Hurray! I finally completed watching all the Eight Season, 177 Episode Series of Dr. House MD last night. This was one of my wish list for 2021. In the past, I had watched some of the episodes but could not watch the full series. Over the last 350 days of 2021, as I watched through all the episodes of Dr House, I realized and learnt a lot about myself not that I am interested in medicine and healthcare, but as a person. Here are some of my learnings from Dr. House MD.
Statutory Warning
This blog may contain references to sex and nudity, substance abuse, or realistic/non cartoon violence and frequent strong language. Read ahead with extreme caution
Co Dependency
Everybody has co dependencies whether to substances, situations, surreal events, sapiens of human origin, society at large, etc. Not many are able to break this in their life to emerge stronger
True Love is not OTC Medicine
Not everyone has been able to find true love of their life as they has treated their love mate as an episodic medical event. Managing true love is like managing a life-long chronic condition
Hookers Polyescort is not a Relationship Transition Gap Binder
Loneliness and emptiness cannot be filled by hookers. They may relieve pain and the weight of your wallet in the short term but leave behind big hole in your wallet and your heart.
Pain in the Ass does not come only from Butt-Plugs and Suppositories
Some people can be a pain in the ass. But like Dr. House, look at their true intent in ragging you. They want you to succeed and improve. Don’t switch them off completely because you are pissed off with them.
Paternity Tests Still Do not Tell You Who You Are
Finding your genetic father still does not answer why you are who you are!
The Intuition Injectable
Talking of the pain in the butt, there are some who inject great intuition into the situation to solve the issue or guide the direction. Sometime they can be painful and overbearing and may not respect the hours of dedicated work and effort you may have put in with no results
Pediatric Morphism is not a Medical Condition
Being a child is not a medical condition. It’s perfectly fine to be a kid or behave childishly. You will not be diagnosed for a mental medical condition. Many problems are better solved when a kid. Play the pranks, its healthy
Hiring, Firing and ReHiring is not a HR Disorder
Word like talent, hire, fire do not exist for a genuine inspirational people leader. Talent will still flock to them inspite of their unstable and inconsistent people behaviour
Jerking is not always Masturbation
Relationship ejaculation does not always happen by jerking of people due to right reasons. Over mental masturbation will definitely lead to ED of true and sensible solutions and ideas
Dopamine High is not Always Hallucination
Day dreams or nightmares are not medically treatable if controlled on to a problem solving situation. Sometimes you need the dopamine high to break away from the situation to analyse it dispassionately to arrive at a solution
Game People Play is not a Medical Pharmacopeia
There is not prescribed drug list to treat games people play. Either face and challenge it or become depressed to consume anti-depressants to cope with it
A Surgery of Lies does not Cover the Wounds of Truth
People always lie. Sometime for the good. But they always. No drastic surgeries can cover up those lies to truth
Music is a Therapy
Like Dr House who played several musical instruments and also solved many medical cases and saved the lives of many patients, music was therapeutic for him and me. You can also see music when you are on drugs
True Friendship is like Intensive Care
True friendship can only be nurtured when you take intensive care and measure and watch all the parameters like in the ICU
Walk through Life not using Carrot and Stick
All of us use stick to force our authority to walk ahead in life. Our fear and dependency on the walking stick makes us powerless and sidekick. How can you live a life without the crutches of a carrot and a stick?
Many don’t know the miracles and health benefits of keeping your fingers in good shape. Here are seven key facts that you need on your fingertip about your fingertips.
Direct Connect to your brain
Like your feet, the fingers have millions of nerve endings that connect to the brain providing it with six different type of sensations as heat, tactile pressure, vibrations, texture, pain, and the position of the body in relation to its surroundings. This direct connection to brain of the fingers leads to stimulating and improving the neural functions of the brain.
Detect Minutest of Objects
The touch receptors in the finger tips are so concentrated that even a thinnest of a pin of 0.2 mm can be felt. The fingertips are even more sensitive to dynamic (or in-motion) touch that you’ll find you have a whole new level of intuitive, precise control.
Feel Vibrations
Our fingertips can decipher tiny vibrations that are created when any surface meets them. Different structures create different vibrations based on the amount of friction and wrinkle width (which is how scientists gauge non-smooth textures) present on its surface. Fingertips interpret motion vibrations in order to assist touch.
Move Without Muscles
Our fingers have tiny arrector pili muscles, which can make the hair on the fingers stand up straight. The brain communicates directly to the fingers for movement
Move In Harmony With One Another
Because of this complex network of muscle, tendon, and bone, it is incredibly difficult, if not impossible, to move one finger by itself. There are 29 major and minor bones, 29 major joints, at least 123 named ligaments, 34 muscles, and 48 named nerves in the hand—and they all work in conjunction with one another to make the fingers functional.
Communicate with Others
The fingers’ dexterity also supplies a vast well with possibilities for non-spoken language. Gestures and hand motions can also increase understanding among non-signing people
Our Aadhar (Identity)
It’s common knowledge at this point that no two fingerprints are alike, and because of this they’ve been used as personal identifiers for millennia—even our unique identification number (UID) uses our fingerprints.
Why the need now?
As I am getting older, I am seeing some of my friends and acquaintances parents suffer from Alzheimer’s, A type of brain disorder that causes problems with memory, thinking and behaviour. This is a gradually progressive condition. Some other mental degradation conditions include:
Dementia: A group of symptoms that affects memory, thinking and interferes with daily life.
Parkinson’s Disease: A chronic and progressive movement disorder.
Huntington’s Disease: A condition that leads to progressive degeneration of nerve cells in the brain.
