The Reality of Indian Healthcare: Challenges and Opportunities

I sat down with Shashank ND, CEO & Co-founder of Practo, who has spent more than 15 years at the forefront of healthcare technology in India. Today, Practo’s software is used in more than 20,000 clinics and the company has over 150,000 doctor partners and healthcare providers on its platform. Practo sees more than 17 - 18 crore visits on their platform every year.

In this discussion we spoke about the paradox of abundance, a healthcare system burdened by ineffective primary care, mistrust of doctors, and geographic disparities. Shashank peeled back the common myth that India's healthcare revolution lies not in adding doctors, but in building more trust and prioritizing preventative care.

Below, I’ve broken up our conversation into five sections, including his direct quotes.

How we got here

AS: What are the systemic issues plaguing Indian healthcare and how did we get here?

Shashank: “First let’s consider where we are in the timeline of India’s history. India has lifted millions out of poverty. The poverty rate in India has plummeted from 55% in 2005 to 16% in 2019, and we’ve lifted almost 500 million people out of poverty. But now that we have sufficient access to nutrition, we are facing a new problem: the issues of abundance. ”

Economic reforms since 2000 propelled India’s services sector to contribute over 50% of GDP, creating millions of jobs. With respect to food, grain production witnessed a 25% increase, while the Public Distribution System ensured subsidized grains reached over 800 million people. Grain storage capacity has also expanded by over 50%, minimizing wastage and ensuring food security.

Shashank: “However, it’s hard to talk about India broadly because there are actually 3 Indias. You have your bottom of the pyramid making less than 2 lakh a year, those making between 2 to 10 lakh and then your upper class making more than 10L a year. Each group faces different challenges. The issue of abundance is concentrated in the upper two groups, which is about 150 million people who primarily live in urban metros.”

The preconditions for lifestyle diseases

AS: Can you say more about the problem of abundance? What is driving the massive rise of diabetes and other lifestyle diseases in our cities?

Shashank: “Well if you look at the average visceral fat and the obesity levels in urban India it is rising quickly. People spend very little time exercising or going to the gym. 30% of Americans have a gym membership, whereas only 2% of Indians do. Plus the Indian diet doesn't help.”

White rice, refined flour, and processed bread are the most commonly used carbohydrates in India. Like many regions around the world, India is also witnessing an prevalence of processed foods and sugary drinks. 

Shashank: “If you have a poor diet and limited exercise, you're a clear candidate for diabetes, hypertension, and all chronic ailments. Later in life that leads to other forms of neurological issues too. So underpinning the entire issue of reduced Indian lifespan are these factors. Plus Indians tend to work longer hours, the average work week here is 50 hours, compared to 40 hours in the US.”

People don’t utilize primary care regularly

AS: “How do we get people to engage in preventive care and do things like regular health check ups?”

Shashank: “Affordability and willingness to pay are big reasons. For a regular health check up people expect a price point of 1,000 to 2,000 rupees. It can be as low as 500 rupees for basic tests. But to do really good preventive checkups, it costs 10,000 to 20,000 rupees. Those tests can give you clarity on the calcium deposits in your heart and your overall cardiovascular health. Then, consider cancer screenings, especially breast cancer which is the most prevalent.

Insurance is also a major problem. A large portion of healthcare spending in India is out-of-pocket, meaning patients pay directly for services. I think we should cover things like physiotherapy and mental health where early issues can be caught and prevented. Because these things are expensive and paid without insurance, people wait too long to see a doctor.”

AS: “It’s a common habit for Indian patients to skip the primary care GP and go straight to the specialist. Why is that?”

Shashank: “That’s right, in other countries you talk to a GP and then that GP navigates you through the care path. Indians usually go directly to a specialist. One reason for that is because people wait until their problems are too severe. But then the market economics for GPs is also not great. They can’t charge much for a consultation. Hence the best doctors want to specialize and all the talent flows to the specialities. Then that further makes the GP experience worse. The need for quality GPs is high and that's causing a big gap in the ecosystem right now.”

Trust in healthcare

AS “We often hear the stats about the low doctor to patient ratio in India. We just have 1 hospital bed for every 10,000 patients. Do we have enough doctors and hospitals in general?”

