere, not necessarily where the individual resides. Based on the continuous feedback from implanted devices in the individual, the surveillance system would monitor and send automated signals to the individual to instruct him/her on what he/she should be doing differently, when required. The medical centre would also intervene and release medication from implanted devices or even perform remote microsurgeries based on predictive date.

Besides implants in the body, the health measurement systems could include devices such as hi-tech toilets which continuously test for sugar, amoeba, and so on; refrigerators, microwave ovens and other household appliances that will monitor the type and quality of food being consumed; and telephones, mirrors and other devices that monitor voice pattern, changes in the iris, and so forth. These devices will be equipped to sense the user's identity through a computer chip on his body and relay the information/data to his medical centre automatically. For the unborn, diagnosis, genetic mapping and interventions will start even before delivery. Maintaining the health of the future generations will, thus, be much easier.

If in spite of such preventive care a person falls sick, then the medical practice would pay compensation provided the individual had adhered to the instructions and feedback given by the system. The role of the insurance company would mainly be one of managing the financial side of the transaction and supporting R&D in healthcare.

Owing to advances in science and technology, quantum jumps in productivity and intense global competition, the fee paid by the individual for such health maintenance would be much lower than the medical expenses incurred today.

In addition to cosmetic dentistry, plastic surgery for skin care and facial structure treatments (which are common today), various capability enhancers — such as chips in the brain that will increase human memory manifold and perfect the vision (including X-ray capabilities), implants in the nose/lungs that will regulate and ensure deep breathing, and implants to control alpha waves in the brain giving the benefits of yoga/meditation — will become common.

The implications of these very real possibilities are immense. The healthcare industry, which accounts for a significant portion of global economic activity, will have to undergo fundamental transformations. The existing players, though likely to resist change because of a large portion of their investments becoming redundant, will have to make fresh investments.

It is also likely that new players who possess the "intellectual property" to herald these changes may take the lead. They are likely to have a different mindset and could be from disciplines/fields outside the medical fraternity. Over time, the existing players can, at best, join the game, as beating the newcomers would be far-fetched.

When will all this happen? The seeds have been sown, the technologies are at various stages of development and the process has already begun. Structural changes, though in spurts and at irregular intervals, will take place over time. And when the various technologies become operational and cohesive, the changes will be rapid and decisive.

(The author is former chairman, Bank of Madura)

Send this article to Friends by E-Mail

Stories in this Section
Raising the bar

Budget blues, economy in red

Crystal-gazing the healthcare scene

After Narayanan, who?

The Enron iceberg

Governance reform, corporate style

Investors' plight

Inflation rate

Textile industry woes