Early-onset Alzheimer’s disease: Early-onset Alzheimer’s disease, also called early-onset Alzheimer’s, or early-onset AD, is Alzheimer’s disease hits people between the ages of 30 to 65 years
Vascular Dementia: A condition caused by the lack of blood that carries oxygen and nutrient to a part of the brain.
Lewy Body Dementia: A progressive dementia that results from protein deposits in nerve cells of brain.
Multiple Sclerosis: A disease that affects central nervous system.
Over 1 million new cases of Alzheimer’s in India are appearing every year. This is a huge issue not only for the person suffering but also for the family members and care takers. I was wondering if the onset can be delayed or avoided. During the pandemic, I was witnessing many people falling prey to mental illnesses and that could further degenerate to Alzheimer’s if not properly diagnosed and treated. I wondered on the need for some solution to combat this during the lockdown and pandemic. I looked towards music.
My Experience with Music
From my childhood I have been musically inclined. Apart from singing I was exposed to various musical instruments. As I grew up I started playing the guitar and learnt strumming and composing as a hobby. Somewhere in between my busy work life I gave up. However, I encouraged my kids to take up playing a musical instrument. As they grew up, I realised that playing a musical instrument was therapeutic and help them focus better. During pandemic I took up to walking to remain fit and during my walks I would listen to rock music. This did help me in reducing my weight and remain calm and sharp while working alone in my office during the lockdown.
Another issue that I realised is that I am typing more and writing less. This is another reason that my finger tips were not being adequately used. To balance all this, I acquired a Yamaha acoustic guitar to connect back to music. How does this help?
There are several research papers on internet that tells how using the fingertips while strumming the guitar helps. Here are a few that I have felt:
Playing guitar helped to lower blood pressure and reduce heart rate as it is mentally calming. A recent BMJ study suggests the same heart health benefits.
Relieves stress and anxiety and reduces cortisol levels in me
My brain was sharper and memory clear. A recent study states, playing a guitar or any string musical instrument is helping to stave off degenerative diseases that are common in older people, including Alzheimer’s and dementia. In fact, seniors who engage in the kind of engaging mental activities like playing an instrument can reduce their risk of developing these conditions by up to 75%.
My creativity increased. Enough studies state that
Mathematical and numerical dexterity increased. It’s not that I am now going to sit for some competitive exams like CAT. But I could focus back on numbers
My vibrational energy significantly improved
Lastly, my interpersonal communications and relationships took a huge 360 degrees turn for the better
So it’s upto you. What strings you would like to pick up? Towards mental degradation or mental upgradation?
Perfect human sight is the greatest gift that a man can get. Years ago, I remember on one of my Rotary Eye Camps in a village near Bangalore, an old lady came to the Eye Camp with the help of her assistant holding her and guiding her to take the steps due to poor vision. The doctors checked her eyes and gave her a pair of spectacles. On wearing the spectacles the lady was overjoyed and filled with tears. She could see perfectly which she had not for years. Her dependency on others and quality of life improved immediately. This incident bought emotional tears to all the people around her. Like the old lady, there are millions of Indians who have poor quality of life due to lack of proper sight as they cannot afford proper spectacles to correct their sight. I seem to be amongst the more fortunate ones who can afford the luxury of sight correction.
My Issues with Hypermetropia, Myopia and Presbyopia
As far as I am concerned, I have always tried to maintain my eyes inspite of long-distance sight (hypermetropia) correction from my teenage years. As I aged (presbyopia), the complexity of near-distance (myopia) reading and long-distance sight have emerged. My lenses that Essilor fitted to combine both of these into one lens in a spectacle resulted in near catastrophe while driving on the highway. As a result I preferred to maintain two sets of spectacle for hypermetropia and myopia. With presbyopia, I have to fit new lenses as the vision for hypermetropia and myopia keep changing. This means a new set of spectacles every year or so to maintain proper vision.
My Experience This Time Getting Vision Correction on Digital
Every year, I visit the optometrist around the festive season to get my vision tested and procure new set of spectacles and lenses as per the advise of the optometrist. Given the lock down situation, I thought of procuring the spectacles through the digital online platforms like Myntra, LensKart, Titan Eye and Amazon, etc rather than shopping for at the physical optician stores. I wanted to try out Lenskart as my daughter had bought two pairs of spectacle recently and was a very loyal customer of them. While all the catalogues of Myntra, Titan Eye and Amazon offered just the spectacles, Lenskart offer the spectacles and a zero-powered bluecut and anti-glare computer lenses fitted along with it. Similar spectacle designs on platforms other than Lenskart turned out to be cheaper as Lenskart was loading the price to the lenses additional. I needed powered lenses to be fitted at an additional cost and throw away the lenses already fitted with Lenskart spectacles.
My WhatsApp Interaction and Talk with Amit Chaudhary of Lenskart
Pissed off with the experience, I WhatsApp Amit Chaudhary, Founder of Lenskart. That’s when I realized the business model of Lenskart versus other digital and brick and mortar opticians out there. Here are some of the excerpts of my telephonic conversation with him
Lenskart is the largest AR eyewear venture in the world
Over USD 150 mil of eyewear is sold by them through their platform and lenses are manufactured and fitted through their fully-automated robotic facility
AR technology and fully-integrated robotic manufacturing facility makes them the cheapest provider of eye wear in the world due to the scale
They are targeting a total addressable market of around 1.5 billion eyes in India
They are therefore integrated to provide the full solution of spectacles and lenses as operationally there are challenges of product warranty when customers buy spectacles from them and fit the lenses outside at a local opticians.
