"whatever you can rightly say about India, the opposite is also true". - Professor Joan Robinson as quoted by Dr Amartya Sen
This observation is perhaps best vindicated by the state of healthcare in India. While the private healthcare continues to grow buoyed by investments from domestic and international healthcare providers, the condition of state-owned healthcare institutions remains as appalling as it used to be before the private sector boom. According to the Government of India’s 10th Five-year plan, private sector accounts for “82 per cent of outpatient visits, 58 per cent of inpatient expenditure, and 40 per cent of births in institutions.” This number has steadily grown post-independence when private sector used to account for 4 - 5 per cent of the total healthcare provided.
It is not difficult to understand why. Over the decades, the care provided by the state-owned institutions has steadily deteriorated thus forcing people to look for alternatives. The private sector, however, with its profit-oriented approach and also , the encouragement from the government due to booming medical tourism, has grown from strength to strength.
The public spending on healthcare, at around 0.9 per cent, is among the lowest in the world. The problem with this situation, obviously, is that while people living in cities have access to the best healthcare money can buy; the majority of the country’s population that lives in rural areas has access to mediocre quality of care resulting in high-mortality rates even in cases that could be easily managed if the standards procedures are followed. This condition is further aggravated in times of natural disasters and pandemics. Employing the services of the private providers is often a big strain on their finances for the rural folks. It is imperative for the government to shift its focus to improve the present deplorable state of rural healthcare.
Fixing the healthcare system, however, will require a multi-pronged effort that targets various aspects of healthcare such as healthcare research, quality standards and infrastructure and so on. An approach that focusses on improving access to healthcare that adheres to minimal standards of safety and quality with continuous improvements is the need of the hour.
Among some of the positive steps towards overcoming these issues, the government has set up the National Accreditation Board for Hospitals and Healthcare providers. But this was long overdue when it was introduced in the year 2006. Stricter implementation of the Board’s standards and mandatory certification for private and public providers could go a long way in boosting the quality of care provided, especially in the state-run institutions. Also healthcare insurance needs to be encouraged all over the country so that financial strain is reduced for rural and urban patients alike.
This issue of Asian Hospital & Healthcare Management features expert views from Debasish Mishra, Executive Director at PricewaterhouseCoopers, India and
Dr Pradeep Chowbey, one the leading surgeons in the country on the situation of healthcare in India and what factors will influence its future.