Health Care in India- Myth or reality: Are we ready for the big transformation ??

We are a country of 1.25 billion plus population out of which approx 88cr are living in the rural areas & urbanization has touched a mere 37cr people. Unlike western countries we have a huge gap between both the settlement. Even though it would be inaccurate, if we presume all these urban citizen lives a very good life. In a lower middle income country like ours, Cities are also having challenges of their own, in many cases people are even deprived from the basic amenities like food, shelter, health & hygiene.   

Being part of relatively educated mass, It's always quite captivating, when I read, we are the 7th largest economy (in terms of nominal GDP) & our GDP growth will surpass china soon. I don't understand whether these figures are  compelling enough to give a smile in the face of that poor man who resides in the remotest corner of  our country with sub 1$ income.

Out of all the essential indicator, healthcare is pivotal. We are the 3rd largest pharmaceutical market in terms of volume & 14th largest in terms of value. India is known for its cost-effective medical tourism & home to highly skilled medical professionals.  Despite all these clamour we are 112 in the WHO ranking for healthcare system globally. This evident because one million Indians die every year due to inadequate healthcare facilities and close to 700 million people have no access to specialist care.

Inadequate Healthcare Budget : 

The Indian Govt spends 2.27 % of GDP on healthcare where as it's approx 8-9% for developed countries.India’s healthcare spending is the lowest among BRICS (Brazil, Russia, India, China, South Africa) nations,. Even neighbouring countries like Pakistan(2.6%), Srilanka (3.5%) spends more on healthcare.  

It was noted that India spent about $40 per person annually on health care where as the United States spent $8,500. The entire GDP of India was $1.8 trillion then while the US health care spending alone was $2.6 trillion.

  

Govt. Infrastructure:

The problem essentially lies with government hospitals and their poor infrastructure. While there are many universal health care schemes being run by the Central and the State Governments in India and the government hospitals offer treatment and essential drugs free of charge, the fact that the government sector is understaffed, underfinanced and that these hospitals maintain very poor standards of hygiene forces many people to visit private medical practitioners and hospitals.

Niti Ayog Report of 2015, based on a survey, showed that around 41% of anganwadis have inadequate space, 71% are not visited by doctors, 31% have no nutritional supplementation for malnourished children and 52% have bad hygienic conditions.

Insurance Penetration:

While the insurance penetration is quite high in most of the developed nation , In India’s healthcare industry lack of a medically insured population and have high no's of patients who spend out-of-pocket (about 71 per cent of the total health care expenditure in the country was borne by households ).

Shortage of HCP:

Our doctor-patient population ratio of 1:1,674, worse than Vietnam, Algeria and Pakistan. India is falling short of 500000 doctors.

Public-health centres across India’s rural areas–25,308 in 29 states and seven union territories–are short of more than 3,000 doctors, the scarcity rising 200% (or tripling) over 10 years.

Lowest Bed/ Patient ratio:

India has only 1.1 beds per 1,000 population compared to the world average of 2.7 bed per 1,000  . 70% of India’s healthcare infrastructure concentrated in the top 20 cities. Hence there is a huge opportunities need to be uncover in the Indian healthcare Industry. Corporate India is already sharing a huge patient load  due to lack of infra from the govt. side . There should be certain alternative need to be developed to bridge the gap in healthcare segment.

Suggestions:

Priority Sector Tag:

Healthcare should be given a priority sector tag (currently, agriculture, MSMEs, export credit, education, housing, social infrastructure, renewable energy and others have been given this status) .This will help channelize funds from the banking sector to create necessary healthcare infrastructure

Development of healthcare specific PPPs:

Tax incentive, low interest, import duty wave off & Scaling up PPPs in the healthcare sector will require. Effort to standardise concession agreements and collateral and exit clauses. Private sector should be encourage to establish more centres in tier 2 -3 cities with viable economic models.

Health care fund :

A fund similar to the provident fund should be introduced for salaried employees .It could be also used to pay for outpatient services and preventive health checks .Investments into this fund could be tax deductible under section.

Foreign Investment:

The healthcare sector has been benefited with a good no of green & brown field projects  over last couple of years. The govt should encourage more on this & also huge incentive should also be given for setting up health care facility in tier 2-3 cities.

Mandatory Rural Posting:

Mandatory rural posting for at least 5-10 years should be imposed on healthcare providers. It could also be linked with their appraisal. However it would be unfair if the govt will be doing same without creating basic infrastructures ( Housing/ Electricity/ Quality education for their kids/ Transportation).

Though the govt initiatives like Pradhanmantri Swastya suraksha Yojna, Universal health cover are few good initiative in this  direction but we need to take more time bound & result oriented initiative to reduce pain of  burgeoning patient population of our country.