An Exploratory Study on Healthcare Innovations Ecosystems and Universal Health Coverage in India

Abstract

Healthcare is one of the fastest growing sectors worldwide. With innovations being a major driving force for this growth, healthcare innovations have become hotspots for policy and action. However, designing such policies is a challenging task since innovations often fail. The novel coronavirus disease 2019 (COVID-19) pandemic crisis has brought the policy focus on healthcare innovations and ecosystems worldwide, and numerous policy initiatives have been undertaken to facilitate healthcare innovations. The World Health Organization (WHO) has explicitly linked the goal of healthcare innovations with improving healthcare systems performance towards achieving Universal Health Coverage (UHC). However, not all innovations have contributed to better outcomes in terms of efficiency, equity and sustainability of healthcare systems, which are the objectives of UHC within Goal 3 of the Sustainable Development Goals (SDGs). Given the above context and the importance of healthcare innovations, a detailed literature review was conducted on the concepts and theories, including theoretical knowledge and empirical evidence on this issue in the global and Indian contexts, as well as critique and research gaps. Studies have applied or developed theories to understand healthcare innovation creation, emergence, diffusion, dissemination and disruption across different country contexts for product, process and outcome innovations. Hence, the epistemology (‘how’) of healthcare innovation lifecycle has been extensively studied, but there is no unifying transdisciplinary conceptual understanding of the ontology (‘what is’) of healthcare innovation. Also, the intersectionality between healthcare innovations, ecosystems and UHC has not been explored. The present study fills this research gap by creating a transdisciplinary operational concept of healthcare innovation in order to identify healthcare innovations empirically (Objective 1) and subsequently analyse the congruence of these innovations with the concept of UHC within the Indian innovation ecosystem (Objective 2). The study adopted a broad exploratory scanning of academic and grey literature to identify organisations/companies across different clusters in the healthcare sector. The operational definition of healthcare innovation developed in this study was used as a heuristic device to identify healthcare innovations from these clusters. An in-depth relational content analysis was conducted by triangulating secondary and primary data to answer the research questions. The study used an interpretive multiple-case research design guided by the philosophy of instrumentalism, constructive empiricism and interactionism. The study findings contributed to both theory and practice. The theoretical contribution was developing a transdisciplinary cluster concept of healthcare innovation using the Essentially Contested Concept (ECC) criteria. This trans disciplinary conceptual framework is the first of its kind developed for healthcare innovation and is a theoretical value addition with practical usability. This framework is available to researchers for empirical testing, modifications and use in the field of healthcare innovation. By analysing the interactions of healthcare innovations with the Indian ecosystem, this study discussed their congruence with the dimensions of UHC, which contributed to practice and policy. Thus, this study provided insights into understanding the gaps in the innovation ecosystem and pragmatic recommendations to address these gaps. In addition, this research helped in understanding the concept of innovation ecosystem in the Indian context and created an ecosystem framework to identify and assess responsible innovations in health (RIH). Also, two other theoretical frameworks were developed based on the empirical findings of this study, which have applications for the adoption and diffusion of healthcare innovations. The Diffusion of Innovation Framework (DIF), helped provide an understanding of factors affecting the diffusion of innovation using the variables of replicability and imitability and also compare different innovations. The Convergent Stream Framework (CSF) model, helped understand the dynamic nature of the interaction of the ecosystem factors and healthcare innovations. These frameworks can be used as a heuristic model by researchers for empirical testing, validation, modification and application in different country settings. The findings from this study are useful for researchers as well as policymakers. For researchers, the study provides useful insights for conceptualising the phenomenon of healthcare innovation from a transdisciplinary perspective, which can form the basis for future empirical studies in this field. For policymaker’s/decision maker’s/practitioners in the Indian innovation ecosystem, the findings provide evidence of the congruence of healthcare innovations with UHC goals and recommendations for action. Since the link between healthcare innovations, ecosystems and UHC has not been previously explored in the Indian context, this study adds new knowledge to this field. The evidence-based recommendations provided in this study would be useful for policymakers for targeting, planning and strategising future policy initiatives in the Indian innovation ecosystem to achieve UHC goals.