The Future is the byproduct of crazy people - who get this massive kick in going all in to make sure a significant % of present generation or future generations experience better lives. And there is no way I can predict that for other civilizations, however, we (Indian) have once in a lifetime opportunity to make Quality Healthcare affordable for everyone. In fact, we can commoditise quality Healthcare hence, not a single human in our nation dies or gets trapped in poverty because of unaffordable Healthcare costs.
The world's most complex and hardest problems have been solved by folks with naivety and all of them were outsiders. But after a time, things start looking easy and obvious. And, I am sure, many of them must have asked themselves - this seems obvious, but why no one is solving this, especially if it can unlock trillions of dollars and create a massive impact?
I started working on this problem after experiencing my dad's inability to afford Healthcare costs. This was the first nudge - there are more than 90% of Indians who can't afford decent Healthcare. And of course, I was naive and started dreaming to solve for 1.2 billion however, that positioning was easy - I knew most of the things are currently limited to the Top quintile of Urban India. This means it is just the 5 to 6% of India’s population who can actually afford quality Healthcare. And taking a grace period of 3 years before firing all cylinders, I thought, let’s ignore the top 10% of India and solve for the rest. Because the rest of the population only differs by language - the type of need and capacity to pay is almost the same for 90% of Indians.
To be honest, we never approach this from a technology pov, we always approach this from a Problem pov. And hence in all my past essays, I only talked about the problem, distribution, comparisons with global solutions, and potential solutions. We added a few constraints: the price should be affordable for 1.2 billion and hence scalable. We were logical in our thinking and had no intention to build something of X or something for tier-2 cities and then started connecting the dots. In fact, many times, I have been asked - are you guys building subscriptions for tier-2 and below cities? And in almost all the cases - my answer has been NO because we never approached this form subscription pov. There was common sense in our thought process, and we studied the Healthcare system of almost every developed country. And that’s how got the conviction about the opportunity and impact of solving this problem.
Here is the crazy part of our journey, we never waited for anyone's approval or funding. We worked silently for six months and struggled to explain what we were building. The struggle was obvious because we were working from a problem-solving mindset rather than building a company or technology. And neither of us (me or Aviraj) has any industry insights about Healthcare or Healthtech.
We kept working and making progress, living among customers, long-term thinking, and accepting the brutal reality about the customers and their capacity to pay - somehow connected the dots. And last week, we reviewed our work and created a demo of solution implementation - I feel emotional because we can literally commoditise Healthcare for everyone in this country. The belief got stronger when I read about the Great Deflation. To understand why we have once in a lifetime opportunity to deflate the prices of some of the products that are too necessary for our people, you must read this essay till the end.
Let’s get started…
Before I start, I remember writing an essay on a similar topic: How Can we deflate the price of physical world products, especially food? And in that essay, I explained if we focus on a few components that actually inflate the final price - we should be able to deflate the prices of physical world products. And the origin of that essay was due to the frustration of seeing a deflation of every software and software-related product and the massive inflation of physical products. Sometimes, I am not ready to accept the simple fact that - the data, smartphones, STD calls were unaffordable for 99% of the population etc. And today almost the entire population can afford all of the above.
On the other hand, let’s have a look at the massive inflation in prices of physical world products and services.
Food prices ~ 100% inflation in the past 20 years
Education prices ~ 200% inflation in the past 20 years
Healthcare prices 130% inflation in the past 20 years - Compounding is about the hit the pricing, and we can expect the same inflation in the next 10 years
Medial cost, real estate, and the list would go on and on…
I have no idea why even after the intervention of technology the prices of these products are still on the inflationary curve (why?). Isn’t the first purpose of the intervention of technology to bring productivity and hence price deflation? Of curse, once the need is satisfied - we use technology to bring convenience.
I actually looked at the list of Indian startups that are inflating and deflating the prices of products. And realised, almost all the startups are actually inflating the final price of the products, and that I don’t understand (why?). If the whole argument or the purpose is to bring more productivity - the product prices from these companies should have been on the deflationary curve, you will agree?
