Dr Harsh Mahajan, a pioneer in the field of radiology and imaging, set up one of India’s first privately run MRIs in 1991, and seven years later, was appointed as the Honorary Radiologist to the President of India, a post he continues to hold. He was awarded one of the highest civilian national honors, the “Padma Shri”, in 2002, for his contribution to the field of radiology and imaging. In a detailed conversation with Rahul Koul, he gave insightful responses to the pointed questions on trends in diagnostics, policy issues and the overall state of healthcare in India. Read the excerpts below
What are the latest trends in the radiology and imaging in India and globally?
Trends in India are the same as rest of the world. No longer is India lagging as it used to be in the past. We are contemporary with the international standards.
When I came back to India after finishing my education, I saw that there was no magnetic resonance machine (MRI) machine. That is when we installed the first one in 1991 even when there was none in the country, not even in AIIMS. We later brought functional MRI to India. Technology advancements are a part of human quest for excellence.
Technology brings lot many changes. In last 25 years, I have witnessed a lot of technology upgradation. Infact it is amazing that the medical technologies are fast being compared to mobiles whose latest versions come within no time. These days the patients are much aware than the past. The smart phones are transmitting knowledge at a bigger scale than we can think. Market forces also play a role in shaping the industry. Apart from that the staff at diagnostic centres plays an important role in the entire experience as it changes the perception of patients.
How do you look at the state of healthcare in India? Has anything changed over last few decades?
The primary healthcare is still an issue that India is grappling with. Infact, it is still lagging behind despite all our policies. Preventive health is not fully developed. Lack of potable water is also leading to disease in many rural areas. Communicable disease are again being tackled. Prevention is better than cure. Focus on preventive healthcare is an issue. Pollution and environmental factors are leading to our maximum health concerns.
Is the diagnostic technology really of help when the awareness levels among patients are not enough?
The holistic approach to the technology is necessary. The technology in isolation means little. While it is easy to procure, and install any new medical technology, the key to the technology’s success lies in its actual utilisation. Our attempt is to educate women about the latest screening and diagnostic tools at their disposal, so that the high-end equipment is put to good use, eventually improving both longevity and quality of life.
Take mammography for example, we have the world’s most advanced system at our centre, but it is useless unless women come in and use it. It is recommended that all ladies above the age of 40 get a mammogram done once every 2 years, but either because of the taboo associated with breast cancer, or extremely busy schedules, no one takes out even a few minutes for this simple test.
“I am not saying that the natural medicine practitioners could do surgery but they can play a role in spreading the word around if involved. Rather than ignoring or sidelining, it is best to utilize their vast network.”
There is a lot of talk about make in India. Do you see the rise of manufacturing in medical technology space as well?
India is doing much in diagnostics and robotic technology. The medical tourism has got a boost due to low cost treatment options. Was a part of the committee to start manufacturing CT scans. The Task Force is overseeing the development of a 1.5 tesla magnetic resonance imaging (MRI) machine, SAMIR at the Indian Institute of Technology (IIT), Mumbai within five-year timeline. The one and half years have already gone into it and I hope it will get completed on time.
We have a lot of Indian CT scanners, so are the x-ray machines. As far as completely Indian machines, the assembling of machines will continue to happen even if we manufacture some parts here. It’s a joint process and various destinations are chosen based on cost and expertise.
We have started our efforts but need to catch up. Government is working towards it and it will take some time for a change in thought process.
Most of the machines we see are imported ones. Will we see the startups or Indian firms who expand into an indigenous industry?
The startups in the high-end technology are fewer or even negligent. Reason is the huge investment into infrastructure and brains. At the moment, we have to rely on the imported technologies. In case there is a huge funding push or a sustainable startup policy, we can certainly do well. We have the best skilled people around.
Have we been able to reach out to the rural areas? How do we make the technologies affordable?
