Dr Aafreen Soudagar
CEO
Kalsekar Hospital

Indian Health – Rare!

Indian healthcare is a step son disowned at a pretty young age by successive governments in India. Now since this son has grown on his own with the help of profit driven private institutions, he shows significant disregard and apathy toward poor and needy consumers. Considering the inherent reluctance of Indians toward personal health and wellness, healthcare historically has never been so effective as a political tool to garner votes. Obama care is a recent example to take a global cue. Specially because healthcare reforms require rigorous planning, consistent efforts, and absolute control to show results, our coalition governments have failed at it miserably due to obvious political reasons. Consistent neglect toward public healthcare has resulted in current chaos and outrage. From a market perspective there is huge disparity in demand and supply in India. We have around 70 percent of population which is considered as poor who cannot afford higher costs of treatments but they have to take treatment from approximately 70 percent of healthcare infrastructure which is operated by profit driven private players and obviously is much costlier than public facilities. This conflicting situation is pushing them further into poverty. According to Indiaspend, an NGO, medical costs pushed 50 million Indians back into poverty in the 10 years from 2004 to 2014.

Catch 22

Approximately 72 percent of the rural population and 79 percent urban India opt for private healthcare services due to absence of public hospitals or lack of infrastructure in such centers, which fuels the growth of private hospitals. Now majority of this growth is happening in urban areas due to availability of resources like doctors, nurses, staff, which gives rise to immense competition amongst private hospitals to grab patients. This further increases cost of treatment as hospitals have to compensate their marketing expenses. Inflated bills lead to unrest amongst patients and relatives giving rise to untoward incidents in hospitals. Since everyone involved in this chain wants to have a larger share of the pie and is not willing to compromise even a little bit, ultimately it is the end consumer who is is bearing the brunt. This situation though quite evident to the lawmakers prevents them from intervening as they have no effective alternative mechanism available. All the efforts of successive governments to strengthen the public healthcare delivery system have gone in vain due to lack of control and local noncompliance.

Contrast

According to 2014 figures, Indians spend 4.7 percent of GDP (2.8 trillion dollar economy) on healthcare. Out of that only 30 percent, that is, approximately 1.5 percent of GDP is contributed through government funding. Rest 70 percent of healthcare spends of Indian consumers is out of pocket. What it means is, out of approximately 100 billion USD spent, 70 billion USD are spent out of their own pockets by Indian healthcare consumers annually. In comparison China which has a higher population and spends around 5.6 times more on healthcare than India has been able to provide 56 percent of expenses through government funding. Europe and other developed nations spend approximately 80 percent and above on public health through government funding (UK 90 percent and US 86 percent approx). Higher public health spends might be one of the influences to improve the public health scenario but it is not a sure shot formula to achieve higher ranks in the global health index. In a recent study published by lancet in 2016 comparing healthcare access and quality of 195 countries, the United States of America has ranked much lower (i.e., 17th) even after spending around 10,000 USD per capita in comparison with Iceland which topped the list by spending less than half, that is, around 4500 USD per capita. Which again emphasizes that control and effective monitoring of health spend is the deciding factor in improving the healthcare scenario globally. India with 75 USD per capita spending has stood at 145th rank out of 195 with marginal improvement over last rankings; however, it still trails behind much poorer countries like Bangladesh, Bhutan, and Sri Lanka.

Scope

Omnipresent and standard care are two major goals for Indian healthcare. The current system has failed miserably on both fronts and hence there has to be a fresh approach to solve this problem. Focusing again on improving public healthcare machinery will be a fatal attempt. Even the PPP model has inherent flaws as private parties start seeking monetary benefits after some time. But the poor cannot be left to suffer financially in the hands of profit centric healthcare institutions. There has to be a midway where the government can accommodate the larger percentage of poor population in mainstream healthcare services without putting financial burden on them. In the current healthcare infrastructure it is possible only when the government creates an access for the poor to avail private healthcare services and compensate these institutions against healthcare provided to poor. India has more than 76 percent population which is medically uninsured. Ayushman health scheme which is targeted at a larger and poor section of population to bring it under government health insurance scheme is one of the welcome moves. If it overcomes all the state level obstacles and gets implemented as planned on 15th of August in the entire nation, it can prove to be a big relief for the underprivileged section of Indian society. Though this scheme does not offset the entire burden of healthcare expenses but it will definitely take away a larger share of expenses arising out of IPD care. Covering OPD expenses along with IPD under this scheme will be a pragmatic move in coming future.

According to a KPMG report, India meets the global average in the number of physicians, but 74 percent of its doctors cater to a third of the urban population, or no more than 442 million people out of the total 1.4 billion Indian population, those need to be distributed evenly in urban and rural areas proportionately. Improving suburban and rural infrastructure and lifestyle is the only solution to this problem. The IT sector has been exceptional in changing the Indian economic scenario in the last couple of decades. The healthcare sector specially the public healthcare has been laggard in taking advantage of this wave. With current advancements in telecommunication coupled with internet penetration in urban as well as rural India, various programs catering to creating awareness about endemic and lifestyle disorders can be easily achieved. On World Health Day 2016, several new computer and mobile-phone based e-health and m-health initiatives were launched. These include the Swastha Bharat mobile application for information on diseases, symptoms, treatment, health alerts and tips; ANMOL-ANM online tablet application for health workers; e-RaktKosh (a blood-bank management information system); and India Fights Dengue. However, awareness about these programs is a key which is still missing in the Indian healthcare scenario.

Hope

Being the youngest nation in the world filled with energy and enthusiasm, Indian youth with the help of Internet-of-things which is spreading the information and knowledge at unimaginable speed, can instigate the positive change at a much faster rate than we expect. By IBEF estimates, the Indian healthcare industry is one of the fastest growing industries in the entire world reaching the size of 372 billion USD by 2022. It is going to be one of the leading employment generators of India. In developed countries like the United Kingdom and the United States of America healthcare and related services provide more than 13 percent of overall employment. In India it is less than 2 percent. I hope this scenario will change if required attention is provided to this sector in coming years. Healthcare sector of India is poised for many challenges and opportunities in coming years. We all as a nation need to work together and make sure that we reach a platform where healthcare will be available to all – equally.

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