The present healthcare system in India is not adequate to deal with the needs and requirements of the current population. The Indian healthcare system is growing at a rapid pace and both the Central and the State governments are taking all the necessary steps to ensure that the highest quality of healthcare services and drugs are available at government hospitals. Healthcare, both in terms of revenue and employment, has been one of India’s largest industries. Hospitals, medical supplies, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment are included in healthcare.
Introduction
Health has been described as a state of full physical, mental and social well-being by the World Health Organization (WHO), and not merely the absence of disease or infirmity. The key determinants of health are the social, economic and physical conditions of a person. In India, health care features a universal health care system administered by India’s constituent states and territories. Each state is charged by the Constitution with raising the quality of nutrition and the standard of living of its citizens and improving public health as one of its primary responsibilities.[1]
The Indian healthcare delivery system is divided into two parts i.e. public and private. The government or the public health system consists of small secondary and tertiary care institutions in key cities, and focuses on providing basic health services through the primary health centres (PHCs) in rural areas. On the other hand, the private healthcare system primarily focuses on secondary, tertiary, and quaternary care institutions with major concentration in metros and Tier- I and Tier-II cities. [2]
Public and Private Healthcare System
In India, the health care system is universal. However, the consistency and coverage of medical care in India is highly discrepant. Health care can be vastly different between states and rural and urban regions. There are frequent shortages of doctors in rural areas, and disparities between states show that people in the poorest states often have less access to adequate health facilities than citizens in comparatively wealthier states. The lack of sufficient public health care system coverage in India means that many Indians are turning to private healthcare providers, although this is a generally inaccessible choice for the poorer segment of the Indian society. Insurance is available to help pay for healthcare expenses, mostly offered by employers, however, most Indians do not have health insurance, as a result of the out-of-pocket expenses making up a large portion of India’s medical care spending.[3] India continuously faces the problem of overpopulation, and due to this, there has been a high number of casualties due to the shortage of medical care and services, as a result of the continuous growth in population. The doctor-patient is worrisome because there is 1 doctor for every 10,189 individuals, while 2,046 individuals battle for a single bed.[4] India is suffering from a big crisis in terms of health. The biggest challenge facing individuals is choosing between public and private healthcare systems in India.
Private healthcare in India provides timely treatment and patients are given personalized attention. However, all this comes at a price to pay, with healthcare services far more expensive in the private sector than in the public sector. The public healthcare services and hospitals receive their funding from the government making it compulsory for them to tend to everybody. Everybody’s primary choice for healthcare services is generally the public sector, however, most of the times people switch to the private sector due to the poor condition of the healthcare services provided by the public healthcare system, such as shortage of trained medical professionals, the poor quality of the medicines and shortage in the number of hospital beds, to name a few. [5] The issue of inadequate human resources and outdated infrastructure, etc. in the public health system is due to the low funding provided by the Indian government.
While, by paying large amounts of money, the wealthy population of the country can access private healthcare facilities, the poor are under significant threat of financial coercion. Public share at the primary health care level is more accessible, but with compromised quality, while private share at the tertiary level is more quality, but high cost and focuses on urban areas. Government spending on tertiary care has begun to expand the scope of care, but without much change at the level of primary health care. Accountable health care for middle and low-income countries remains a problem. Accountability refers to the idea that people, organisations, and the community are accountable and may be needed to justify their actions. Access, availability and quality of health services around the nation continue to be severely impacted by low levels of public health funding, supply-side shortages, an unprecedented shortage of human capital and rising healthcare costs. Such challenges make it hard for the public sector to stay accountable. The government has been trying to tackle two main issues i.e. ensuring that all people can access healthcare equitably, and ensuring that healthcare is made accessible at a reasonable cost and without compromising on quality.
A robust primary health care system is distinguished by accountable, accessible, affordable, person-focused, comprehensive quality care, efficiently delivered, equity-based values and organised across the spectrum of the health sector by an integrated, interdisciplinary team using effective technology and rooted in the principles of continuity of care. The government should keep a major emphasis on primary health care in order to ensure health protection for every person, for a large chunk of our population still lives in resource-constrained rural settings with low affordability, availability, and accessibility of quality health care services.
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Some of the major attempts to resolve rural health problems include the 2016 National Health Policy and the 2018 budget announcements called Ayushman Bharat which has two components of improving healthcare in India: the government has made it free for the poor and disadvantaged people under its Pradhan Mantri Jan Arogya Yojana to improve access and quality of primary health care by reinforcing 1,50,000 sub-centers and primary health centres (PHCs) and converting them into health and wellness centres and addressing health care at secondary and tertiary levels.