There is a stand out quotes that while talking with Amit that summarized their business model
“We are the Maruti of the eye wear business. Customers like you form the top 10% who are the Ferrari’s who would like spectacles not only for functional, but for esteem value”
I like the lazer sharp vision of Amit. As entrepreneurs like him who raise lot of VC and PE capital at some time want to dominate and move away from their core business model and value proposition in the pressure for growth, profitability and valuations.
Although Amit offered to service me as an exception, but that is not core to their way of working. Consumers sometimes miss out on this and crib and bad mouth the start ups on social media, missing out how these start ups are making the world better by offering sight to millions by being cheaper, better and faster. Remined me of the old lady in tears who could see properly and so did I on Amit’s perspective.
Kudos to such start ups which are bringing in technology and production techniques to reach scale!
India’s leading business podcast QuoteUnquote With KK (https://kapilkhandelwal.com/podcasts/) produced by healthcare and investment industry veteran, Kapil Khandelwal of Toro Finserve LLP was launched on Dailyhunt, India’s #1 local language content platform, this month. This podcast organises a virtual fireside chat with thought leaders around the world on various current issues and topics across business, economics, investments and socio-politics. The show successfully completed its first season comprising ten episodes with global thought leaders Mark Mobius, Parag Khanna, Rajeev Peshwaria and Mark Kahn, to name a few.
Kapil Khandelwal, as quoted in his podcast, shared “we have been listening to our listeners and in next year’s season, we’re going to run QuoteUnquote with KK on 2 tracks – Healthy and Wealthy. Healthy because of what we have gone through last year, and Wealthy because without a healthy world we cannot become a wealthy world. So, these are two very intermingled issues. We have lined up star speakers from different areas in healthcare and investments and current events and developments. On popular demand, we are going to run this podcast on a fortnightly basis. Our team is very excited to give more to the audience demands and feedback. QuoteUnquote with KK is available on global platforms like Spotify, iheart radio, Amazon. The strategic idea of our partnership with Dailyhunt is to provide access to Indian audiences looking for premium, short-format content. Additionally, Dailyhunt users will also be able to access all my blogs published on various subjects.”
Umang Bedi, Co-founder, Dailyhunt says, “Our 285+ million users challenge and inspire us to introduce formats that improve their experience on the platform. Communities socialized over content last year like never before, and Indian audiences are absolutely entitled to premium and intelligent content, regardless of their location or their network. I had the privilege of hosting a talk show with business leaders on Dailyhunt last year, and taking from its success, I’m quite confident that KK will enjoy an engaging and stimulating relationship with our users.”
On the launch occasion, Kapil Khandelwal, Father of offshore Quant Fund Investing in India and Managing Partner, Toro Finserve LLP, said, “I am glad to announce that India’s largest discovery platform, Dailyhunt is now hosting QuoteUnquote with KK. This will take the virtual fireside chat to over 285+ million monthly users on the Dailyhunt platform. I welcome the audience of Dailyhunt and am looking forward to interacting with them, on the platform”
Season one of QuoteUnquote with KK, with all ten episodes, is now available on Dailyhunt.
India’s leading business podcast QuoteUnquote With KK (https://kapilkhandelwal.com/podcasts/) produced by healthcare and investment industry veteran, Kapil Khandelwal of Toro Finserve LLP has partnered with Hubhopper, India’s largest podcast hosting and distribution platform. The podcast reaches over 200 million listeners world-wide and organises a virtual fireside chat with thought leaders around the world on various current issues and topics across covid pandemic, self-growth, business, economics, investments and socio-politics. The show successfully completed its silver jubilee episode recently.
On partnering with Hubhopper, Kapil Khandelwal, commented “during 2021, with Pandora (not available in India) and some other platforms distributing our Podcast to English, Spanish and other foreign language listeners globally, our split of Indian and foreign listeners skewed from 90:10 in 2020 to 55:45 currently.QuoteUnquote with KK started with the intent to bring ‘outside-in’ perspective to our Indian during the lockdown on what the future holds, given the tremendous uncertainty amongst people, corporate executives and listeners. During 2021, India has demonstrated exemplary leadership in not only managing Covid situation and inoculating over one billion vaccine doses in the quickest possible time. Therefore over the last few months, we had been witnessing a steep rise in our foreign listeners whose interest in India has peaked. Our Season 3, will focus on the India success stories and continue the ‘outside-in’ perspective of the global thought-leaders focussed on India. We also need to address our core co-hort of Indian listeners who have been motivating us all along to produce such content. Moreover, our pilots with Zee5 and Dailyhunt as the first podcast on their platform to deepen our reach to the core Indian listeners has been very positive and successful and validates our cross-platform strategy we implemented for podcasts for the first time in India. Hubhopper partnership builds onto our experience to reach deeper to the heartlands of India and further execute our cross-platform strategy to introduce QuoteUnquote with KK on their platforms”
Gautam Anand Raj, Co-founder, Hubhopper says, “We are on the verge of a new dawn for podcasting in India with both creators and listeners adopting the medium as a staple within their daily routine. We are extremely proud to partner with QuoteUnquote in bringing their content to new ears across the country.”
