Dr Amit Gupta
Senior Consultant & Head, Department of Critical Care
Bansal Hospital, Bhopal

Healthcare in India – Present scenario

Health sector is the lifeline for a nation’s wellbeing. It is the sum of the health of its citizens, communities and settlements in which they live. Healthcare in India strives to provide world-class healthcare to its 140 billion people complemented by the inflow of medical tourists from around the world. Healthcare in India is full of extreme contradictions. It offers the best juxtaposed with the pedestrian; the super-specialists with the quacks; products made of cutting-edge technology versus surgeries conducted under candlelight, the list is exhaustive.

Healthcare in India faces several challenges including inadequate access, low insurance penetration, and a growing chronic disease burden. At the same time, traditional business models have found it hard to show attractive returns on investment, except for a few large providers.

Post-independence, gradual advancement in healthcare delivery that has happened over several decades with contribution from public and private stakeholders has led to an increased life expectancy from 32 to 69.73 years.

The urban middle-class segments account for a majority of healthcare expenditures in India; hence with their numbers on the rise, coupled with a surge in income levels, the per capita expenditure on healthcare is expected to increase. The demand for quality healthcare is also driven by the improvement in health awareness.

Healthcare industry in India comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment. The industry is growing at a tremendous pace owing to its strengthening coverage, services and increasing expenditure by public as well as private players.

The healthcare industry in India is projected to reach USD 372 billion by 2022. The hospital industry in India, accounting for 80 percent of the total healthcare market, is witnessing a huge investor demand from both global as well as domestic investors.

The hospital industry is expected to reach USD 132 billion by the year 2023, from USD 61.8 billion in the year 2017, growing at a CAGR (compound annual growth rate) of 16–17 percent. The Indian medical tourism market is expected to grow from its current size of USD 3 billion to USD 7–8 billion by the end of this year.

The diagnostics industry in India is currently valued at USD 4 billion. The share of the organized sector is almost 25 percent in this segment (15% in labs and 10% in radiology).

The primary care industry is currently valued at USD 13 billion. The share of the organized sector is practically negligible in this case.

On budgetary allocation in healthcare
There has been a gradual increase in the percentage of allocation; the percentage of GDP spent on healthcare is a concern. Overall, India’s public health expenditure (sum of central and state spending) has remained between 1.2 percent and 1.6 percent of GDP between 2008-09 and 2019-20. In 2020-21, the Health Ministry received an allocation of Rs 67,112 crore. This is an increase of 3.9 percent over the revised estimates of 2019-20 (Rs 64,609 crore).

Under the Ministry, the Department of Health and Family Welfare accounts for 97 percent of the allocation, at Rs 65,012 crore, whereas, the Department of Health Research is allocated Rs 2100 crore (3% of the allocation).

The National Health Mission (NHM) receives about 50 percent of the ministry’s allocation, which amounts to Rs 33,400 crore in 2020-21. Under the NHM, the rural component, i.e., the National Rural Health Mission (NRHM) has been allocated Rs 27,039 crore, a 3 percent decrease while National Urban Health Mission (NUHM) at Rs 950 crore remains the same over the revised estimates of 2019-20.

Other items under NHM include funds for health and medical education amounting to Rs 4686 crore in 2020-21. Allocation to autonomous institutes like the AIIMS and the Indian Council of Medical Research saw a decrease of 5 percent at Rs 9616 crore from the revised estimates of 2019-20.

Pradhan Mantri Jan Arogya Yojana has seen the highest increase in allocation at 100 percent (Rs 6400 crore) over the revised estimates of 2019-20 (Rs 3200 crore). The scheme provides a cover of Rs 5 lakh per family per year to about 10.7 crore families belonging to the poor and vulnerable population. Allocation for Food Safety and Standards Authority of India has been reduced to Rs 283.71 crore from Rs 360 crore. The higher allocation has been made for Pradhan Mantri Swasthya Suraksha Yojana at Rs 6020 crore (27% increase). It focuses on correcting regional imbalances in the availability of affordable tertiary healthcare services.

On vision of health and family welfare
Increasing life expectancy and improving the health status and quality of life of its people, by focusing on health issues to reduce disease burden and facilitate the attainment of universal access to equitable, affordable and quality healthcare, which is accountable and responsive to the needs of the people of India.

On monitoring quality of private healthcare
The spectrum of quality within private providers is quite varied. Large networks are digitally enabled to monitor clinical excellence parameters and create structures and processes for the JCI (joint commission international) and NABH certifications. In contrast, there are several nursing homes, which, though registered as hospitals, do not have a distinct value proposition in terms of quality, and primarily focus on lower pricing and catering to a different customer segment. There is a lack of a comprehensive monitoring mechanism that enables patients to compare clinical outcomes.

A quality regulatory mechanism encourages hospitals to constantly map their own performance on diverse components of patient care, making the establishment of good clinical practices par for the course. Efforts to improve the quality of care are particularly challenged by the lack of reliable data on quality and by technical difficulties in measuring quality.

The ongoing efforts in the public and private sectors aim to improve the quality of data, develop better measures and understanding of the quality of care, and develop innovative solutions to long-standing challenges.

In future we have to move forward to develop and implement departmental standards like green OT and responsible critical care unit (ResCCU) or green ICU to provide excellent quality care.

On importance of public-private partnership in making healthcare a success
PPP is to be seen in the context of viewing the whole medical sector as a national asset with health promotion as a goal of all the stakeholders (health providers, private, public, the civil societies). Synergies, where all the stakeholders feel they are part of the system and do everything possible to strengthen national policies and programs need to be emphasized with a proactive role from the government. PPP will help both unlock capacity and ensure cost-effective delivery of care in rural areas. However innovative business models will be critical for widespread private sector participation.

The project must be designed in a way that it is mutually rewarding – economically as well as socially.

The way forward

Health driving factors such as clean water, sanitation and food should be taken on priority. Technology infusion, expanded infrastructure along with filling up gaps in human resources and efficiencies from process improvements can help improve health care accessibility and affordability.

The government should consider setting up a National Quality Monitoring Agency that will monitor clinical quality, publish data on clinical outcomes, patient safety and infection rates in various hospitals across the country, public or private. Consumers must have access to clinical data from all hospitals in equal measures, in order to transparently access and be able to make informed choices.

Rewards and benefits should be provided to hospitals that consistently deliver great standards of care, while appropriately penalizing defaulters, will encourage compliance and help build a robust healthcare delivery model. 

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