
What is the Future of Home Healthcare in India?
No one anticipated that the novel coronavirus, first reported in China in December 2019,would become a global pandemic and alter the way our world works, forever. In India, theoutbreak of SARS-CoV-2 blatantly exposed the vulnerabilities of our healthcare system, with the scarcity of hospital beds being a major concern during the first two waves of the viral infection. Niti Aayog reports that 65% of hospital beds in India cater to 50% of the population, while the other half is dependent on the remaining 35% of hospital beds. This is brought on by pronounced regional disparities in India’s healthcare system(1) There are stark differences in healthcare infrastructure development between urban and rural areas, as well as between different states. According to the Human Development Index 2020, India has merely 5 hospital beds and 8.6 physicians per 10,000 people. The country ranks only 155th on the Global Health Index (2) With a population of more than 1.38 billion, India’s healthcare infrastructure is woefully inadequate.Due to a severe shortage of hospital beds, as well as to ease overcrowding in hospitals, many patients were advised to use homecare services during the peak infection period of COVID-19. Thus, our country’s healthcare crisis opened up a number of previously untapped and unexplored avenues, which have since developed significantly. What is Home Healthcare? Home healthcare is an umbrella term referring to the medical services and assistanceoffered to healthcare seekers at their homes. This includes: ● Home healthcare services such as home medical and nursing assistance and lab services● Home healthcare devices that cover all health screening, monitoring, and self-diagnostic devices● Home healthcare solutions such as telemedicine and telehealth services COVID-19: The spark plug for growth of home healthcare in India Home healthcare services were previously available in India, but they truly expanded their reach during the height of the infection and lockdown and proved that they could close the enormous gap between demand and supply. During the lockdown, healthcare seekers had access to respiratory therapy, lab tests, health monitoring equipment, and teleconsultation services from the comfort of their homes. Around 21.5 million COVID patients received home-based care, and 93% of patients recovered from COVID-19 through home healthcare(3). The ‘contact-free’ nature of telemedicine services made them immensely popular during the pandemic period. According to a survey, telemedicine users nearly doubled during the lockdown, from only 21% of consumers in the pre-lockdown period to 44% at that time. Additionally, 73% of those who have never used telemedicine services before are indicating a readiness to do so now(4). The telemedicine market in India, valued at $830 million in 2019, is projected to grow at a CAGR of 31% and touch $5.5 billion by 2025(5). Similarly, home diagnostic testing also saw a significant increase in popularity during the lockdown, due to its prompt and practical results. In FY-2021, the Indian diagnostics lab market was estimated to be worth $12319.32 million. It is expected to grow at a CAGR of 12.25% by FY2027(6). There was also a significant increase in the at-home collection of samples for laboratory tests. A survey showed that almost 74% of respondents preferred sample collection at home rather than going to a hospital or lab. Patients also preferred receiving their postoperative care and therapy at home due to lower chances of infection, greater comfort, and lower costs(5). There was an impetus in the popularity of home diagnostic and health monitoring devices as well during the same period. Besides convenience and comfort, patients prefer home health care for its lower cost. By using home healthcare services, patients can reduce their overall medical treatment expenditures by up to 25%(9). Growth Catalysts Ageing Indian population WHO reports that by 2025, India’s elderly population is projected to increase to 158.7 million, thus making up 11.1% of the country’s overall population (7). According to ‘The National Commission on Population’, India’s elderly population will reach 193.8 million by 2031(8). The 75th NSS survey found that 21% of India’s elderly suffer from at least one chronic disease, with hypertension and diabetes accounting for 68% of them(7). This implies that in the future, there will be a significantly growing demand for home healthcare services such as telemedicine, medical assistance, at-home laboratory services, and personal monitoring devices. The increasing burden of chronic diseases By 2030, it is projected that lifestyle diseases will account for a staggering 74% of all fatalities (up from 56% in 2008) in India, with the bulk of cases being related to cardiovascular disease, cancer, and diabetes. As a result, home care facilities would experience a huge increase in demand. Cost of treatment Besides convenience and comfort, patients prefer home health care for its lower cost. By using home healthcare services, patients can reduce their overall medical treatment expenditures by up to 25%(9). Changing family structure The 2011 Census reported that 52.1% of Indian households were nuclear families. With a greater shift to this type of family structure coupled with the increased participation of women in the workforce, people are hard-pressed to dedicate their time and attention to their aged parents, especially in urban India. This contributes to an increased dependency on home healthcare facilities to bridge the gap. Market value The global home healthcare market value was estimated to be $320.6 billion in 2021 and is expected to grow at a projected CAGR of 7.9% from 2022 to 2030(11). The Indian market in particular was valued at $7.4 billion and is anticipated to increase at a CAGR of 19.27% from 2022 to 2030(3). What can India learn from the successful home healthcare models of other countries? India’s home healthcare expenditure accounts for only about 3.6% of all healthcare expenditure, compared to 8.3% in developed nations. Countries such as the US, Japan, Canada, Denmark, Iceland, Sweden, and Norway have successful models of home healthcare. Country Home Healthcare Programm USA Triple Aim: By providing post-acute care at home, Medicare expenditure was reduced by 39% per patient Hospital at Home: Johns Hopkins’ initiative for the delivery of acute care at home resulted in a 32%