On the launch occasion, Vani Garg, Associate Executive Producer QuoteUnquote with KK and Founder, Consoul said, “in the mobile first era, OTT transformed the video content distribution on demand with hyper personalisation shifting consumers from Cable/Satellite TV to their mobile phones. We are witnessing the same shifts with the consumers for authentic audio content which was predominantly on our FM Radio to cross platforms and podcasts on apps. Our strategy of distributing the original thought leadership audio content of QuoteUnQuote with KK is paying off. Consumers in India are not still mature for a Subscription Audio on Demand (SAOD) like Subscription Video on Demand (SVOD) on OTT and we will continue to monetise our content through Advertising Audio on Demand (AAOD) like Advertising Video on Demand (AVOD) on OTT. We are witnessing a dire shortage of content for AAOD in India. QuoteUnquote with KK has an early mover advantage and a large following of listeners globally. Our partnership with Hubhopper further deepens on our cross platform strategy to reach out maximum Indian listeners on Jio Saavn, Hungama, Gaana, Wynk Music, mobile phone platforms such as Xiaomi Music, Jio Phones – KiaOS wallet platforms such as Paytm, PhonePe and in cab entertainment systems such as Ola Play, to name a few ”
Season One (2020) and Two (2021) of QuoteUnquote with KK, with all 25 episodes, is now available on Hubhopper platforms.
Why is India’s National Digital Health Mission is likely to succeed?
Background
Last year the Government of India announced the National Digital Health Mission (NDHM). We were asked to review and comment on the draft as one of the stakeholders in healthcare. This inclusive approach to involve the various stake holders was never seen before. We believe that COVID-19 and NDHM has increased the pace of digital healthcare and can unlock USD 200 to 250 billion in next 10 years in terms of primary and secondary impact to the nation’s economic value. Such is the magnitude of the NDHM initiative for India. So will this succeed?
To understand the critical success factors for India, let’s understand some notable failures and learn from them. Also we need to learn from the currently ongoing Covid Vaccination Drive in the country that’s the largest in the world and the fastest that will cover over a billion people.
We have several tech giants and countries that have invested and failed in rolling out digital health initiatives. Some of these that come to my mind are:
Google Health
I had written in my column on Why did Google Health Fail? (see text below)
Why Did Google Health Fail?
IBM Watson Health
Some of the insider views on the closure of IBM Watson Health (shut down on 31 Dec 2020) are as under:
Business call by IBM leadership – viability of the case in oncology
Muted doctor’s acceptance
50:50 prediction accuracy of the algos
Wrong expectations set when initially selling the idea to the doctors and Manipal
Difference in clinical pathways of oncologists on the Watson output
Implementation was very complex due to the different oncology tumour and stage
Oncologists time to teach the system versus doing it by their own experience
Doctors believed that they were recruited to treat the patient and not teach the Watson
Limited use case of the system
More for research than for actual treatment and second opinion
UK NHS Spine Program
As part of the leadership team of one of the vendors involved in the UK NHS Technology initiative and also interacting with the Managing Director of British Telecom Healthcare that was leading the rollout in the UK of the NHS Spine, I gathered that the digital health (in those days-2007, this was not called digital health) in UK had a partial success. The reasons were multi-fold:
Exgaggerated benefits of the program
Botched up decentralized implementation at the different trust level
Multiple stakeholders with their wrested interest
Manpower and resources shortages
Multi-year delays and costs overruns
Poor change management and acceptance at the ground level with the clinical workers
And many more issues
African ICT and Digital Initiatives
As part of the Health and ICT Minister’s Panel for Africa, the major issues voiced by the Ministers from the African continent happens to be the disease of Pilotonomics. There have been multiple pilots of initiatives but none have actually fructified to be a mainstream as some of them have been abandoned by the sponsors and the donors as the budgets ran out
Have seen the failures across the Tech Giants, developed world countries and low income countries, the issues of failures are a myriad of technology, sponsorship, change management and end user acceptance.
Why will India succeed?
During the Covid-19 pandemic, India Government initiated a host of digital initiative (see blog Sustainability of Digital Health | Kapil Khandelwal (KK)). The most important being the roll out of the CoWin App for the vaccination of the citizens. For the first time on the world, a billion people would be mobilized through this initiative for their vaccination. With the pace and success of the initiative and the citizen acceptance, we will see that the National Digital Health Mission will succeed. Some of the positives that I am seeing include:
PMO and senior Ministers’ and Bureaucrats’ driving this Mission
Inclusive attitude to gather all the stakeholder’s voices right from the beginning
ICT framework and the National Telemedicine Act also being enacted bringing the decades of differences between the Medical Council of India (MCI) and various players to an end
Many doctors have actually started using Telemedicine during the lockdowns
Let’s not belittle the National Digital Health initiatives for shorter political gains!
Republished Column: A Dose of IT: Why did Google Health fail?
Google Health is not going to be there anymore.
After its launch in May 2008, Google Health has gone through its chequered existence till the Google Execs announced, last week, to withdraw the product by end of 2011. As I epilogue, I will use the PESTC model to conduct the postmortem analysis on the death on Google Health
Politically, 2007-08 was a time when concerns around reforming healthcare reform were at its peak and a one of the key agenda items in the US Presidential war. Such rhetoric on healthcare and need to reform healthcare was politically echoed world over by many leaders. This political analyst wanted to get more bang for the buck on healthcare spend. This meant more business for healthcare ICT to create solutions to address the issues of healthcare access, costs, quality, outcomes and so on. Politically, it made sense for tech heavy weights to put their might in launching healthcare solutions and in this political back drop that Google Health was launched. However since then and Obama’s healthcare reforms bill, not much impact for many tech major’s who waged on healthcare and hence to reassess their decisions to throw their towels in.
