Dr Rashi Agarwal
Director,
Praxis Healthcare Pvt. Ltd.

Indian Healthcare – A Complex Mixed Public–Private Model

The healthcare system in India still needs a detailed review and needs to be worked at. Healthcare is not universal, and nor is it accessible equally in all areas of India’s vast territory. The NHS in the United Kingdom, Medicare in the United States of America, and the national programs in Canada and Europe are very different from the system followed in India. Indian healthcare is a complex mixed public–private model, with limited government funded public healthcare, alongside pricier and urban-concentrated private providers. Unlike, most global markets, where healthcare is mainly government aided and private healthcare constitutes only a very small percentage, India is mainly catered to by the private sector leaving only the unaffording catered to by the poorly organized public sector.

Access to superior technology and quality healthcare is easily available only to out-of-pocket or privately insured patients. Despite India’s relatively low per capita expenditure on healthcare to date, India’s market for medical devices is in the world’s top twenty (e.g., in 2015 India’s medical equipment market was estimated at about €2.3 billion). The market is expected to continue its steady growth until 2018. There is an urgent need to improve both access to and quality of healthcare, otherwise health systems could face widening gaps between the health services they provide and the disease burden in their population.

On budgetary allocation in healthcare

The constitution of India considers the right to life to be fundamental and obliges the government to ensure the right to health for all. The states are responsible for organizing and delivering health services to their residents. The central government is responsible for international health treaties, medical education, prevention of food adulteration, quality control in drug manufacturing, national disease control, and family planning programs. It also sets the National Health Policy including the regulatory framework and supports the states. To achieve the public healthcare expenditure objectives of the National Health Policy, there is a need for an annual 40 percent rise in government health expenditure. But the budget shows an increase of only 12 percent. A mere 11.5–12 percent increase in budgetary allocations for health is disappointing and discouraging especially with the announcement of schemes that require large sums of money.

On monitoring the quality of private healthcare

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. Efforts to improve the quality of healthcare in India and attempts to evaluate the impact of these efforts invariably face challenges because of the lack of reliable administrative data. Gathering accurate data on quality of care in hospitals through various ratios and statistics and then using appropriate tools to improve the ratios will lead to better quality of care. Better tools through accreditation systems in the system followed with strict adherence will improve the quality of care administered.

On importance of public–private partnership in making healthcare a success

The public–private partnership (PPP) model is imperative in providing good quality healthcare to all. Private hospitals are concentrated only in urban centers and a vast majority of the population, living in remote rural areas, has no access to such facilities and cannot afford them. Efficient and affordable healthcare can be provided through the PPP model to all in India. The policy goal of PPP in healthcare would be to bring out the synergies in key stakeholder interests between the public and private sector and at the same time have a strong regulatory mechanism of maintaining quality along with equity in service.

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