How technology is checking health corruption in India

Corruption is rife across India's healthcare system

In 2011 Amarendra Kumar learned that a doctor at one of Delhi's biggest hospitals was pushing for his baby niece to have a heart operation she didn't need.

"I was speechless," Mr Kumar said. He got second and third opinions that confirmed the baby only required monitoring.

A year earlier he had watched his friend Amit Bhagat run in circles trying to find a trustworthy doctor after his father suffered a heart attack.

The traumas spurred the business graduates to design their first start-up, Surgerica, to make it easier to find good doctors. The online marketplace launched last year lists health providers across India and lets users rate their performance.

Corruption is rife across India's healthcare system, from expensive private hospitals to crowded government facilities.

Duped

In July, Health Minister Harsh Vardhan promised to crack down on doctors taking commissions for referrals after an Australian doctor wrote of his horror at witnessing the common practice in a Himalayan hospital.

This came little more than a year after Oxfam revealed that thousands of women had been duped into having unnecessary hysterectomies.

Corruption has left many unable to trust doctors. But it is also fuelling innovation, with young Indians using new technologies to shake up the old dynamic.

Several online health marketplaces launched last year - including Surgerica, Medypal and Lybrate - feature doctor ratings similar to the popular US website rateMDs.com. But these platforms are kitted out especially for India's unique market.

"Most Indians gaining access to Internet for the first time are gaining access through their mobile phone, not a computer, so any startup has to be mobile-centric," said former Facebook data scientist Saurabh Arora, who founded Lybrate in Delhi.

Lybrate users tap into an Android app to search for doctors, book appointments and rate their performances. They can also keep their medical records online with cloud storage.

"This empowers patients to see their records, earlier it was just a doctor keeping it to himself," said Mr Arora, who secured $1.5m (£954,179) capital from Silicon Valley-based fund Nexus Venture Partners in September.

Those without a smartphone can still provide feedback on their doctor by making a "missed call" to a number - a common marketing tool in the subcontinent, where every rupee counts. Lybrate is free for patients while doctors pay a monthly fee.

Mr Bhagat designed Surgerica, raising $200,000 seed funding, to shed light on the murky world of healthcare pricing.

This is a key concern in India where most people are uninsured but the dire state of government hospitals means even poor patients seek private care, which drags some 39 million people into poverty each year, according to government statistics.

"Here hospitals are very free to set their own prices, there's no logic behind it," Mr Bhagat said.

Surgerica users can search for the average cost of a procedure and get quotes from more than 900 hospitals and 1,200 doctors.

Mr Bhagat is finding it hard to persuade some of India's billion-dollar private hospital chains to join his platform. "We are chasing those hospitals but they don't like us," he said.

Struggle

Medypal was designed by serial entrepreneurs P Rammohan and Brahmesh Jain to encourage competitive pricing.

The Bangalore-based online marketplace uses a reverse auction model where people request procedures and service providers offer competing quotes.

Patients can compare the quality of each bidder by checking ratings and reviews.

Innovation has not just focused on helping people find doctors.

Problems like counterfeit pharmaceuticals, the black market for blood and unscrupulous chemists increasing prices of generic medicines have all been addressed by start-ups in India.

People are now buying and getting generics delivered using Healthkart's new app; finding blood donors through Socialblood, which started as a Facebook application in 2011 and now sells services to blood banks; and checking their medicine is genuine by sending an SMS to Pharmasecure, which puts unique IDs on drug packets.

Indian start-ups are attracting more money, with $1.6bn invested last year, compared to $760m in 2012, according to venture news site Your Story. But this is dwarfed by the $29.4bn venture capitalists pumped into the US in 2013.

Typically, entrepreneurs struggle for funding.

Health innovators find it especially hard, according to Pradeep Jaisingh, who founded India's first health accelerator program HealthStart last year.

People are now buying and getting drugs delivered through apps

"These models even globally have taken time to mature and become sustainable, so in India also we've got to learn and validate them and continue to adapt," Mr Jaisingh said.

As it stands, few of the 243 million Indians with access to internet (19% of the population) are going online for their health, according to KPMG healthcare head Amit Mookim.

"The use of e-commerce in healthcare has been low, it's still very nascent," Mr Mookim said.

"The other issue is that the medical-legal framework that we have in the country today still desires much to be upgraded - patients literally do not know their rights as far as hospitals are concerned."

While websites use algorithms to police ratings, health professionals are questioning their ability to stamp out bad practices.

Balram Bhargav, a cardiologist at Delhi's All India Institute of Medical Sciences (AIIMS), founded a society to stop unnecessary medical investigations this year after getting infuriated with patients coming to him balancing stacks of tests.

Dr Bhargav believes "there is a huge opportunity for technology to change the way healthcare is being practiced in this country", but ethics and standards cannot be ignored.

"The most important thing is to get back the patient-doctor trust in India."