India despite being the fastest growing economy in the world still lacks behind in the health care sector. Health seems to be the foundation of a developed nation and India still needs to work a lot for the betterment of health care industry and the facilities provided by them. The health care system of India being heterogeneous in nature including services provided by both public as well as private sectors however needs a lot many developments.

India tends to have a global health care system but it’s sad that there is a wide discrepancy in the quality of healthcare services. The government health care institutions are restricted to the key cities and only the basic facilities are available in the rural areas. The lack of proper coverage of health facilities by the public sector in India shifts a majority of population to avail the services from the privately owned hospitals which generally are not affordable by all.

The health care sector has reached to a point where the health of the people is kept on stake for the sake of earning money which has led the health care services being converted into an inhuman business by the health care providers.

India ranks 130 out of the 189 countries on the Human Development Index (UNHID 2018).

There is a significant scope for enhancing healthcare services considering that healthcare spending as a percentage of Gross Domestic Product (GDP) is rising. The government’s expenditure on the health sector has grown to 1.4 per cent in FY18E from 1.2 per cent in FY14.

Paradox of the Indian Healthcare system:

Healthcare is a fundamental right, but it is not fundamentally right in India:
The Supreme Court has held healthcare to be a fundamental right under Article 21 of the Constitution. However, historical public spending of just over a percent of GDP on healthcare has ensured that the country’s healthcare need has remained underserved and left for the private sector to service.

Among the cheapest in the world, yet unaffordable for most locally:
Compared to India, the cost of a knee replacement treatment is over twenty times more in the US and double in Malaysia. However, there are millions in India (with a per capita income of less than $4 a day) who cannot afford this procedure in their country. With a health-insurance penetration rate of only about 20%, India has one of the world’s highest rates of out-of-pocket spending in healthcare.

Less than one doctor for 1,000 patients, but medical tourism booms:

The doctor-patient ratio in India is less than the WHO-prescribed limit of 1:1000. There is a dearth of medical schools and clinicians. Most hospitals in India are overburdened, understaffed and ill-equipped. However, all this has not prevented the private healthcare sector to establish sophisticated medical tourism facilities on the plank of ‘world class service at low cost’. India
treated 3.6 lakh foreign patients in 2016 and the country’s medical tourism market is expected to grow to US$ 7-8 billion by 2022

Healthcare a Business not a service-

Treating patients is not a viable business model.

  • The Indian healthcare market currently at Rs 6 trillion can increase to Rs ~9 trillion  by 2022.
  • India is experiencing 22-25 per cent growth in medical tourism and the industry is expected to be more than 7-8  billion US$ by 2020.
  • The hospital and diagnostic centers attracted Foreign Direct Investment (FDI) worth US$ 5.25 billion between April 2000 and June 2018
  • Healthcare sector in India witnessed 23 deals worth US$ 679 million in H12018.

An attractive option for business but non patient centric approach resulting in medical corruption and thus Rising trust deficit between patients and the health ecosystem

Regulation

In India, mechanisms for monitoring, let alone regulating, the private sector have not kept pace with its expansion, despite concerns about quality of care. Health professionals are
aware of practice-related laws but know that enforcement is weak or non-existent and that professional associations, which are nominally responsible for self-regulation, are also ineffective. When public providers illegally use public facilities to provide special care to private patients, the public sector ends up subsidizing unofficial private practice. It is nearly impossible to completely prohibit private practice by health workers on the public payroll, but several steps can be taken to ensure that private practitioners compete on a fair basis and do not flourish by “moonlighting” at public expense.
Ensuring that patients, the public, and the media, as well as providers, know the rules is an important factor in regulating the public–private mix

Key Issues –

With Growing population and healthcare cost, India is facing a challenge of affordability and accessibility to provide quality healthcare services for masses.  The Indian healthcare sector needs to reshape the paradigm of care and create an environment of regular introspection to achieve the goal of Healthy India. To undertake this journey, we need to redefine the health system and clearly lay out the preferred path for several key aspects, including insurance coverage, adherence to treatment and care protocols, regulations, price control, payment models, technology adoption and ethics

