State of Indian Healthcare

Unfolding opportunities

Debasish Mishra

Debasish Mishra

Executive Director / Partner PricewaterhouseCoopers India.


Private Sector now provides more than 70 per cent of the healthcare in India. The growth of private healthcare has had many positive impacts on the healthcare scenario in India.


Where does India stand with regards to the research happening in healthcare? What can be done to improve the scenario?

Indian Council for Medical Research (a Government of India agency) conducts research in areas related to healthcare. The quality of research being done represents a mixed picture—while research in some institutes is on par with those being conducted in other parts of the world—the research on use of stem cells for movement disorders being a case in point, the research output on respiratory infections, diarrhoeal diseases, cardio vascular diseases, is insignificant compared to the burden of disease due to these conditions in India.
India is also a big destination for clinical trials given our population size and ethnic diversity.

Government of India has given incentives for research and development in health, pharma etc—expenses incurred on pharma R&D are tax deductible.

There is an immediate need for strategic planning to improve the level of research and also to collate and disseminate findings from various small scale community-based research projects that are being performed across the country. Creating a network of research and innovation centres—‘knowledge clusters’ will help improve the efficacy of research.

Institutions such as Public Health Foundation of India are a timely introduction in the field of public health and would go a long way in addressing the gap in Public Health Research appropriately.

What are your views on the current quality and patient safety standards in India? Are the standards good enough?

The National Rural Health Mission has given a thrust on the rural healthcare system in India. For the first time in the country, infrastructure standards have been introduced for all public health facilities—primary, secondary and tertiary. The Indian Public Health Standards specify the infrastructural requirements for all facilities with the aim of standardising the quality of care imparted in all facilities. However, implementation is still an issue—while the new facilities are being built as per IPHS, the existing facilities across the country need upgradation.

There is no mandated quality and patient safety standards which private hospitals are required to adhere to—the current standards are more voluntary in nature. National Accreditation Board for Hospitals and Healthcare providers has set up some standards on quality and patient safety but accreditation is a voluntary process. Similar standards exist for diagnostic laboratories, blood banks and wellness centres etc.

All large hospitals, however, have internal clinical audit processes through which they review events within the hospitals and institute appropriate corrective measures.

Since the standards are voluntary in nature and not mandatory, acceptability by providers is slow. However, the situation may improve if the purchasers of healthcare (insurance companies, corporate, government agencies) insist on adherence to standards before empanelling providers.

What are the current trends that are shaping the Indian healthcare sector?

Some of the current trends are:

  • • Higher economic growth and higher disposable income leading to higher per capita health spend
  • • Changing profile of disease from more infectious diseases to more lifestyle diseases which are chronic in nature
  • • Health status of the urban poor is a growing concern, owing to the increase in migration to cities, and congested and unhygienic living conditions.
  • • Increased role of private sector in a completely unregulated manner is creating several qualities of service issues
  • • Emergence of public private partnerships
  • • Increased penetration of private health insurance, but the share of out-of-pocket purchases continues to be an overwhelming proportion of total healthcare spend
  • • Better government schemes for healthcare delivery and health insurance for the poor
  • • Increased interest by private equity players in investments in healthcare delivery.

How has the growth of the private sector changed India’s healthcare scenario?

Private Sector now provides more than 70 per cent of the healthcare in India. The growth of private healthcare has had many positive impacts on the healthcare scenario in India:

  • • Availability of services has improved tremendously with all services available under one roof for example people do not need to travel abroad for any medical condition
  • • Cost of services is lower in relation to rest of the world
  • • Quality of healthcare has improved: Success rates of Indian healthcare providers is equal to or better than their counterparts in developed countries
  • • Employment opportunities have increased. Healthcare sector now employs more than 5 million people and is now the second largest employer in the services sector after education
  • • Growth and establishment of medical tourism to India. High quality medical services at corporate hospitals have positioned India on the global map as a preferred destination for high end medical / surgical care.

What are your views on the current boom in the investments happening in Indian healthcare?

The health industry is now receiving its due attention from financial investors. Tie ups with foreign universities and medical institutions are common place now with most up coming hospitals. This has led to a significant improvement in quality of care being imparted.

However, most of the current investments in private healthcare are taking place in the large metropolitan cities and in the tertiary care space. There is a crying need for investments in Tier II cities where there is demand for healthcare services and incentives from government for setting up health infrastructure.

The government health services, though, need much more focus than is being currently meted out. Health sector budget is less than 1 per cent of GDP and with a billion plus population, and significant proportion being below poverty line, the requirement is much more. The overall public health spend must go up.

What challenges does Indian healthcare face today? How can they be overcome?

The challenge in Indian Healthcare is to make healthcare access available and inclusive—improving budgetary allocation to public healthcare, reducing the urban / rural, male / female, rich / poor and social inequities in healthcare delivery. Another challenge is to ensure healthcare quality is consistent across the country. A third challenge is to reduce costs of delivery without reducing quality. A proper regulatory mechanism needs to be introduced (overcoming the Centre and State Government opposition to each others’ initiatives) to improve the quality of service delivery and keeping unscrupulous elements at bay. The large scale public health challenges need to be met with technology enabled solutions as well.

In the global arena, what do Indian healthcare providers need to do in order to become more competitive?

Indian providers have world class quality. They are also cost efficient as compared to developed countries. However, Indian providers need to improve their understanding of cultural sensitivities of people of different countries to serve them better.

Patient participation (patient-centred care) is a relatively new phenomenon in Indian healthcare. Can Indian hospitals benefit from this?

Any healthcare system cannot be sustainable without active participation from the patient. Hospitals can use this trend of better informed patients to encourage awareness on the real risks that Indian population faces and the need for preventive care and healthy life style.

Providers can also use this knowledge to become more responsive to patient needs.

All over the world, the patient is becoming more and more knowledgeable about the options available to them. Is the same thing happening in India?

Awareness is largely in urban areas thanks to the role of the media and the Internet. Not so much in rural areas where the patients are largely dependent on the doctor for medical advice and in their absence on quacks.

What can today’s healthcare providers do to bring healthcare services to the poor?

Healthcare providers can

  1. Use technology extensively for
    • • Telemedicine, medical call centres, mobile phones in healthcare delivery
    • • E-learning solutions and medical simulation to improve quality of training
    • • Electronic Medical Records for coordinated care, Computerised Physician Order Entry and RFID to improve safety of care.
  2. • Enter into Public Private Partnerships with the government for various health / subsidiary services and improve the overall quality of care—such as ambulance services, facilities management, diagnostics, urban health facilities, mobile medical units for rural areas.

As compared to developed economies, Health insurance plays a relatively small role in Indian healthcare, what is your take on this issue?

Currently, health insurance has only 3 per cent coverage in India—that indicates a huge potential for growth in this industry, but it will need a quantum change in people’s attitude towards insurance and health in general.

There are many reasons for poor health insurance penetration

  • • Poor awareness of need for insurance
  • • Lack of innovative products in medical insurance
  • • Lack of distribution channels
  • • Inadequate provider network
  • • Poor perception of consumers with regard to claims settlement and to a large extent the insurance companies are responsible for this perception.
  • • Regulatory requirements like very high start-up capital.

The situation is however, changing slowly. People are realising the benefit of health insurance; especially with the increase in lifestyle diseases such as diabetes, hypertension, asthma etc. and the insurance industry is likely see a 25 to 30 per cent growth over the next five years.