Challenges Of The Healthcare Landscape In India
According to World Bank’s Universal Health Coverage Index, India is at the 157th position of entire 195 nations. Is there health and well-being for all? Are we targeting health and wellness for all? Indeed, yes! Then what are the reasons for such condition? How should the country transform its healthcare system? What are its current pain points? Healthcare includes not only medical care, but also all aspects of preventive care as well. WHO defines health as a state of total physical, mental, and social well-being and not a mere absence of disease or infirmity. But, in India, there is no such health well-being. There are economic problems too. On the one hand, there is massive poverty which does not allow people to use expensive health services in the private sector. On the contrary, public health expenditure is less. Therefore, the out-of-pocket expenditure shifts families from APL to BPL. The problem is multidimensional, that is: accessibility, affordability, and availability.
Basic healthcare and infrastructure
India faces a growing need to fix its basic health concerns in the areas of HIV, malaria, tuberculosis, and diarrhea. Additionally, children under five are born underweight and roughly 7 percent of them die before their fifth birthday. Only a small percentage of the population has access to quality sanitation, which further exacerbates key concerns. For primary healthcare, the Indian government spends only about 30 percent of the country’s total healthcare budget. One way to solve this problem is to address the infrastructure issues by standardizing diagnostic procedures, building rural clinics, and developing streamlined health IT systems, and improving efficiency. The need for skilled medical graduates continues to grow, especially in rural areas which fail to attract new graduates because of financial reasons. A sizeable percentage of the graduates also go abroad to pursue higher studies and employment. The Mental Health Bill for providing universal mental health is a significant step, but the lack of mental health practitioners creates a huge gap in the implementation of such initiatives in the future.
Rural versus urban
There are gaps between the rural and urban populations in its healthcare system which worsen the problem. 70 percent of the population still lives in rural areas and has no or limited access to hospitals and clinics. Consequently, the rural population mostly relies on alternative medicine and government programmes in rural health clinics. In contrast, the urban centers have numerous private hospitals and clinics which provide quality healthcare. These centers have better doctors, access to preventive medicine, and quality clinics which are a result of better profitability for investors compared to the not-so-profitable rural areas.
Payment mechanisms
The key driver of India’s healthcare landscape is the high out-of-pocket expenditure. This means that most Indian patients pay for their hospital visits and doctors’ appointments with straight up cash after care with no payment arrangements. According to the World Bank and National Commission’s report on macroeconomics, only 5 percent of Indians are covered by health insurance policies; such a low figure has resulted in a nascent health insurance market which is only available for the urban, middle, and high income populations. The government plays an important role in running several safety net health insurance programmes for the high-risk population and actively regulates the private insurance markets. Currently there are programmes including the Community Health Insurance program for the population below poverty line etc. There are additional plans offered to government employees, and a handful of private companies sell private health insurance to the public.
Pharmaceutical sector
According to the Indian Brand Equity Foundation (IBEF), India is the third-largest exporter of pharmaceutical products in terms of volume. Around 80 percent of the market is composed of generic low-cost drugs which seem to be the major driver of this industry. The increase in the ageing population, rising incomes of the middle class, and the development of primary care facilities are expected to shape the pharmaceutical industry in future. The Jan Aushadhi scheme provides quality generic drugs at affordable prices. But, there are issues regarding lack of medicines reported as only 73 of 361 essential drugs are listed under the Jan Aushadhi scheme. Furthermore, there is a huge push toward traditional Ayush mission, but the existing infrastructure of Ayush is underutilized and practitioners are moving away from the traditional system for better opportunities.
Medical devices sector
The medical devices sector is the smallest piece of India’s healthcare pie. However, it is one of the fastest-growing sectors in the country like the health insurance marketplace. Till date, the industry has faced a number of regulatory challenges which has prevented its growth and development. Recently, the government has been positive on clearing regulatory hurdles related to the import–export of medical devices, and has set a few standards around clinical trials. Protection framework for providers: incidents of violence against doctors in the Indian subcontinent have increased in the last few years. Most doctors in India are concerned about their safety at work. According to an ongoing study by the Indian Medical Association, more than 75 percent of doctors have seen violence at work. National newspapers constantly report doctors being abused, bullied, manhandled, and even killed by the patient’s relatives.
Mahatma Gandhi devoted his life to ahinsa – the practice of nonviolence. Through these principles, he inspired millions across a much divided nation to unite and break the shackles of British monarchy. However, over the years his legacy seems to have been permeated by an undercurrent of acrimony, and a sense of distrust toward the medical community. The highest number of violent incidents occurs in the ICU and is caused by relatives of patients. Communication gaps and unrealistic or too high expectations for patient recovery are a major concern. No law exists for the protection and safety of the medical community. While it is a non-bailable offense to assault an uniformed public servant such as a bus driver or a policeman, there is no distinct penalty for hitting an on-duty physician in a white coat. Therefore, a holistic approach is required to take this challenge. If all efforts are made with proper implementation, the dream of health and well-being for all will become a reality.