If you really ask me, at the current stage of our nation we should be using technology to deflate the prices, making products and services more affordable for our people, or bringing the whole productivity part - so a billion population could start valuing the time.
I shouldn’t be writing this, in fact, this should be obvious in a population of 1.4 billion humans, 90% of the population is just struggling to afford Healthcare, Insurance, Education, and food is the biggest concern. And if we are not unlocking this, our aspiration to be the world’s largest economy will just be a dream.
We all have seen this graph and can connect it with inflation and deflation. But unfortunately, this data comparison is for the USA. I hope someone will create a similar graph for India as well.
There is no way, I can focus on all the industries in one essay, and I also lack the understanding hence I am going to keep this essay limited to Healthcare. Also, we have been working on this for the past 10 months - and understand the nuts and bolts of the different connections among stakeholders.
India’s Healthcare per capita is INR 5200 this means a family spent around INR ~20,000 per year on Healthcare, and still each year 50 million Indians are getting trapped into poverty due to unaffordable healthcare costs (the same story for the developed countries as well). And if all our maths are correct, in the next 5 to 7 years, the Healthcare, per Capita should touch INR 10,000 this means on average Indian family would spend INR 45,000. And if the nominal income is not growing at a similar rate, we all can imagine the situation. And I have this irrational optimism we will not let the nation be in that situation. And to understand, we need to flip the pages of History that I love to do. :)
In the History of Human civilization, the story of the Great Deflation is one of the most interesting ones. This is the story of 1870 to 1890 - the great deflation. During these 20 years, massive productivity kicked in and the prices of products started deflating massively. Of course, this great deflation was powered by the Second Industrial Revolution which was thanks to the invention of the Steam Engine. In the entire human civilization just for 20 years, we achieved a sustained 2% yearly deflation. And if we can understand the root cause behind the sustained deflation - we can apply that with the current timeline for our nation and achieve something similar, no?
We as a nation are super young, just 75 years young, more like me: a young 27 years full of energy to take on this world without any resources (lol). And hence to understand this we have to review the timeline of the USA. And if you look at the above graph - it's not the case that we only had inflation, we indeed had deflation. However, from 1870 to 1890, we had almost zero inflation hence humans during that era experienced sustained deflation. This 20 years timeline is interesting for multiple reasons.
Let me list…
The Second Industrial Revolution (Invention of the Steam Engine) brought massive productivity.
It was a transition from agricultural to industrialization.
Due to unprecedented Productivity, the price of almost all products fell almost continuously.
However, the nominal wages remain the same and the continuously prolonged rise in real wages, disposable income, and saving created a new class of humans - the Middle Class.
The most interesting part of the Great Deflation: Goods produced by craftsmen, as opposed to in factories, did not decrease in price. (A great example of why LLMs should be a default part of many industries*)
The productivity of humans was the root cause of the Great Deflation. Aren't LLMs doing something similar.*
Note: There is no way I am indicating any fact that inflation is completely bad. In fact, inflations are one of the reasons most of the LPs invest and hence the whole cycle of capital circulation. And founders like me dream and take on big problems.
Now, we need to return back in 2023 and try to make sense of the current situation thanks to the LLMs. And what does this mean for countries like India - why this is a once-in-a-lifetime opportunity to deflate the prices of Products and Services that matter the most to our people? Of course, I will only talk about this from the Healthcare pov. :)
Now to understand this, we need to understand the distribution of Health Professionals, Health Facilities, and Health Providers in India based on the quintiles (not on India-1,2 and 3).
The distribution of Facilities and Providers, of course, this data is a few years old, however, the new data is almost the same. If you look at the above data, you can see that except for the top-2 quintiles of Urban India - we have deficiencies in Providers and Facilities among the eight quintiles of India (Urban and Rural).
Let me explain the above data points.