Economically, this was the time for world’s worst economic downturn since the Great Depression. Healthcare was seen as anti-recessionary. Tech major’s boardrooms and leadership strategy break outs discussed derisking and growth by enter social sectors such as healthcare, education and so on. Google’s board and leadership could not have been thinking differently when giving thumbs up to invest in healthcare business. However as many tech major now realize that healthcare requires long-term strategic vision and investments to stay in the game. Like many other tech major, Google has other investment priorities in other portfolios of their business such as android OS and mobile phones and devices, etc. It made sense for them to exit out of a sector that requires time and investments to change the way people and clinicians manage health.
Socially, the rise of social media is changing the way people manage information, communicate, exchange content and interact including their doctors and care givers. Google Health failed to capture this trend in their solutions.
Technologically, Google failed to learn from the failures of many others who failed in the past and replicated solutions where there are far more superior solutions and players in the field. Some major gaps, I guess alignment with doctors and clinicians is the first step towards creating a technologically superior solution that can align with healthcare consumers. Secondly, there were hardly any vertical partnerships in healthcare that Google went out to create an ecosystem. Lastly, Google did not integrate their other products such as Google Maps that could provide location aware services to the consumers on their health.
Consumers and competition, contributed to putting the nails in the coffin of Google Health. Google Health focused on one end of the healthcare value chain and did not believe in working in aligning the overall healthcare ecosystem. Moreover, consumers are moving towards mobile-based solutions on their smart handphones that Google Health failed to capture as a trend. Lastly, competition has far better ideas and staying power as health tech solutions is a long-term game.
With Google Health putting down their shutters on their shop, what are the implications? Firstly, the spotlight now falls on Microsoft HealthVault. Analysts will now try to second guess Microsoft’s response to this development. Health is a very large opportunity that Google may not like to miss. It may come back with an acquisition sometime later.
Earlier this year I read an investment analyst’s report on Future of Happiness. The subject was very interesting given the current times in Covid. A lot has changed in the world in these times. Firstly, the pace of digitization and social isolation during extended periods of lockdown and secondly, losing some of our near and dear ones who succumbed to Covid in a tragic event. This crisis of mental and emotional well-being and suffering that me and fellow humans have undergone made me wonder about what happiness is and my quest for happiness alone. My journey was a difficult one but, I did see a sense of happiness and I am sharing this through my blog and my podcast.
The Happiness Movement
Even before Covid, in 2012, the United Nations (UN) declared March 20 to be observed as the International Day of Happiness. The day recognizes that happiness is a fundamental human goal and calls upon countries to approach public policies in ways that improve the well-being of all peoples. Venezuela was the first country to establish a Ministry of Happiness. Several other countries followed suit. Closer home, Madhya Pradesh Government under the BJP rule established a Department of Happiness and organized a week-long Festival of Happiness in 2017. The issue here is inspite creating bureaucratic and governance structures, the citizens and people were unhappy. This let me to believe that there is something fundamentally wrong. Therefore let me first define happiness and then decode how to achieve happiness.
What is Happiness?
A Google search on a formal definition of happiness lead me to the various online dictionaries and no formal definition of happiness. This fuzzy description of what we feel under the wide umbrella of happiness is a wide range of positive human emotions that we go through. However, a definition of happiness is well articulated in the book “The How of Happiness”, by positive psychology researcher Sonja Lyubomirsky as “the experience of joy, contentment, or positive well-being, combined with a sense that one’s life is good, meaningful, and worthwhile.” After having defined happiness, it’s now time to understand how we experience happiness?
How do We Experience Happiness?
The Western world scholars have two distinct explanations on Happiness and how to experience it? These are:
The “More” Approach: Here happiness is experienced by acquiring material objects that maximize pleasure and minimize displeasure. This approach hinges the fact that happiness depends on acquiring more things or experiences, depends on factors outside of one’s body.
The “Enough” Approach: Here happiness is happiness is experienced by our ability to ride the waves of human experience and cultivate internal wellness, even through turbulent times.
These two approaches however do not yield a perfect sense of emotional and mental well being as an outcome of happiness as it’s a bit alien to my values and personal belief system.
Indian Approach to Experiencing Happiness
Earlier this year, Dr. Devdutt Patnaik, India’s leading mythologist, speaker, illustrator and author, known for his writing on Hindu sacred lore, legends, folklore, fables and parables www.Devdutt.com released a book “Dharma, Artha, Kama, Moksha – 40 Insights into Happiness” This book resonated very well with me and my values when I read it. In fact, I invited Devdutt to my QuoteUnQuote with KK | Kapil Khandelwal (KK) Podcast. We discussed and dissected many issues around the whole architecture of the 40 insights and the 4 key pillars to experiencing Happiness.
Please read the book and listen to the Podcast “The Mantra for Happiness” to practice and experience Happiness in your life!
On 23 August 2021 the government announced a National Monetisation Pipeline of INR 6 tn, (~2.6% of GDP), aimed at monetising its brownfield infrastructure to fund greenfield ones. Most of these projects will be concentrated in the roads, railways, and power sectors and no monetisation of India’s healthcare assets. NMP provides the guide to funding the National Infrastructure Pipeline (NIP) announced by the Finance Minister on 31 December 2019. I had written an article on the NIP giving my observations and feedback on the NIP with respect to healthcare (see below).
National Monetisation Plan Sector-Wise
Why is Healthcare Assets Monetisation not Under NMP?
