There is no queue of patients. No air of anxiety. No clock ticking as you quiz the physiotherapist as a potential customer. It’s mostly because it is not a usual clinic. The sprawling Nightingales Centre at the posh lane in Indira Nagar in Bengaluru is an extension of home healthcare that Medwell Ventures runs. Other centres in other cities are not, and will not be, as spacious. It’s an asset-lite concept that Medwell has devised to deliver care. In April, it raised $21 million in a Series B round to ramp it up.

Even though tertiary hospitals have done well—few people travel abroad for treatment these days—the days of setting up big hospitals are numbered, if not over. Hospitals continue to get on the hamster wheel of procedures, getting as many done in the first four to five days as possible. ‘Maximise the encounter’, is the hospital lingo. This hunting game surely maximises their return per bed, where all their capital is invested, but it’s also bleeding the healthcare system.

“In broader terms, hospitals are not the most efficient delivery mechanism. The age of big institutions is over; only highly specialised services will remain in hospitals. The concept of going to a hospital and getting hooked to a machine, say, as in dialysis which has already moved out, will die in 10 years,” says Ashwin Naik, a Resident Fellow at Ashoka India, who founded the Vaatsalya Healthcare, a chain of hospitals for smaller towns.

There are no studies to nail this, but doctors say by most conservative estimates, nearly 40% footfalls in Indian hospitals are unnecessary. Home healthcare has been around in other countries but mostly as attendant care, driven by medical insurance. What some early movers are trying to do in India is not only different but it also provides a chance to fix the fundamentally broken care system. We look at two different home care approaches—Medwell’s branch- and sub-branch driven model; Portea’s call centre-styled model which is now turning to be a marketplace for mature services. How these two models blow pipes into homes and serve people will determine how Indians seek care at home, a market which industry veterans peg to be half of the overall $160 billion healthcare market.

Your OPD is a business development centre, not a place for healing

Ferzaan Engineer, co-founder of Medwell, believes if a lot of medical services today are being bought in a ‘mall-like paradigm’, it’s because the community hospital or the neighbourhood clinic has broken down. “In the home setting also you buy services but the blind spots will go if you are getting it all through one provider.”

Mall Medicine

If a lot of medical services today are being bought in a ‘mall-like paradigm’, it’s because the community hospital or the neighbourhood clinic has broken down

Engineer, former India head of Quintiles, the world’s largest Contract Research Organisation, draws the analogy of the IT services industry.

AUTHOR

Seema Singh

Seema has over two decades of experience in journalism. Before starting The Ken, Seema wrote “Myth Breaker: Kiran Mazumdar-Shaw and the Story of Indian Biotech”, published by HarperCollins in May 2016. Prior to that, she was a senior editor and bureau chief for Bangalore with Forbes India, and before that she wrote for Mint. Seema has written for numerous international publications like IEEE-Spectrum, New Scientist, Cell and Newsweek. Seema is a Knight Science Journalism Fellow from the Massachusetts Institute of Technology and a MacArthur Foundation Research Grantee.

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