Health care in India

Context – The problems in India’s health sector.

What are the issues with healthcare sector in India?

1. Low government spending – Public expenditure on health accounts for only 1.13% of the total health expenditure which is abysmally low when compared to WHO recommendation of 5%.
2. High out of pocket expenditure– Out of pocket expenses account for 62% of the expenditure. This led to an increasing number of households facing catastrophic expenditures due to health costs.

• 85% of the population cannot afford high cost, corporate private health care.

3. Insurance-76% of Indians does not have health insurance. Government contribution to insurance is just 32%. Low insurance penetration forces people to spend out of pocket.

• The behaviour of a private corporate hospital is skewed in favour of profitability.

4. Malpractices in the healthcare sector – Selling substandard and counterfeit medicines, unnecessary hospital admissions and exploitation.
5. Weak government policy– only 1.27 crore people have taken advantage of the Ayushman Bharat scheme out of 12 crore card holders.
6. Dark reality of private hospitals– The insurance backup incentivizes hospitals to expand the bill but the patients do not get attended to in their best interests.
7. Low health workforce density – India’s public system has a shortage of nurses. The ratio of 0.6 nurses per doctor while the World Health Organization specification is three nurses per doctor.
8. 80:20 Rule – Only 20% of people can afford modern health care, 40% cannot afford it at all and the other 40%, the non-poor, pay with difficulty.

• Nearly 7 crore of the non-poor slide into poverty on a year-to-year basis.
• Under-qualified doctors– Due to this, 80% of people routinely reach Registered Medical Practitioners who are not trained to treat patients.

What needs to be done to improve healthcare sector?

• Increase the number of doctors– Ramp up the number of doctors with counterpart obligation to serve in rural areas.
• The Licentiate Medical Practitioner [LMP] – The scheme involves a three-and-a-half year course that leads to a bachelor’s degree in medicine and surgery. Doctors trained under this scheme will work in rural areas.
• Empower graduates of BSc (Nursing) to be nursing practitioners.
• Focusing of primary care– India needs to shifts focus from secondary and tertiary sectors to primary care. PHCs should be made attractive to doctors by providing incentives and making rural service mandatory for medical students.
• States should be incentivized to carry out the appointments of health workers and doctors.

Way forward-

• PHCs should be well-staffed and well-provisioned through a reasonable fee which will cover at least part of the cost.
• Focus should be shifted to preventive healthcare from curative healthcare.
• Policymakers need to focus on the larger picture with steps being taken to reclaim the space under public care.