The Hindu Editorial Analysis- 4th June 2024 | Current Affairs & Hindu Analysis: Daily, Weekly & Monthly - UPSC PDF Download

The Delicate Balancing of Health-Care Costs

Why in News?

As we navigate the dynamic landscape of Indian health care, cost considerations are increasingly influencing every aspect of service delivery and patient care. With rising health disparities and uneven access to medical services, the need for equitable and sustainable health-care policies has never been more urgent than now. Ongoing discussions about setting rates for medical services are not just bureaucratic exercises. They fundamentally shape how we perceive, access, and deliver health care across India. In this globalised era, we see a variety of responses to similar challenges worldwide, shaped by differing cultural, economic, and systemic factors.

Healthcare Sector of India

• Healthcare Sector: Includes hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment.

• India’s Healthcare Delivery System:

  • Public Sector: Limited secondary and tertiary care institutions in key cities; focuses on basic healthcare facilities through Primary Healthcare Centers (PHCs) in rural areas.
  • Private Sector: Major provider of secondary, tertiary, and quaternary care institutions; concentrated in metros, tier-I, and tier-II cities.

• Medical Tourism:

  • India ranks 10th in the Medical Tourism Index (MTI) for 2020-2021 out of 46 global destinations.

• Future Projection:

  • Hospital Sector: Valued at INR 7940.87 Bn in FY21; expected to reach INR 18,348.78 Bn by FY 2027, growing at a CAGR of 18.24%.
  • Indian Medical Tourism Market: Valued at US$ 2.89 billion in 2020; expected to reach US$ 13.42 billion by 2026.

• Major Challenges Faced by Healthcare Sector in India:

  Lack of Infrastructure:

  • India struggles with deficient infrastructure, including a lack of well-equipped medical institutes.
  • Government Mandates: Private medical colleges required to be built on at least five acres of land, leading to construction in rural areas with inadequate living conditions and low pay scales for doctors.
  • National Medical Commission (NMC): Proposed removing the minimum land requirement of five acres.

  Shortage of Efficient and Trained Manpower:

  • Severe shortage of trained manpower, including doctors, nurses, paramedics, and primary healthcare workers.
  • Doctor-to-Patient Ratio: 0.7 doctors per 1,000 people, compared to the World Health Organisation (WHO) average of 2.5 doctors per 1,000 people.

  Population Density and Demographics:

  • The size and diversity of the population pose challenges in healthcare service delivery.
  • Aging population and rising chronic diseases increase the healthcare burden.

  High Out-of-Pocket Expenditure:

  • Public hospitals offer free health services but are understaffed, poorly equipped, and mostly urban.
  • This forces many to use private institutions, leading to high out-of-pocket expenses.

  Disease Burden:

  • High prevalence of communicable diseases (e.g., tuberculosis) and increasing non-communicable diseases (e.g., diabetes, cardiovascular diseases).
  • Annually, approximately 5.8 million Indians die from heart and lung diseases, stroke, cancer, and diabetes.

  Lack of Diagnostic Services:

  • Diagnostic services are mainly concentrated in metros and big cities.
  • Challenges include shortage of hygiene infrastructure, lack of awareness, limited access to facilities, lack of trained medical personnel, and dearth of medicines and good doctors, especially for the 70% of the population in rural areas.

  Public-Private Partnership Issues:

  • Challenges in fostering effective collaboration between public and private sectors in healthcare.
  • Ensuring the private healthcare sector serves broader public health goals.

• Measures Needed for India to become Global Healthcare Provider:

  Increase in Public Spending:

  • India’s healthcare spending is 3.6% of GDP, including out-of-pocket and public expenditure.
  • Comparison with BRICS Countries: India spends the least; Brazil spends the most (9.2%), followed by South Africa (8.1%), Russia (5.3%), and China (5%).

  Infrastructure Development:

  • Invest in building and upgrading healthcare infrastructure, including hospitals, clinics, and research facilities.

  Healthcare Education and Training:

  • Strengthen medical education and training programs to produce skilled healthcare professionals.

  Research and Innovation:

  • Foster a culture of research and innovation in healthcare.
  • Provide incentives for pharmaceutical and biotech companies to conduct research and develop new treatments.

  Telemedicine and Digital Health:

  • Promote the use of telemedicine and digital health solutions to increase access to healthcare services, especially in rural areas.

  Regulatory Reforms:

  • Streamline and simplify regulatory processes to facilitate faster approval of drugs, medical devices, and healthcare technologies.
  • Ensure a transparent and efficient regulatory framework.

  Public-Private Partnerships (PPPs):

  • Encourage collaborations between the government, private sector, and non-profit organizations to leverage resources and expertise.

  Health Insurance and Financing:

  • Implement and expand health insurance schemes to provide financial protection to citizens.
  • Develop innovative financing models to fund healthcare projects and initiatives.

  Disease Prevention and Health Promotion:

  • Focus on preventive healthcare measures to reduce the burden of diseases.

  Quality Standards and Accreditation:

  • Establish and enforce stringent quality standards for healthcare services.
  • Encourage healthcare facilities to obtain international accreditation to enhance their credibility.

  Medical Tourism Promotion:

  • Develop and promote medical tourism by offering high-quality healthcare services at competitive prices.
  • Improve visa and travel infrastructure to attract patients from other countries.

• Recent steps Taken by the Government for the Growth of Healthcare Sector

  • National Digital Health Mission (NDHM): Launched in 2020, NDHM aims to create a digital health ecosystem, including health IDs for citizens and the establishment of a national digital health infrastructure.
  • Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): AB-PMJAY, launched in 2018, is a national health protection scheme that provides financial protection to over 100 million families for secondary and tertiary care hospitalization.
  • National Health Policy 2017: The National Health Policy outlines the government’s vision to achieve the highest possible level of health and well-being for all and emphasizes preventive and promotive healthcare.
  • Health and Wellness Centers (HWCs): The government is working towards transforming primary health centers into HWCs to provide comprehensive primary healthcare services, including preventive and promotive care.
  • Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): PMSSY aims to enhance tertiary care capacities and strengthen medical education in the country by setting up new AIIMS (All India Institutes of Medical Sciences) institutions and upgrading existing government medical colleges.
  • Research and Development Initiatives: The government has been encouraging research and development in healthcare, including support for the development of vaccines, drugs, and medical technologies.
  • National Medical Commission (NMC) Act: The NMC Act, passed in 2019, aims to bring reforms in medical education and practice by replacing the Medical Council of India (MCI) and promoting transparency and accountability.
  • Jan Aushadhi Scheme: The Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) aims to provide quality generic medicines at affordable prices through Jan Aushadhi Kendras.

Way Ahead

• There is a need to adopt technology wherever possible to streamline the operational and clinical processes for healthcare facilities in order to manage efficient patient flow.
• In addition, there is the challenge to think beyond the obvious and promote virtual care protocols, and telehealth services, which can be leveraged to reduce the patient-load burden to a large extent.
• To sum it up, there is an urgency to make healthcare service and service providers more transparent operationally. 
• This will help ensure people and processes can be made easily accountable to provide better healthcare services.