It has been clearly apparent from the Covid 19 pandemic the clear shortages in the bed supply whenever there was a spike in the Covid cases. The private sector just did not have the capacity to manage the situation, burdening the Government and its healthcare resources to step up. I had warned about the gross under supply of beds in my critique to the NIP, “As per one of our investment thesis on healthcare infra in India, to meet the global norms of 3 beds per 1000 population India needs an investment of $200 billion by 2025. This is approximately the total NIP projected across all the infra sectors. The current NIP shows a committed pipeline of $2.5 billion which is only through Center and State Governments. A gap of 99% of what needs to be invested for India to meet global norms for healthcare infra supply! Unlike roads which is hogging over 80% of NIP’s committed investments, healthcare infra is gestational. Therefore, there is a weak and lagging healthcare infra investment in India leading to demand gaps.” These concerns that I had voiced have come out to be true during the Covid pandemic. The issue here is not about how much to invest in healthcare infrastructure but the issue of would the Government want a political turmoil now to sell off its healthcare assets out. More importantly, for the monetization of healthcare assets, there are other regulatory and tax issues for the Government to iron out to be ready for this sector’s assets to be monetized.
I believe that it has been a prudent move by the Government to exclude healthcare out from the NMP.
National Infra Pipeline (NIP) – Where is the Healthcare Infra Connectivity like Roads for the Masses? (Published in Jan 2020 in VC Circle)
Over the last few months of 2019, the Government through various Ministries and industry bodies and Political Forum have tried to reach out to investors in healthcare infra to compile the pipeline of investments that are at various stages of implementation. This report was announced by the Finance Minster on 31 Dec 2019. We congratulate the Ministry of Finance in coming forward with the efforts in reaching out various stakeholders and sets the focus and discussions back on the economy.
While the report recognizes the fact that various mechanisms need to be put into place to debottleneck and fast track the investment process into infrastructure to meet our goals of a $5 trillion Indian economy by 2025 and be the second biggest economy in the world by 2050. It also recognizes the issues relating to land reforms, which the Government dropped out in earlier regime due to political opposition, financing, regulations amongst others. As India’s dedicated healthcare infra fund, we point out some of our observations and feedback on the report with respect to developing and funding healthcare infra in India.
As per one of our investment thesis on healthcare infra in India, to meet the global norms of 3 beds per 1000 population India needs an investment of $200 billion by 2025. This is approximately the total NIP projected across all the infra sectors. The current NIP shows a committed pipeline of $2.5 billion which is only through Center and State Governments. A gap of 99% of what needs to be invested for India to meet global norms for healthcare infra supply! Unlike roads which is hogging over 80% of NIP’s committed investments, healthcare infra is gestational. Therefore, there is a weak and lagging healthcare infra investment in India leading to demand gaps.
While there is a further ripple effect of this investment on the wider economy in terms of job creation, healthy and productive population amongst others which we believe will be the second order issues that can be addressed as investment flows in. The key issue here is what measures the Government and Private Sector needs to take to accelerate the pace of investments and delivery of healthcare infra to the masses like road connectivity.
Any healthcare infra investments structure whether PPP or private with asset-lite models is taxed under GST. While there is no scope for pass thrus of these costs on the output side. Several representations to the Government on correcting this anomaly have been presented at the highest levels. Unless this is corrected, private sector participation investment is only a minor aggregate to the investments.
RBI in its efforts to contain the inflation has not directionally provided a proper guidance of interest rates over the last few years. These changes in interest rates are difficult to model and predict for our investors both Indian and foreign. Healthcare infra investments require a stable interest rates regime.
Over the last few years of liquidity crisis with the banking sector, healthcare infra financing like other infra financing has been deprioritized by the banking system as a whole as very high risk. Our discussions with senior leadership with various top banks does not give any confidence that the worst is over for the healthcare infra sector bank financing with many still negative with the burden of NPAs of the past. A policy to establish healthcare infra as a priority sector for bank would be in positive direction.
Ayushman Bharat is a positive step in Nation’s healthcare financing and delivery. However, the last report of Niti Aayug states that around 90% of all players in India owning healthcare infra employ less than 10 employees! Seriously, are these really hospitals delivering quality care? Given the current reimbursement rates, private sector participation in the whole scheme can only be marginal or absent in their current healthcare infra operating cost base. A more innovative low-cost infra investment model needs to be developed which some players are working towards to pivot towards the requirements of Ayushman Bharat.
There is an approximately $45 billion of healthcare infra assets which are sitting on the books of Central and State Governments and Private and Social Sectors. Many of these require funding for upgrading and expanding their infra. Various archaic regulations and other operations bottlenecks are preventing investments flows into these existing healthcare infra from Indian and foreign investors.
While healthcare infra is a highly gestational business, it is dependent on supply of adequate clinical and operational manpower from the investments in the education sector. The NIP duplicates the investments in AIIMs under health and education. A similar push is required in the education sector for private sector participation.
While working on the regulations for the Social Stock Exchange (SSE) with SEBI. There are several regulations that govern the social sector in terms of ownership of land and infra that need to be streamlined for a healthy investments in social health infra. We estimate that the addressable social ventures that would qualify to be listed on the SSE would potentially deliver an annual turnover to be around $5 bn on a conservative basis from various impact investors. If the regulations are streamlined, our expectations is that this would be increased by a multiple of 3X.
While the NIP is a great exercise for setting the vision and strategy for the way forward. We believe that investor confidence is still muted and the dialogue between the Government and Healthcare Infra Investors and Operators need to be urgently set up for strategizing how the current estimates in NIP for healthcare infra can be boosted 100X to meet the current deficit to Healthcare Infra Connectivity like Roads for the Masses to meet the global norms.