UP = Urban Population
RP = Rural Population
Q5 is the top quintile based on the economic state
Q1 is the lowest quintile based on the economic state
WHO’s recommendation 1 Professional per 1000 people
WHO’s recommendation 1 Facility per 10,000 people
And if you look at all eight quintiles of India, some of the rural and urban quintiles have one doctor for 22,807 population. This is 21X lower than the WHO recommendation. And this is the same for the Facilities.
And LLMs are a blessing for supply-constrained markets - every single time I close my eyes: I see a future where every Indian has access to quality healthcare at the most affordable price.
Also, it is easy to say LLMs will disrupt Healthcare, but thinking that through in a medium that could be scalable to 1.2 billion and the entire experience is as seamless as making a UPI Payment. And that part of building healthcare we imagine every day. And have been connecting dots every single day.
And, I am repeating this line, we have not started this because we observed the capabilities of LLMs. There is nothing wrong with being opportunistic. But I don’t think we could have been able to imagine the depth of the problem. In fact, I had some sense that LLMs will be helpful especially trained vertically, however, recently when we created one of the demos for AASHA (आशा) - our intelligent AI engine. I was shocked by its level of personalization, seamless, frictionless experience, and most importantly - we can make it available for 1.2 billion just with their smartphone (No external Hardware). And first time in the past 10 months - I could see how things would look at the scale. I realised we can actually commoditize Healthcare and make sure not even a single person from our nation dies or gets trapped in poverty because of the inaccessibility and unaffordability of healthcare.
Now one of the reasons, I am seeing all the stars in front of my eyes is because if you look at the root cause behind the Great Deflation - it was the Productivity, that created the reverse price. But at the present stage of our nation, productivity would be just the one aspect because apart from super-inefficient professionals and facilities, we have a supply deficiency, and we can do that math on why LLMs will commoditise quality Healthcare.
According to a study by the Association of Indian Medical Colleges, the average cost of creating one doctor in India is around Rs. 20 lakhs - this includes medical education, the cost of living during medical school, and a license to practice.
Cost of Starting Medical Practice = INR 50 lakhs to 1 Cr
And on average, it takes an individual 8 to 10 years to become a doctor and start treating patients.
This means for an individual to become a doctor and start treating patients demand almost INR 1 Cr which is the biggest obstacle in eliminating Professionals and Facilities deficiencies. However, the LLMs can eliminate this obstacle just like that. And on top of that, LLMs can eliminate all the repeated activities in a Healthcare treatment improving the existing Healthcare professionals and facilities' productivity by 10X.
This means LLMs can not only eliminate the deficiencies of Professionals it can also make existing professionals 10X productive. Even converting low-skilled professionals such as ASHA into qualified Primary Healthcare professionals will be much better than informal professionals (India has 60% of informal primary Healthcare professionals).
But again, solving India’s healthcare unaffordability problem of 1.2 billion was never about technology, it is about
Figuring out the low-cost distribution channels
Spotting partners that can be the first point of contact and customers can trust
Converting a passive Healthcare experience into an active one and hence improving the Health experience
Select the right price point
thinking the right solution
Figuring out technology that can transfer knowledge from one language to the rest of the top-15 languages
Thinking the solution at scale…
Finally, an integrated Healthtech solution that could deliver a great experience at an affordable price. All of the above is only possible because we started with the problem, and now we have the power of LLMs.
Today we can literally build a UPI-like experience in Healthcare for 1.2 billion Indians at the most affordable cost.
Living everything aside, LLMs could be a blessing for Indian societies. It can improve the real wages of blue-collars by deflating prices and could be the hope to reduce inequality and build an inclusive society of 1.4 billion…
*I think we as a Human civilization should be careful about the impact of LLMs. As the recent OpenAI blog made it clear that - the superintelligent might be the reason behind human extinction. That I am not buying because, at any point in our civilization, at least 5% of the human population will be completely disconnected from the mediums that super-intelligent can use to attack humans - however the danger is read, we should be careful.