India has only 10 lakh registered doctors to cater to 1.3 billion citizens. As per the MCI claims, half of the doctors in the country are quacks( unregistered doctors who don’t hold a degree in allopathy). While urban areas have 58% qualified doctors, in rural areas the number is as low as 18.8%.
India continues to spend about 1.2% of its GDP on health sector far less than some of the poorest countries of the world. We are ahead of only a few countries like Myanmar, Pakistan, Sudan and Cambodia.
However, the availability of public health care services is abysmal. There is only one government allopathic doctor per 10,189 people, only one government hospital bed per 2046 people, and one state-run hospital per 90,343 people. Out of 1 million doctors in the country, only 10% of them work in the public health sector(according to National Health Profile). They lack good infrastructure, proper management, dedicated staff and many other things which are required to provide reasonable and appropriate healthcare.
In 2014, 38.2% of India’s population was below the poverty. These people depend on government hospitals for their treatment. Many times they go to hospitals with one disease and come back infected with some other illness due to improper sanitation and inadequate quality of care provided by the staff. In 2017, around 300 infants died in Gorakhpur Baba Raghav Das Medical College due to poor management and a shortage of oxygen supply. But there is little to no evidence to suggest that the government has learnt from its previous mistakes.
India spends only 1-2% of it it GDP on healthcare. With the investment on private healthcare the overall spending stands at 4.5%.
Foreign patients also are coming in large numbers to India for relatively cheaper private healthcare. They mainly come from the Middle East, Africa, Pakistan and Bangladesh for paediatric cardiac surgery, liver transplants, etc. Some even have started coming from UK, Europe and North America for cheap and quick coronary bypass or orthopaedic treatments. This is ironic that while people from other countries are utilising our private healthcare services while its citizens are reeling under catastrophic healthcare expenditure.
After independence in 1947, the private hospital used to provide services to only 5-10% of the patients, but today its accounts for 82% of outpatients visits and 58% of inpatient. Government have supported private sector by releasing prime land resources at low rates, by exemption from taxes and duties for importing drug and high tech medical equipment.
Many private players in healthcare sectors have shifted to profiteering over the last couple of years. They now dominate the upper end of the market, with five stars hospitals manned by foreign-trained doctors who provide services at a rate which only rich people can afford. But the public alternative is so worse, with the long waiting time , dirty surrounding and lack of proper equipment. Many tests cannot happen because of the lack of facilities and medicines. As a result, patients don’t have any choice other than turning towards private sector hospitals.
Private hospital charge so high that more than 40% of all patient admitted in the hospital have to borrow money or sell their assets, and about 25% of farmers are pushed below the poverty line due to the burden of the out of pocket healthcare spending.
Last year, Fortis Hospital in Gurugram billed a dengue patient around Rs.16 lakh for 15 days treatment in its intensive care unit. Despite that they could not save that patient. Despite having new technology and well-trained doctors, there have been many cases of medical negligence in private hospitals. Max Hospital in Shalimar declared baby died when he was alive.
The government needs to price the services in a serious manner. Today in most of the states, health schemes of Central government do not have perfect pricing system which actually should be based on open tender. Maybe fixing the price in the form of a package of services with similar processes will be helpful
In the UK and Thailand, 80% of services provided is by the Government Hospitals where doctors and staff salaries are fixed. In Japan, private doctors offer services based on fixed prices by the Ministry of Health in consultation with staff holders. Government ensures that there should be no overbilling by imposing stringent penalties.
We need some companies which can bring together different healthcare components such as doctors, hospitals, clinics, diagnostic centres together on one platform and provide home services.
Startups like PORTEA provide home care services. It says “It provides chemotherapy for 30-40% less fee than what hospital charges. The cost of the drug as well as admission and nursing charges are nearly Rs 25000 in an average private hospital compared to Rs 16000 if treatment is given at home. Home care services also reduce the risk of secondary infection.
Healthcare cost comes down if the government stops looking at the poor patient as a source of revenue or some burden on taxpayers money. If a patient pays Rs 1000 for healthcare services then about Rs 250 goes to the government as various taxes. Income tax exemption for the hospital as an incentive won’t reduce healthcare cost for the patient but will benefit the promoter.