Most Transformative Change in India Is the Dramatic Rise in Life Expectancy: Ganesh Pillay
By Arunima Rajan
In an interview with Arunima Rajan, Dr Ganesh Pillay, Chief of Research and Academics and Regional COO (Central India) at ASG Eye Hospital, says that the most transformative change is the dramatic rise in life expectancy from just 32 years in 1947 to over 70 years today
What is the single biggest change in Indian healthcare since independence?
The most transformative change is the dramatic rise in life expectancy from just 32 years in 1947 to over 70 years today.
This near doubling of life expectancy reflects India’s success in controlling infectious diseases, expanding immunisation, improving maternal and child health, and building a vast public health infrastructure. While access and quality remain uneven, this demographic shift has fundamentally altered the disease burden—from primarily infectious diseases to chronic, non-communicable conditions such as diabetes, cardiovascular disease, and eye disorders such as cataracts and diabetic retinopathy.
What percentage of patients still rely on OOPE?
Yes, out-of-pocket expenditure (OOPE) has fallen significantly, but it remains high.
OOPE as a share of total health expenditure dropped from 62.6% in 2014–15 to 39.4% in 2021–22, according to National Health Accounts data cited in the Economic Survey 2024–25. Some recent reports indicate OOPE is now around 47–49%, reflecting continued progress but also the persistence of high household spending.
Ayushman Bharat (PM-JAY) has contributed to this decline by covering inpatient costs for over 30 crore hospitalisations since 2018, with beneficiaries saving an estimated ₹1.25 lakh crore in OOPE. OOPE has fallen, but nearly half of all health spending still comes from patients’ own pockets.
Has Ayushman Bharat changed the demographic profile of your patients?
Yes, Ayushman Bharat has broadened access, but the core patient profile in specialty hospitals like ASG remains largely middle-income and self-pay. PM-JAY has enabled millions of low-income families to access secondary and tertiary care they previously could not afford, particularly for procedures such as cataract surgery, which is a high-volume service for eye hospitals. Having said that, many beneficiaries still face out-of-pocket costs for medicines, diagnostics, and transport, which can limit utilisation among the poorest. ASG’s patient mix continues to be dominated by self-pay and insured middle-class patients, with PM-JAY beneficiaries forming a smaller, though growing, segment—especially in tier-2 and tier-3 cities where ASG has expanded. The scheme has increased awareness and willingness to seek care, but financial and logistical barriers persist, meaning the demographic shift is real but gradual.
How can we address brain drain in Indian healthcare?
Brain drain is driven by better pay, working conditions, and career opportunities abroad. Retention requires a multi-pronged approach—one that focuses on internal training, R&D, better growth opportunities, and attractive remuneration practices.
Competitive compensation and benefits: match global standards for specialists, especially in high-demand fields such as ophthalmology.
A core pillar of ASG’s Vision 2030 is training local talent to become world-class ophthalmic professionals. ASG is deploying significant resources into:
Long-term fellowship programmes in subspecialties like vitreo-retina, phacoemulsification, paediatric ophthalmology, and cornea, with stipends of ₹70,000–₹80,000 per month and no course fees.
Mentor-led clinical training at high-volume centres, ensuring fellows gain hands-on surgical experience under expert supervision.
Standardised academic protocols across ASG centres, enabling consistent, high-quality training regardless of location. By creating clear, funded pathways for career advancement within India, ASG reduces the incentive for ophthalmologists to seek training or employment abroad.
Vision 2030 prioritises research and development in advanced surgical techniques, diagnostics, and clinician training by 2026. This includes the following:
AI-driven diagnostics and cutting-edge imaging (e.g., OCT) to enable early disease detection and precision care
Laser-assisted cataract surgery and other innovative procedures that keep clinicians engaged with the latest technology
Centralised procurement and digital workflows to ensure consistent standards of care across the network
Access to world-class technology and research opportunities makes ASG an attractive employer for top talent, countering the pull of overseas centres.
ASG’s HR strategy emphasises clear career progression and internal mobility.
Career growth pathways: lateral and upward movement through a permanent careers desk and portal, with over 100 roles mapped to 12 competencies.
Leadership development programmes (e.g., Launchpad and high-potential identification) and an in-house mini-MBA for aspiring leaders.
What is the impact of PE on Indian healthcare system?
Private equity (PE) brings more than capital—it drives clinical standardisation, accountability, and efficiency. PE-backed hospitals increasingly adopt independent boards, clinical outcome tracking, and standardised protocols, which are rare in traditional family-run hospitals. PE investors push for higher bed turnover, reduced wait times, and a better patient experience, which can improve clinical throughput. PE investment has enabled rapid expansion, technology upgrades (AI diagnostics and tele-ophthalmology), and professional management, enhancing both scale and quality.
Has digitisation altered your operations?
Ayushman Bharat Digital Mission (ABDM) and telemedicine have had the most tangible operational impact.
ABDM: Over 630 million Ayushman Bharat Health Accounts (ABHAs) have been created, enabling seamless health record linkage. Hospitals integrated with ABDM report 30–40% faster patient onboarding and reduced administrative costs.
Telemedicine: Consultations crossed 100 million annually by 2025. For ASG, tele-ophthalmology and remote screening have expanded reach to tier-2/3 cities, allowing hub specialists to support spoke centres without proportional cost increases.
What has not yet been implemented: full interoperability of electronic health records (EHRs) across providers, AI-driven predictive analytics for population health, and widespread adoption of digital prescriptions and e-pharmacy integration remain works in progress.
What changes would you want in the next 10 years?
We believe priorities for the next decade could be on the following areas:
Primary and preventive care: Strengthening Ayushman Arogya Mandirs (1.8 lakh operationalised) and expanding outpatient coverage under PM-JAY.
Non-communicable diseases (NCDs): Scale up screening and management for diabetes, hypertension, and eye care critical as life expectancy rises.
Digital health infrastructure: Expand ABDM, ensure data privacy (DPDP Act compliance), and integrate AI for diagnostics and triage.
Health workforce: address shortages and brain drain through better pay, training, and rural incentives.
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