Last week, Microsoft showcased their latest Operating System (OS), The Windows 11. This is the new OS that will upgrade the Windows 10 that runs billions of computers globally. While talking to the analysts, Satya Nadela, the CEO and Chairman of Microsoft envisioned Windows 11 to be the ‘center’ of all the operating ecosystems. I downloaded the developers version on one of my tablet, Lenovo’s Yogabook, to test out the initial impressions of the new Windows 11 and does it meet the vision of Microsoft’s CEO and Chairman
Teething issues with the update to Windows 11
Microsoft has certain minimum hardware and security requirements which prevent existing systems to upgrade to Windows 11. Security enhancements in the new OS, requires TPM 2.0 (Trusted Platform Module) as well as Secure Boot, both security technologies, to run perfectly. This is why Microsoft has not listed Windows 11 support for a huge list of processors that do not come with these technologies. After many workarounds and system checks, I was able to get the Window 11 developer’s version update. This whole exercise took away over 11 hours of time from start to finish! Microsoft views to this is that its part of making more secure as a platform. However, unlike earlier upgrades to Windows 10, where many users complained that their files were deleted, this was not the case this time round.
Windows 11 minimum system requirements
Processor:
1 gigahertz (GHz) or faster with 2 or more cores on a compatible 64-bit processor or System on a Chip (SoC)
RAM:
4 gigabyte (GB)
Storage:
64 GB or larger storage device
System firmware:
UEFI, Secure Boot capable
TPM:
Trusted Platform Module (TPM) version 2.0
Graphics card:
Compatible with DirectX 12 or later with WDDM 2.0 driver
Display:
High definition (720p) display that is greater than 9” diagonally, 8 bits per color channel
Internet connection and Microsoft accounts:
Windows 11 Home edition requires internet connectivity and a Microsoft account to complete device setup on first use.
Cosmetic Surgery in the Windows 11 Operating System
There are a few positives in the first look at Windows 11 OS, the user interface is much cleaner, intuitive and clears all the patchwork of interfaces from earlier Windows OS in Windows 10. There is a feeling of an immersive experience. When I attached my system to external high-end curved monitor, the experience was very fabulous. For the doctors who want to view the radiological images, this would be a plus.
Windows 11 Desktop on External Monitor
Chronic Aliments Still Persists
Moving on to congratulating Microsoft on their efforts, let me critique Microsoft on the issues that still persist from the previous OS that it need to really work and iron out for the new OS to be a real clinical workplace productivity enhancer. Some of these options are very easy for Microsoft to incorporate with its final release of Windows 11 to the world at large. Here are some of my views, I will add more as I do use the new OS in the next few weeks to come.
Windows Dictation and Read Aloud Tools
I have been using Windows dictation tool to get many of my documents typed out. However when I say certain medical terms under ICD 10 or names of molecules or medications, there is a typo returned in the typed output. I have seen a demo of Microsoft Azure tools for healthcare that are available to enterprise cloud and app developers of Microsoft, why should it be so difficult to roll this out for students, medical workers on their retail license of Windows 11? After setting the regional setting to India, Indian accents and Hinglish is still not available. Microsoft keyboard on my android phone has been trained for the last 2 years, Windows 11 can take the same from the information stored on their Keyboard App on Android and use those to train the dictation tool. Read Aloud Tool still has a Caucasian woman and cannot Hinglish words well or recognize them.
IoT Device Integration
There are several devices that the doctor can control right from his desktop in his clinic without having to get up and switch or off during diagnosis. Amazon and Google has been working perfectly with on IoT devices through Alexa and Google Assistant. Cortana is still lagging on the same functionality and experience. Unless the Microsoft CEO and Chairman in his statement on being in the center meant that we may have to use the Windows 11 desktop and get over to Google Assistant (on the Android App or browser) or Alexa to command the IoT devices connected to the network.
Pen Writing and Annotation
There are enhancements in the pen settings. However the current handwriting recognition is same as the Windows 10. Fast scribbles of the prescription still show as typos. The auto completion of medical terms still give garbles. The pen annotation of radiological reports still need to give micro-level pinpointing at 10x zoom. Still the same experience continues from Windows 10.
Microsoft Teams Integration
Microsoft Teams which was more for enterprise customer as a video conferencing and virtual collaboration app is now fully integrated into Windows 11. This means the doctors and their patients can freely teleconsult through their desktops
Multiple Desktops
This was a feature in the MacOS for years is now introduced in Windows 11. Doctors can now have multiple desktops for their outpatients, inpatients, personal and other work and personal workplace segregation.
Android Apps in App Store
This is just a feature in the App store. We still have to see the power of running these app on the Windows OS run systems. One of the main reasons for updating the developer version was to check the apps compatibility on Windows 11 desktop.
The Rhythm of Blues
As the Windows 11 is a developer version of the OS. Please be prepared for the system to crash and show you blue screen a few times in a day.
Not Everyones OS for Healthcare in India
Microsoft has bumped up the minimum requirements for upgrading to Windows 11. As per Microsoft their justification is 3-fold
Security: Windows 11 requires hardware that can enable protections like Windows Hello, Device Encryption, virtualization-based security (VBS), hypervisor-protected code integrity (HVCI) and Secure Boot. The combination of these features has been shown to reduce malware by 60% on tested devices. To meet the principle, all Windows 11 supported CPUs have an embedded TPM, support secure boot, and support VBS and specific VBS capabilities.
Reliability: Windows 11 will now be in a supported and reliable state. By choosing CPUs that have adopted the new Windows Driver model and are supported by our OEM and silicon partners who are achieving a 99.8% crash free experience.
Compatibility: Windows 11 is compatible with the apps you use. It has the fundamentals of >1GHz, 2-core processors, 4GB memory, and 64GB of storage, aligning with our minimum system requirements for Office and Microsoft Teams.
