The Country Where House Calls Are Making a Comeback
WHY YOU SHOULD CARE
Because sometimes old ways help us address new problems.
By Sanjena Sathian
It’s Saturday morning, but Dr. Madhumita Sen Banerjee is on the job, whizzing from patient to patient, stethoscope and blood pressure monitor at the ready. “Aap tikh ho jayenge” — you’ll be OK — she tells Subash Sharma, the 62-year-old she’s attending to at the moment. It takes 45 minutes for her to diagnose him with acute gastritis. No more alcohol, and less coffee; take a couple of over-the-counter pills a day. That’ll be 1,000 rupees, please — or around $15.
In India, this is your average primary care visit. Except that it’s twice the standard price Sharma’s family would normally pay, says his daughter-in-law Hanika, because it’s all taking place in the home of Sharma’s son. (Sharma is bedridden due to a lifelong polio condition.) Banerjee, who works for a company called Nationwide, makes traditional house calls to patients like Sharma, assisted by a modern business model: on-demand health care.
Unlike in other parts of the world, home health care is experiencing a comeback in India thanks to a neat intersection of technology, a rising middle class that can afford a personal, convenient touch and a rapidly aging population to rival Japan’s — the over-60 crowd will more than double between 2010 and 2050, according to the Population Research Bureau. Along with Nationwide, there’s Portea Medical — backed by Accel Ventures — Nightingales and Healthcare at Home. Sure, they’re responding not only to the growing trend that more working kids just can’t play nurse 24/7 but also to the messiness of primary, geriatric and postoperative health care in the country. The headaches in these industries include the politics of finagling the best nurse in the hospital to change grandpa’s bedsheets, the confusion of trekking sans hospital help to a pharmacy to obtain the medication the doctor has ordered, the unsatisfying food, long queues and possible infections.
Indians simply don’t save for stuff like health care costs, preferring instead to bank money for weddings, cars and education.
It all plugs into a global conversation about preventive and primary care. In the U.S., debates over universal coverage brought up questions of the heavy burden of emergency room visits. Even Ashton Kutcher has gotten in on the game, investing in a startup called Pager that bills itself as Uber for doctors. Telemedicine, occasionally hailed as the saving grace for rural populations, offers one potential solution, but many Indian doctors — like Nationwide’s CEO Santanu Chattopadhyay — say that’s not enough, as it allows docs only to diagnose, at best, rather than to treat patients. Showing up at a patient’s home can legally accomplish what TV’s Dr. Gregory House did illegally — allow care providers to suss out troubles like poor air circulation or dangerous flooring that might cause an elderly person to trip and fall.
In India, there’s an extra wrinkle: a very thin insurance net, with just 17 percent of the country receiving benefits, according to the Insurance Regulatory and Development Authority of India. Most insurers don’t cover outpatient services — meaning primary care, routine checkups, physical therapy, even postoperative follow-ups. Radha Kizhanattam, principal at USF Ventures, calls this gap in Indian society a “big opportunity” for the private sector. Indians simply “don’t save for stuff like this,” she says of health care costs, preferring instead to bank money for weddings, cars and education. The companies that can pull together the “fragmented” elements of the market will reap rewards, Kizhanattam says. All the while, the national landscape is slowly beginning to shift — the health care industry is growing at a rate of some 16 percent annually and will hit $280 billion by 2020, according to a KPMG report.
It’s a terribly familiar-sounding problem of a nation clawing its way from developing status to economic giant. Except that here, it’s not simply good-hearted NGO’ers trying to bridge the gap. Portea, much like Pager or U.S.-based Heal, pitches itself as a solution in part because of its technology. At Portea’s call-center-like headquarters in Bangalore, where the lobby is swarming with nurses awaiting job interviews, CEO Meena Ganesh explains that yet another hospital won’t “disrupt” the health sector. An active tech investor, Ganesh locates herself amid the slew of non-brick-and-mortar operations — e-commerce and the like — booming in India’s tech world. Expanding Portea’s reach, she says, might come from more partnerships with insurance companies.
Not everyone agrees: This business is “not really entirely about technology,” says Kizhanattam; she describes it as a logistical issue, a question of amassing existing services, coordinating vans and bus transportation of doctors, nurses and equipment across cities, linking medical records between home visits and clinical offices. (Nationwide and Portea both employ their own doctors; they’re not mere Uber-esque platforms.) Chattopadhyay frames it as an issue of skills. Nurses in India are treated as lower-skilled than in other parts of the world, so they’re trusted with less; and family doctors fall on the bottom rung of the medical profession’s hierarchy. (Nationwide runs training programs to offer better options to potential GPs.) These two issues — operations and training — are far less attractive for an investor like Kizhanattam.
There’s one more trouble with the home health business, of course. It takes time to dispatch doctors all over the city, especially a sprawling, smoggy, clogged one like Bangalore. Akila Pandurangan, Nationwide’s head of nursing, and Rumana Begum, call center director, remember one haunting call — a patient rang up requesting a doctor, and then collapsed, while on the phone. The patient later died. Pandurangan explains people are reluctant to move ill family members due to traffic. “But they should have rushed him to the hospital,” Begum says, “instead of wasting time.”