Reform in Practice: Luis Miranda (ISPP) on Deregulating Indian Healthcare

What is one area of regulation in India that should be deregulated?

Frankly, there are so many areas that need deregulation, but the one that I'm looking at these days is actually the whole healthcare industry. And the trigger for this is, way back in April 2019, we had a dinner where Dr. J.P Narayan, who started the Lok Satta Party, was over and one of the comments he made was that every year six crore people go back into poverty because of healthcare cost. And I said to myself, this is crazy because we've all been working on how do we get people out of poverty and here was something throwing people back into poverty and something had to be done.

So COVID happened after that and so once the pandemic got over, I started talking to a lot of people and went down this huge rabbit hole, understanding a space that I knew nothing about. But I just feel that there's a lot of opportunity over here and the fact that despite all the regulations that we have and all the best intentions that we have, six crore people go back into poverty. It, in my view, is a clear example of a space that needs more deregulation.

What would a more effective alternative look like?

So let's look at why do people sort of go back into poverty because of this. And it's a combination of various things that I've learned from talking to people who are in this space. Not necessarily all of them are believers in free markets or believers in less regulation.

But I think the challenges that we have are a few. One, primary healthcare. So we need to basically allow that to grow more.

Today, a lot of people don't want to get into primary healthcare. They want to get into specialisations and that's first frontier. I, for example, go to a GP.

He's private. He operates over there. He's possibly 65, 70 years old.

When he dies, I don't know where we're going to go to next year. So we need primary healthcare as one big area because it also works on preventive healthcare maintenance. And that's one area which quite often is also not covered by insurance.

What currently happens is that even for primary healthcare, you've got to go to a hospital. That's not the best sort of reason to get into a hospital environment. The second area is to do with the price of drugs and diagnostics.

What's interesting is that diagnostic tests are very inexpensive today. And someone will come home, do a blood test. And why is it so? Because there's competition here.

So therefore, again, can we have medicines also that are at a cheaper price because today the markups are crazy? The third area is to do with technology. And this is, again, an area where technology has played a large role over here, whether it's to do with just the health stack or the ability to build that out and get data records for people. Or secondly, it's how do we use telemedicines to be able to give quality healthcare to remote places.

The fourth is insurance. We have regulation over there, but despite that, we were talking at this lovely conference which the Mercator Centre put together, how the entry barriers to insurance are high. And I chair a health insurance company, but I think we need to have more players.

Insurance today covers only about 5% of the population. There's a large need to cover a lot more people and do it in an efficient manner in a way that actually helps patients. And then we have the issue of capacity building.

A lot of the capacity in recent times has been built by the private sector. How do we have more capacity? How do we therefore also convert people who are not in this sort of trained, formal way to be able to do stuff in a way that also makes sure that they have certain protocols that they follow? The next area is to do with just the quality of the air and the environment that we live in. How do we live in a safe place to live longer? And finally, it's the communities.

Are we listening and addressing the views of the community? So if you look at these areas, I think we're going to be able to have better health outcomes and have significantly less number than 6 crore going back into poverty every year.