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In August 2018, the High Court in Patna district, one of the most populous districts in India, ordered a crackdown [1] on illegal pathology labs across the state. These unlicensed ‘mom-and-pop’ shops, which often entice patients with low prices and deliver results of dubious quality, have long been a problem. But despite previous efforts to control them, many continue to operate.
Part of the problem is that accreditation by the National Accreditation Board for Testing and Calibration (NABL) remains voluntary in many states. And as unorganised local labs still make up the majority of the more than 100,000 laboratories operating in India today [2], accreditation is too big a hurdle for many.
“Out of these 100,000 labs, only about 850-odd are accredited labs. Secondly, if you look at the equipment, the gadgetry, used in these labs, only 10% of the labs use automated analysers, 30% use semi-automated and 60% do the work manually, so where is the quality?” — Mr Sanjeev Vashishta, MD and CEO of PathKind Diagnostics
But price remains a key consideration for many patients as healthcare expenditure is a largely out-of-pocket expense. Catering to patients with highly disparate incomes (India’s Gini coefficient for 2017 was 0.83 [3]), is a key challenge for healthcare and laboratory leaders in the country. For those working in hospital settings, this is compounded by mistrust.
“Everything that we do [at the hospital] is seen through the prism that these guys are trying to make an extra buck. So convincing patients to do tests within the hospital is a challenge,” admitted Mr. Dilip Jose, Managing Director and CEO of Manipal Hospitals, who joined Mr. Vashishta and a number of other C-suite executives on the panel.
Building trust by focusing on quality and patient safety
Making accreditation and quality a key selling point in patient and healthcare professional education campaigns can help laboratories and hospitals to distinguish their services.
“We conduct a lot of camps for the consumers, telling them the virtues of those tests that we are doing. [We] reach out to the doctors through CMEs and roundtable discussions, informing them about what the company stands for, and what new tests and technologies are available,” said Mr Vashishta.
In addition, providing test results fast helps to offset some of the price sensitivity of patients, Mr. Jose pointed out. With an in-house lab team that is something the hospital is able to provide. An added advantage having their own diagnostic services is that these hospitals become a one-stop service for patients. By collaborating closely with physicians, the hospital lab team is able to offer test packages that fully investigate a suspected diagnosis, which is another value-add offered by the hospital.
“Rather than doing five tests individually, we offer packages such as a renal profile package or a fever package, which is easier,” he said.
Whether hospital or accredited laboratory, leveraging patients’ previous experiences with unlicensed labs can also help.
“Some of the patients would have, over time, experiences of tests having to be repeated because the outside lab did not get the results we were expecting or a sample got lost. [So] we have to keep at the quality issue.” — Mr Dilip Jose, Managing Director and CEO of Manipal Hospitals
In the same month that Patna district started its crackdown on illegal laboratories, NABL CEO Anil Relia announced that the board will start to assess and accredit collection centres as well as laboratories, and will launch a mobile app that allows consumers to check if they can trust the nearby lab by geo-tagging accredited facilities. This will make it easier for people to find accredited labs and collection centres, helping consumer make the best choices for their health.
[1] “Patna High Court directs state govt to submit district-wise details of illegal path labs being run in the state” http://www.pharmabiz.com/NewsDetails.aspx?aid=110824&sid=1
[2] “Now, only doctors can sign diagnostic reports” https://timesofindia.indiatimes.com/india/now-only-doctors-can-sign-diagnostic-reports/articleshow/59445426.cms
[3] India inequality report 2018: Widening gaps by Oxfam India
This article is based on a panel discussion: Are we ready to drive the next wave of healthcare growth? at LEADx Diagnostics Leadership Summit in Mumbai, India.
