The growth of the private healthcare sector in the country picked up from the mid-eighties and registered a sharp increase post the liberalization period. By 2010-11, India had close to 10.4 lakh private health enterprises. Within the sector, there were nearly 7.38 lakh enterprises with a single person operating them and about 2.97 lakh registered establishments.
Within the provider space, the corporate hospitals have a big network of facilities in Metro cities. In 2017, analysis of 15 pan-India corporate groups revealed their expansion into 73 cities (tier II and III). Despite this spread, corporate facilities formed just 2.9 percent of total healthcare facilities in India. The bulk of the network of private health facilities is estimated to comprise regional hospitals, nursing homes, as well as clinics and dispensaries in small cities. There is high dependence on private healthcare delivery compared to delivery of care in public healthcare. NSS 2013-14 reported that more than 71 percent of healthcare delivery happened in private facilities in rural India and more than 77 percent in urban India.
Various reasons are attributable to the low utilization of public healthcare delivery. There are issues such as lack of basic infrastructural facilities like beds, wards, toilets, drinking water facility, clean labor rooms for delivery, and regular electricity. Further there are issues of absence of qualified human resources as well as problems with human resource training. However, this issue impacts not just the public sector but the private sector as well. Within private healthcare, there are further issues such as low utilization of standardized treatment protocols, and non-adherence to processes. Even compliance to available quality standards of NABH is low.
In 2017, just 480 hospitals, 116 small healthcare organizations, and only 29 clinics had NABH accreditation. Amongst the reasons for this low adoption are voluntary nature of the NABH standards and the perceived high cost of adherence (NABH has published minimum entry level standards for smaller healthcare organizations which are expected to be more affordable to implement). In terms of outcome measures, some factors such as mortality, readmission, patient experience, safety of care, infection control, and effectiveness of care are important quality indicators. Analysis of data in the public domain could not give any comprehensive view on health outcomes monitoring across private healthcare in India.
Given the dependence on private healthcare and the problems related to quality of care, it is imperative to make efforts to improve the situation. There are various problems impacting quality, some of which are availability and training of qualified human resources, adherence to standard treatment protocols, and noncompliance to processes. Gradual improvement in the situation could be achieved through financial mechanisms, of which insurance could be one such mechanism. Various standard treatment guidelines are available with organizations in both the public and private space. Insurance schemes could utilize these guidelines, and ensure compliance to them as one of the criteria for e-claims processing. Compliance to processes can be achieved through empanelment criteria. The second thing needed is to ensure monitoring of the adherence on a continuous basis through audit, with provisions for disciplinary action. For example, analysis of the Suvarna Arogya Suraksha Trust Model reveals listing out of detailed empanelment criteria, medical audits of claims, and mechanisms for disciplinary action as some of the measures to ensure quality of care.
Currently, there are various state insurance schemes as well as the newly launched Ayushman Bharat. As coverage under such schemes increases, the need to ensure quality processes is strengthened. Successful implementation of the two measures outlined above, should have a positive impact on the quality of private healthcare. However, quality improvement will be a gradual process, requiring efforts of both private and public stakeholders.