We have to remember that the healthcare is a state subject in India and most of the implementation of health schemes is by the state administrations. The individual states have tried to do their bit. The states such as Karnataka, Andhra Pradesh, Goa and even Delhi have tried to build the better public healthcare infrastructure. But needless to say, we require much more.
There are existing traditional routes to reach out to rural population. The indigenous system needs to be integrated with the allopathy.
The technologies of course are expensive and the private healthcare providers spend a lot on getting them to India. Hence, they have to recover the costs to keep them running as there is no subsidy on this by the government. While are also not asking for any subsidy but the support to build the infrastructure from the government is rightly expected. The healthcare industry is different from other sectors.
Unfortunately, it is the Indian elite section that tends to oppose the natural system of medicine. What does such opposition exist in first place?
Opposition is at the technical level. Need to give a direction to this as we can’t ignore the fact that huge chuck on Indian population has been using the traditional form of healing on a regular basis.
I am not saying that the natural medicine practitioners could do surgery but they can play a role in spreading the word around if involved. Rather than ignoring or sidelining, it is best to utilize their vast network.
What are your expectations from the government?
The cost of the technology remains high due to the heavy taxes and ultimately the patient bears the brunt. The 200 percent extra has to be paid extra over the MRP at which the machine is imported. Also, the government must understand that the commercial rates can’t be applied to the land acquired by the hospitals as it will always lead to expensive healthcare. The huge capital is required for land, infrastructure and staff by the healthcare providers who in absence of incentives have to recover the cost, which ultimately leads to burden on patients.
There is a feeling that the private healthcare providers are making a lot of money. I don’t agree to such notions. It is very difficult to even recover the cost incurred on building the business for the first ten-fifteen years. Even after that margins are less.
Coming to the outlay for healthcare in budget, we need to do much better. Our health spending is 1.2 percent of the GDP. Even if we put together the spending done by private healthcare groups, it is roughly 3.5 percent. The central government and states must ensure that money is spent on healthcare.
Is the digital healthcare a new reality? Does India really require it?
Yes, the digital health is a new reality and we must use it for transformation. Shortage of doctors and paramedical staff is a reality we are familiar with. So, the telemedicine can be used for providing medical care in the places where physical presence is not possible immediately. We can best use the modern communication tools to make a connect. The public health centres (PHCs) and community health centres (CHCs) can be connected via satellite.
With huge population and under effective healthcare outreach, India needs it. It is cost effective and quick. While we can’t always have MBBS doctors at far off places, we have to find ways to ensure that there is some medical care.
Has the medical education in India been updated enough to match the technical skills required for doctors in wake of new technology upgradations?
Our doctors are fit enough to deal with new changes. We have been updating the curriculum but still disparity exists within few areas. Even there are gaps between private and public medical teaching systems. We need to bridge that.
NEET is a very good step towards ensuring that there is no malpractice in medical admissions. This single platform for testing knowledge and aptitude of all the aspiring doctors, is indeed a much need step.
I also feel that experience and theory must go hand in hand. While the young doctors must go to villages to get real groundwork experience, they must also be incentivized to work in the rural areas. They must be given facilities while working is far off places as they already handle lot of stress while getting education.
“The time has come when Indians really realize that health is much important than other emotive issues. Even our politicians too will be compelled to fight elections based on healthcare problems and solutions.”
What is the kind of future you vizualize for the Indian healthcare system in next few years?
Healthcare is a fundamental right in our country. However, unfortunately the health has been least of the priorities for both the Indian citizens as well as the policymakers. We need to change that. I expect India to do as many as public-private partnerships to boost the health infrastructure. The government must provide attractive package for private healthcare providers. Health insurance must be made a reality and to begin with, at least the below poverty line families must get insured against vital disease.
Healthcare must be given a priority it deserves. The time has come when Indians really realize that health is much important than other emotive issues. Even our politicians too will be compelled to fight elections based on healthcare problems and solutions. I am being optimist about all these steps and much assured that India will emerge as a healthy nation apart from being a healthy economy.