Challenges: Healthcare System in India
The healthcare scenario in India is not an ideal one, and it faces a huge number of problems and challenges which include inadequate scope of basic healthcare facilities, lack of medical professionals, quality assurance, insufficient health spending and, most significantly, insufficient research impetus. Since the scale of these problems is high, the government alone can not solve them. While the government will continue the funding, the need is to get the private sector to participate. Due to the various limitations in our healthcare system, it is pertinent that technology is relied upon in order to maximise the output without compromising on quality.
The lack of trained medical professionals is another issue faced by the current healthcare system. There is one government doctor for every 10,189 individuals in India, while the WHO recommends the appropriate doctor-patient ratio to be 1:1000. Major states like Delhi, Kerala, Karnataka, Tamil Nadu, Punjab and Goa have more doctors than is mandated by the WHO, and this leads to an imbalance in the distribution of the workforce, as many of the medical professionals do not want to move to states such as Bihar and Uttar Pradesh, which leads to a shortage in the number of healthcare workers in these states.
Despite government efforts, the majority of our citizens remain deprived of access to healthcare, particularly at secondary and tertiary levels, which is another concern facing the healthcare sector. Moreover, availability, transparency and the double risk of communicable and non-communicable diseases also serve as barriers.
Policymaking
Policymaking is one of the most important steps that has to be taken in order to provide effective healthcare services. The problem in India is basically one of supply rather than demand. Policymaking must primarily concentrate on promoting the development of supply-side capacity. The price would be the product of the equilibrium between demand and supply. While price controls may be needed, particularly on the essentials, focusing on creating supply is the key to solving this from a long-term perspective. The problem of supply is not just limited to capacity but also to access of the healthcare services, thus both of them need to be addressed too.
According to Sumit Goel, partner at Healthcare Advisory, KPMG India, “certain industry practices in the healthcare value chain had inflated the prices to levels which were a cause of serious concern from a patient’s affordability perspective. Hence, regulatory price controls were introduced, which in turn impacted profit margins of the private healthcare sector. While the need is appreciated, the controls should not lead to healthcare providers becoming financially distressed, especially when hospital infrastructural inadequacy is a serious issue in itself.” [6]
Conclusion
Several schemes have been launched by the Government of India to provide better treatment to its people. Ayushman Bharat-PMJAY, the Program for Non-Communicable Diseases, the Program for Tuberculosis, Communicable Diseases, Malaria, HIV and the National Tobacco Control Program, the Pulse Polio Campaign or the National Immunization Program, performed incredible work. However, more work needs to be done in this sector. Public-private partnerships can be one of the options for resolving the issues facing Indian healthcare. One billion people do not have access to medical care, according to the World Health Organization, and a further 100 million are pushed into poverty in an attempt to access it. There’s a great need for social entrepreneurship in healthcare.
More research and work needs to be done at the community level, in order to bring about some substantial change. To draw on our collective power, we need to look beyond the narrow positions of the state, company and patients; and social entrepreneurship can just hold the key. [7]
References:
[1] Mohd Iqbal, Khan Amit Banerji, “Healthcare Management in India: Some Issues and Challenges” 16 Journal of Health Management (2014).
[2]“Healthcare Industry in India”, available at https://www.ibef.org/industry/healthcare-india.aspx (last visited on January 12, 2021).
[3]Healthcare System In India, available at https://www.internationalstudentinsurance.com/india-student-insurance/healthcare-system-in-india.php (last visited on January 12, 2021).
[4]“Public v. Private Healthcare in India”, available at: https://docmode.org/public-vs-private-healthcare-in-india/ (last visited on January 12, 2021).
[5]“Public v. Private Healthcare in India”, available at: https://docmode.org/public-vs-private-healthcare-in-india/ (last visited on January 12, 2021).
[6]“Indian healthcare: The needs and demands”, available at : https://www.expresshealthcare.in/public-health/indian-healthcare-the-needs-and-demands/416037/ (last visited on January 14, 2021).
[7]“Indian healthcare: The needs and demands”, available at: https://www.expresshealthcare.in/public-health/indian-healthcare-the-needs-and-demands/416037/ (last visited on January 14, 2021).
BY – Sanjana Jha | KIIT Law School