IT hardware asset refresh cycles in India are not driven by change of operating systems requirements. As many of the old desktops and laptops will not be meeting the minimum criteria laid out by Microsoft, many of the older systems will be running on Windows 10 till they are refreshed in healthcare and their consumers. Let’s understand, Indians don’t buy new phones or desktops and laptops every year because there is a new model (as Apple assumes it to be).
I will continue to add over here as I come across the good, the bad, the ugly about Windows 11 as I test the OS futher.
Statutory Disclaimer: folks wishing to download it can do so from the Microsoft Insider website. However, people other than developers are highly recommended not to download the build as of now. This is because such early beta testing versions are full of bugs that are only ironed out as and when beta testers report them to Microsoft.
Last week, India’s Finance Minister announced a slew of financial relief to the stimulate growth and improve the healthcare infrastructure of the country which has been affected badly by the second wave of Covid. The package worth INR 0.62 million crores can be sub divided in three broad themes:
Those that improve the financial liquidity through a guarantee. The impact will depend on how much money is borrowed through this route. The lower interest rate charged which can be 2-3% less than the normal rate will help to lower the cost of funds. It needs to be seen if such funds are taken for investment or for repaying old loans.
Provide direct relief for the weaker sections which will benefit the recipients.
Initiate medium terms reforms that will help farm productivity, exports, power sector and manufacturing.
This blog is about the healthcare sector relief measures announced and my comments and feedback on the announcement
My Analysis for Healthcare Sector Measures Announced
The presentation from the Finance Minister is in the link below. Here are the summary of the measures announced and the comments on the same:
Announcementsengenderingadditional fiscal cost above the Budget FY22 numbers
Comments/Remarks/Feedback
Additionalspending on health : Total amount: Rs 23,220 crs (of which Centre’s share is Rs 15,000 crs)The focus is on children and paediatric beds, increase ICU beds, oxygen supply, enhance testing facility among others
Welcome policy measure
AdditionalFood grains (alreadyannounced) In the wake of the second wave of COVID- 19 pandemic and to ensure food security to vulnerable, 5 kg food grains to be provided from May – November 2021
Food security and nutrition to the vulernable section of the society will assist in health and well being and reduce susceptibility to Covid and other infections due to malnutrition
Free Tourist Visa for first 5 lakh travelers with a total cost of Rs 100 crs
There could have been a Visa Fee waiver for the tourist visiting India for Medical Tourism
Additional outlay for broadband connectivity to each village under BharatNet PPP Model for expansion and upgradation in digit connectivity
This will give a boost to the National Digital Health Mission and private sector digital health enterprises in India
The PLI scheme for Large Scale electronics manufacturing has been extended by 1 year till FY26
There should be an exclusion clause for the innovation based enterprises for health sciences which are developing products and technologies for replacing Chinese/imported products
Announcementsengenderingincrease in contingent liabilities/ Announcements engendering increase in contingent liabilities/ capital infusion
Comments/Remarks/Feedback
Loan Guarantee Scheme for COVID affected sectors aggregating Rs 1.1 lakh crs (Rs 50,000 crs for Health and Rs 60,000 crs for other sectors) Focus on guarantee cover for “expansion” and “new projects”Maximum loan amount of Rs 100 crs for a duration of 3 yearsInterest cap: 7.95% (For Health); 8.25% (For others)Guarantee cover: 50% (For expansion), 75% (For Others)
This is part of the overall investment required by the healthcare sector to match the global norm of 3 beds per 1000 people. This is in the right direction. The new trend in healthcare infra post Covid is not to build the large hospitals but smaller units. Also where is the manpower to run these new facilities set up under this scheme?
Enhancement of the Emergency Credit Line Guarantee Scheme from Rs 3 lakh crs to Rs 4.5 lakh crs
Positive for the healthcare operators who are cashflow strapped
Credit guarantee scheme for Micro Finance Institutions aggregating Rs 7,500 crs Guarantee to be provided to scheduled commercial banks for providing loan to MFIs for on-lendingMaximum tenure : 3 yearsInterest rate cap from loans from banks : MCLR + 2%Interest rate on loan from MFIs: 2% below maximum limit prescribed by RBI
Positive for the healthcare MSMEs who are cashflow strapped
Financialsupport for Registered Tourist Guides Guarantee cover : 100%Limits: Rs 10 lakhs for agency and Rs 1 lakh for tourist guide
There could be some investment for skill development for nursing assistants who accompany tourists during their convalesce period while tourismWhat about the airline sector which is suffering and not been able to provide connectivity as before Covid
New Streamlined Public Private Partnership (PPP) Policy
Recognizing the current process for approval of Public-Private Partnership (PPP) as long and cumbersome, the centre has announced the formulation of a new policy for appraisal and approval of PPP proposals and monetization of core infrastructure assets. This will help speedy clearance of projects. As I have been writing, PPP in healthcare has not taken off ever since I was on the Planning Commission’s PPP in Healthcare Regulatory Committee. These issues have to be ironed out as Government after Government have tired to draft policies for assisting PPP in healthcare sector, but there is not enough private sector enthusiasm and participation at a large scale to make PPP in healthcare a thumping success. Let’s wait for the fine print of the PPP policy that will come out.
Summary
The Finance Minister has forgotten that there is dire shortage of skilled front line medical workers. With the Covid pandemic, many youths are not forthcoming to join the healthcare sector. Measure could have been announced to make the healthcare sector more attractive for the youth of India to join. It looks like the stock markets have not give a warm response to these measure announced by the Finance Ministry and is running on its own steam.
Disclaimers: We have not used our proprietary algorithms for this blog
