Healthcare is the most imperative need for any household. The expenses and time spent on it can sometimes be staggering. Especially for the hapless gig economy worker whose needs have been relatively ignored. Healthcare expenses usually involve direct and indirect costs. And these indirect costs can be staggering, especially for an ordinary individual who earns daily wages. Direct costs like out-of-pocket expenditure that a patient incurs when interacting with a healthcare system apart, the indirect costs which include the opportunity costs of labour and the price of mental and emotional trauma can have serious consequences for gig economy worker.
For gig economy workers, indirect costs are typically higher when compared to those of urban salaried professionals - a visit to the doctor often entails the loss of hourly or daily wages, loss of an existing/potential customer, and particularly in the case of women, it leads to loss of stability to a family, etc.
According to a report by the Medical Council of India in March 2018, it is estimated that India has only 8.33 lakh active doctors for a 130 crore population. A typical doctor visit, along with waiting time, takes four hours in entirety. While a white-collar worker can visit a doctor and avail sick leave (full or half day), knowing fully well that such an absence will not impact on the income due for that day’s work, one cannot imagine a cab driver, or a plumber or any other daily/ hourly wage earner taking a day off without suffering a proportional loss of pay.
Case in point is Vijay, a cab driver. Vijay works in Bangalore with a car he purchased for `6 lakh on a loan at 9% interest for 36 months which he pays in EMIs at approximately 20,000 per month. He owns two phones and has both Uber and Ola Driver Apps to optimise demand for his services. His monthly income is `40,000 after deducting fuel and other maintenance expenses. While he makes more than what he made as a driver for a local company, the unpredictability of the gig economy makes it tremendously stressful.
Last month, Vijay’s wife complained of severe knee pain. The nearest Orthopedist was 30 minutes from his home. With a one-hour waiting period, and added time to buy medicines, the whole process took half a day. Anyone familiar with the healthcare system in India is cognizant of the average wait at hospitals and clinics.
If Vijay, with an income of `40,000 per month (~`1,330 per day) takes half-day off to visit a doctor, and then spends around `300 on consultation fees and tests as well as `665 on lost income, it amounts to a total cost of healthcare access of `965. The cost of healthcare access is triple the doctor’s consultation fee for a non-salaried professional. And this cost would be significantly lower for a salaried person who relies on monthly income.
Gig economy workers, often paid by the hour with no sick leave privileges, end up delaying visiting doctors until their health situation worsens. And this naturally rules out preventive diagnosis, even if it could have helped them achieve a better quality of life. Of the 4 million gig economy workers (plumbers, drivers, etc) operating in cities, there are 1.5 million cab drivers like Vijay. The overall unorganised workforce in India is 400 million strong and presents a much larger and diverse set of problem statements.
As an entrepreneur, how can one solve this problem and build a sustainable business? Imagine building a technology-driven startup, which can serve this market by providing end to end service for preventive as well as curative healthcare? The range of services could include planning doctor visits, diagnostic tests, understanding results, helping get the right insurance plan and claims management for the beleaguered gig economy worker. The delivery model could be a mix of smartphone-based telehealth service, or an offline delivery model similar to how ASHA workers operate.
One could use technology to create healthcare correspondents who can provide door to door service for blue-collar workers, much like Banking Correspondents who help people with basic banking needs in rural India. An interesting aspect to explore could be the aggregation of the support staff currently being hired by diagnostic centres. They would already possess the certifications needed for basic diagnostics. Another potential group that can be considered are hospital nurses who are often not paid enough but have the technical capabilities of basic healthcare diagnostics. Once enough data is accumulated, technology can be used to generate recommendations for various actions that the patient could take. If these tasks are suggested by the system, healthcare correspondents with only basic skills can also be onboarded and trained to use the platform easily. The service could be bundled as a B2B2C value-added service provided to organisations that employ gig economy workers.
The revenue model could include a mix of flat fees for service provision and a percentage of the total healthcare spend. Assuming five doctor visits per worker per year, 20 million doctor visits are done by the 4 million strong gig economy workforce in cities. At `965 (approx $14) healthcare access cost per visit, that is about $280 million of total healthcare access costs (direct and indirect) for this segment, excluding costs of diagnostic tests and medicines.
A business solving for this can look at a part of healthcare access cost as their revenue. Even tapping 1% of the 4 million gig economy workers (40,000 gig workers), and charging 10% of the healthcare access cost as fees (4,000,000 x 1% of market x 10% service charge x $14/visit x 5 visits per annum), leads to a revenue of $280,000 per annum based on some back of the envelope calculations. More importantly, building a brand that gig economy workers can trust would help build a larger market through referrals and would allow a startup to become the one-stop healthcare correspondent provider for the gig economy worker who is in dire need of intervention.
As an entrepreneur, how would you go about building this service?