  • Public Share of Healthcare expenditure low- Public sector spending in healthcare is only 1.4 percent of GDP: rest (3.3 percent) comes from the private sector.
  • Maternal Health safety is still an issue- India still accounts for 20% of maternal mortality deaths in the world with 190 deaths per 100,000 live births
  • Infrastructure -Scarcity of bed remains a big challenge- India has only 1.1 beds per 1,000 persons compared to the world average of 2.7. Gap in bed capacity of over 2 million
  • Human resource shortage- Lack of skilled service provider, nearly one doctor per 1700 of population. Nursing and para-medical education is lagging behind both in number and quality. India needs additional 6.4 million health care resources to serve the population.
  • Increasing affordability issues- Rising Healthcare cost is another major concern with about 60% of the expenditure being out of pocket. Around 39 million people are pushed to poverty every year because of ill health in India. Marginal health insurance coverage.
  • Growing concerns around quality of care - There is desperate need for regular measurement of quality of care in hospitals. Lack of regulatory framework and dependence on self-regulation resulting in medical corruption and thus Rising trust deficit between patients and the health ecosystem.  There is a complete lack of proper Implementation of quality standards.

Way Forward:

Allocating higher budget to national healthcare expenditure can help in solving many issues related to infrastructure building and strengthening the existing ones.

Determining access to affordable basic health care is a major concern and needs to be addressed urgently to provide financial security to the low-income section of society.

We need to strengthen its low cost drug program, with focus on regular supply of drug and public healthcare facilities so as to improve access of low cost drugs to masses.

Develop an effective and affordable primary healthcare system with aim of access to all vision, that works effectively well in delivering basic wide ranging healthcare services in area
where healthcare access remains distinct. This needs to be backed by Public funding.

Establish a model like national essential medicine system that not only provides access to affordable medicine but also increases availability but also monitor quality.

Quality is another area of concern and some time-bound steps are required from all stakeholder to curb spurious drugs manufacturing and sales. According to the institute of health Management research , India accounts for 40% of Unsafe patient practices. There are only 22% JCI accredited healthcare facilities in India (Feb 2015).  Adopting quality culture and patient safety could bring down the medical errors, hospital related infections and help prevent wrong diagnosis.

Human resource development is also an important area since there is severe gap in supply and demand. Establishing and upgrading the existing health education institutes along with the launch of community healthcare programs can fill the existing gap and drive the healthcare sector to a brighter future. Quality and affordability of medical education is a major concern in India. The lack of Public funding and the high fee charged by the private medical colleges is very high leading to low enrollment of qualified students. Need for a more clear policy on fee structure and admission process medical education.

Establishing a robust healthcare funding program can provide social security to almost all the citizens. Moreover technology can play a key role in improving the healthcare outcome of
the country. The government needs to develop an appropriate vision to mobilize and use ICT tools in order to create outcomes. Technology can also improve transparency in the costs along with co-ordination and management of private sector to improve to quality and affordable healthcare.

Need for strong monitoring and evaluating system to determine successful implementation of Healthcare Regulation, policies and health schemes.

Social security, drug security, transparency, quality and good governance are keys areas that can transform the Indian Healthcare system. With right patient centric government policy and
effective execution, India can achieve its dream of Healthcare for all.

Some of the following steps warrant the state’s more immediate attention:

  • Collecting data on prices of similar treatments in public and private facilities to identify and address the exact reasons for the price divergence between public and private healthcare delivery systems,
  • Safeguarding periodic monitoring of quality healthcare services within both public and private systems while linking suitable insurance facilities for patients (including those who are terminally ill) to minimize healthcare risk,
  • Ensuring cheaper, effective diagnostic facilities at affordable cost for people in accessible distance from clinics/hospitals,
  • Complimenting development of healthcare systems with better provision of ancillary municipal services like good pest control, sewage systems, water purification systems and treatment of waste, and
  • Giving equal investment weightage to education (primary and secondary) incorporating elements of healthcare awareness to inculcate habits of proper hygiene, basic nutritional requirements, mental well being and physical exercise amongst the young to prevent the incidence of chronic ailments.