Healthcare in India
The private sector is the dominant healthcare provider in India.
Health care system
The private healthcare sector is responsible for the majority of healthcare in India. Most healthcare expenses are paid out of pocket by patients and their families, rather than through insurance. This has led many households to incur Catastrophic Health Expenditure (CHE) which can be defined as health expenditure that threatens a household's capacity to maintain a basic standard of living. One study found that over 35% of poor Indian households incur CHE and this reflects the detrimental state in which Indian health care system is at the moment. With government expenditure on health as a percentage of GDP falling over the years and the rise of private health care sector, the poor are left with fewer options than before to access health care services. Private insurance is available in India, as are various through government-sponsored health insurance schemes. According to the World Bank, about 25% of India's population had some form of health insurance in 2010. A 2014 Indian government study found this to be an over-estimate, and claimed that only about 17% of India's population was insured. Public healthcare is free for those below the poverty line.
Penetration of health insurance in India is low by international standards. Also private health insurance schemes, which constitute the bulk of insurance schemes availed by the population, do not cover costs of consultation or medication. Only hospitalisation and associated expenses are covered. India has typically addressed concerns pertaining to pricing of medication through indirect but more pragmatic means such as tax sops for medical expenses and patent law. Indian patent law only protects formulation and not the composition of a drug. This means that generic drugs that typically become available after the patent protections afforded to a drug's original developer expire, are available in India much earlier. Indian pharmaceutical companies routinely re-engineer processes for manufacturing generic drugs to make medication available at much lower costs. Accordingly, most of the research budget in Indian pharmaceutical companies is oriented at developing processes for synthesising drugs, rather than drug development.
Plans are currently being formulated for the development of a universal health care system in India, which would provide universal health coverage throughout India.
Public and private healthcare
According to National Family Health Survey-3, the private medical sector remains the primary source of health care for 70% of households in urban areas and 63% of households in rural areas. Reliance on public and private health care sector varies significantly between states. Several reasons are cited for relying on private rather than public sector; the main reason at the national level is poor quality of care in the public sector, with more than 57% of households pointing to this as the reason for a preference for private health care. Most of the public healthcare caters to the rural areas; and the poor quality arises from the reluctance of experienced health care providers to visit the rural areas. Consequently, the majority of the public healthcare system catering to the rural and remote areas relies on inexperienced and unmotivated interns who are mandated to spend time in public healthcare clinics as part of their curricular requirement. Other major reasons are distance of the public sector facility, long wait times, and inconvenient hours of operation. The study conducted by IMS Institute for Healthcare Informatics in 2013, across 12 states in over 14,000 households indicated a steady increase in the usage of private healthcare facilities over the last 25 years for both Out Patient and In Patient services, across rural and urban areas.
Following the 2014 election which brought Prime Minister Narendra Modi to office, Modi's government unveiled plans for a nationwide universal health care system known as the National Health Assurance Mission, which would provide all citizens with free drugs, diagnostic treatments, and insurance for serious ailments. In 2015, implementation of a universal health care system was delayed due to budgetary concerns.
The National Rural Health Mission (NRHM) was launched in April 2005 by the Government of India. The goal of the NRHM was to provide effective healthcare to rural people with a focus on 18 states which have poor public health indicators and/or weak infrastructure. It has 18,000 ambulances and a workforce of 900,000 community health volunteers and 178,000 paid staff.
Only 2% of doctors are in rural areas - where 68% of the population live.
The National Urban Health Mission as a sub-mission of National Health Mission was approved by the Cabinet on 1 May 2013. It aims to meet health care needs of the urban population with the focus on urban poor, by making available to them essential primary health care services and reducing their out of pocket expenses for treatment.
Quality of healthcare
In major urban areas, the quality of medical care is close to and sometimes exceeds first-world standards. Indian healthcare professionals have the advantage of working in a very biologically active region exposing them to treatment regimens of various kinds of conditions. The quality and amount of experience is arguably unmatched in most other countries. Despite limited access to high end diagnostic tools in rural areas, healthcare professions rely on extensive experience in rural areas. However non-availability of diagnostic tools and increasing reluctance of qualified and experienced healthcare professionals to practice in rural, under-equipped and financially less lucrative rural areas is becoming a big challenge. although rural medical practitioners are highly sought after by residents of rural areas as they are more financially affordable and geographically accessible than practitioners working in the formal public health care sector.
In 2015 the British Medical Journal published a report by Dr Gadre, from Kolkata, exposed the extent of malpractice in the Indian healthcare system. He interviewed 78 doctors and found that kickbacks for referrals, irrational drug prescribing and unnecessary interventions were commonplace.
With the help of numerous government subsidies in the 1980s, private health providers entered the market. Opening up of the market in the 90s gave further impetus to the development of the private health sector in India. Most of the healthcare capacity added after 2005 has been in the private sector, or in partnership with the private sector.
- Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 59. ISBN 978-1-137-49661-4.
- "Catastrophic Health Expenditure and Poor in India: Health Insurance is the Answer?" (PDF).
- Puja Mehra. "Only 17% have health insurance cover". The Hindu.
- "Modi's ambitious health policy may dwarf Obamacare". Quartz.
- George T. Haley; Usha C.V. Haley (2012). "The effects of patent-law changes on innovation: The case of India's pharmaceutical industry". Technological Forecasting and Social Change. 79 (4): 607–619. doi:10.1016/j.techfore.2011.05.012.
- "Hepatitis C sufferer imports life-saving drugs from India". 20 August 2015.
- International Institute for Population Sciences and Macro International (September 2007). "National Family Health Survey (NFHS-3), 2005–06" (PDF). Ministry of Health and Family Welfare, Government of India. pp. 436–440. Retrieved 5 October 2012.
- Ramya Kannan (30 July 2013). "More people opting for private healthcare". Chennai, India: The Hindu. Retrieved 31 July 2013.
- "India's universal healthcare rollout to cost $26 billion".
- Aditya Kalra (27 March 2015). "Exclusive: Modi govt puts brakes on India's universal health plan". Reuters India.
- Umesh Kapil and Panna Choudhury National Rural Health Mission (NRHM): Will it Make a Difference? Indian Pediatrics Vol. 42 (2005): 783
- Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 60. ISBN 978-1-137-49661-4.
- "NUHM". Retrieved 6 May 2015.
- Kanjilal, B; et al. (June 2007). "A Parallel Health Care market: Rural Medical Practitioners in West Bengal, India" (PDF). FHS Research Brief. 02. Retrieved 30 May 2012.
- Fox, Hannah (8 April 2015). "I've seen first-hand how palliative care in India is compromised by privatisation". The Guardian. Retrieved 19 April 2015.
- Baru,Rama V(2010): “Public Sector Doctors in an Era of Commercialisation” in Sheikh and A George(ed)Health Providers in India, on the Frontlines of Change(New Delhi: Routledge)81-96.
- Britnell, Mark (2015). In Search of the Perfect Health System. London: Palgrave. p. 58. ISBN 978-1-137-49661-4.