Shashank: “That’s true, but there’s nuance there. We have an access issue, more than a supply issue. Even the busiest hospitals in Bangalore are running at 70% utilization. We have plenty of doctors in the metro cities. In rural India, where 700 million people live, we have limited infrastructure and less doctors. That’s mostly because doctors prefer not to work in low income areas because of the lifestyle and low pay. But there’s no shortage of doctors in the metros.”

AS: “Despite the availability of doctors in metros, we hear about patients not trusting health care providers. They feel they get taken advantage of by being prescribed unnecessary procedures and tests. Is that general mistrust in doctors warranted?”

Shashank: “There’s more nuance to the question of trust. In general, I don't think doctors are trying to squeeze patients out. They have a reputation to manage and healthcare is all about trust and reputation. If you lose your reputation, it's going to be very difficult for you to grow. So I think doctors are doing their best. 

But I think the challenge is how this information about affordability and quality is shared with patients in advance so they can make more informed choices of where they're going.

Today healthcare is a black box. You don’t know how much you’re going to have to pay for a service. You're not aware of your cost prehand, you're only aware of everything posthand and that's when the frustration and misalignments happen. We need to find ways to make the healthcare system more transparent. 

There’s vastly different healthcare options available to consumers. Like I said, there are 3 distinct income groups in India and all of them exist shoulder to shoulder. You can get a knee replacement done for 20,000 in some places. In other facilities, the same procedure would be 2 lakh rupees. Now imagine you’re in the lower income group and you walk into a nicer hospital and get a bill for 2 lakhs for something you thought would cost 20k. You would lose trust quickly. Same goes for high income patients going to lower-end facilities. They’ll complain about the quality of the rooms and the overall experience.

A lot of making healthcare experiences better comes down to matching the right patients with the right providers. Like we said, there are plenty of specialists in urban metros, but the patient doesn’t understand what quality or price point to expect until after the procedure is completed. By then it’s too late and this erodes a lot of trust.”

I think this is a fascinating point. Shashank challenges the black and white view of doctor mistrust, arguing it stems from information opacity, not malicious incentives. He sees doctors protecting their reputation, but patients lack pre-emptive cost and quality awareness to make informed choices. This shifts the narrative from villainizing doctors to understanding the systemic issue of information asymmetry.

The family doctor concept

AS: “Are there any models you’ve looked at within Practo that could help patients get access to care earlier, rather than waiting to see a specialist?”

Shashank: “There is this family doctor concept we have looked at. It’s about giving people one trusted point of contact in healthcare they are able to reach out frequently. Then they build a habit of speaking to that person about even their smallest health concerns. That would help people get ahead of their issues. 

That family doctor is the one who would intervene on a monthly, quarterly basis and would give you the heads up saying ‘Hey you can easily prevent this, just do these XYZ things. You're doing these small things wrong which is becoming a habit and that habit over years will become a symptom. Then that symptom over years will become a major health issue.’ So there’s a lot of power in having a trusted family doctor type provider in your life. Today, that model isn’t profitable yet, but it’s worth exploring.”

One way Practo solves the trust problem

Shashank: “We’ve been laser focused on solving the trust and transparency issue in healthcare. On every single doctor profile on Practo you can see reviews and ratings. Not just from patients, but our own internal Practo audit team who go to doctor’s clinics and actually reviews their overall cleanliness. 

We also provide ratings on the types of machines they use to sterilize medical equipment and the age and exact model of their medical devices. It takes a lot of time and effort, but it’s something we knew we had to invest in to ensure quality. Eventually that leads to trust. It takes a long time to build a great healthcare brand, and trust is at the center of it all.”

In Conclusion

Shashank: “In general, we have an awareness issue across the board. People aren’t aware of the right foods to eat. They don’t know the value of regular exercise. And there is low willingness to pay for the comprehensive annual check ups that actually give you a detailed picture of your health. There’s a lot of work to do to solve patient behavior and correct lifestyle diseases in our country. That being said, there’s also opportunities to use new technologies, like AI, that can solve these problems.”

My conversation with Shashank was fascinating. It’s clear he’s spent 15+ years in the deep end of healthcare, tackling some of the most significant problems in this space. As India's health paradox unfolds- abundance breeding chronic disease- we have new challenges to solve. 

Beyond doctor supply, it's trust and transparency that ails the system. Patients navigate a murky maze of costs and quality, fueling frustration and mistrust. Shashank suggests there are many things yet to build: matching patients with right providers, empowering choices through trusted family doctors, better rural infrastructure, and more insurance coverage.