Lack of Spending : India spends only 4 percent of its GDP on its healthcare which is quite low as compared to any other emerging nation or developed countries. China spends 9.9%, South Africa 9.1, USA and Canada more than 17%.
I am not saying that just raising GDP is the solution but the running cost of extensive healthcare infrastructure and other facilities is very high it can’t be met with current expenditure. And when you look India’s spending few decades back it was as high as 8 % in 1996 and now it has come down to just 4% in 2015.
Solution: As you can see from above graphs that we are spending way low in healthcare and as India is also most touted destination when it comes to medical tourism therefore to improve our vulnerable state of healthcare we really need to improve our spending. And also managing our spending.
Lack of Infrastructure : Anyone who had a visit to public hospitals must not be an alien to the deplorable, awful conditions of our public hospitals. With two to three people sharing one bed, stretchers, and long queues or in many cases patients running to different departments and carrying their glucose bottle themselves. But this is not it, in many rural areas even today hospitals don’t get proper water supply. They don’t get 24/7 power. Lack of proper roads reaching hospitals or public health centers (PHC). So expecting them with state of art diagnosing machines will be foolish of ourselves. Picture get worse when we compare rural and urban healthcare infrastructure.
Solution: Again improving infrastructure is about spending more public money in healthcare but with proper plan layout. We need public private partnership.
Lack of Healthcare Workforce : .A country of 1.25 billion which is more populated than whole Africa or any other continent in the world has just 0.6 doctors and 0.8 nurses per 1,000 people is way lower than the WHO average of 2.5 doctors and nurses per 1,000 people.We are a developing country facing huge challenges and generating healthcare workforce is one of them.
Solution: India has got very few seats when it comes to post graduation in medical only 14,500 as compared to 56,000 in graduate courses. We need more number of seats to stop doctors and nurses relocating to other nations. With improving number of seats we can also stop a huge money going into unnecessary tests and medicines which doctors prescribe to get their commission from medical representatives to repay their loans which they took to complete post graduation. A seat in private college can go up to INR 5 million. Thus forcing doctors to go for bribe.
Lack of Public Participation: Only 21.62 crore people, or 17 per cent of the total population, were covered by health insurance at the end of March 2014. Providing healthcare totally free in public hospital is not helping India to reach its healthcare goals.
Solution: As financial inclusion we need a medical inclusion where every Indian is seen contributing toward better medical facility. Few such models have worked for some small areas. The Yeshasvini micro-health insurance in Karnataka is one such tested model. With just contribution of 5rs a month, one can undergo surgery free of cost in one of the public and private hospital. We can use mobile pay to bring this reform with one rupee a day no one will be hurt.
Lack of basic Public Healthcare Centers : A simple health centre which doesn’t even perform surgeries is found after travelling 100kms in some parts of the country. Rural and urban gap in terms of healthcare facilities is huge. People in rural areas have access to very few doctors or hospitals thus making them go for alternate medicine or facilities. A survey should 75 percent of practitioners work in urban areas and 23 in semi urban and only 2% works in rural areas where 70% of the population lives.
Rush in hospitals is so large that it become unmanageable just because of lack of hospitals and proper clinics and Doctors. AIIMS in New Delhi has footfall of 7000 patients per day in OPD. With India’s spending woefully small private hospitals have managed some load but they all are very high end which almost 80% of India can’t afford. There is no wonder when we see people mortgaging their land to access health facilities.
Some of the way forward measures can be:
•There needs to be a clearly defined policy and set of guidelines for the successful implementation and sustainability of the healthcare PPP models. This will attract private investments in remote diagnostics, telemedicine services and operations of rural health services in the states.
•The healthcare sector should be given infrastructure status by the central government and declared as a “priority” growth area by the state governments. This has to be followed by a consistent policy that is inclusive of incentives and subsidies with respect to land acquisition, tax structure and an approval process. This will help to attract the private sector for investing in manufacturing of medical equipment, setting up training centres for medical professionals (nurses, paramedics etc.) in rural areas, super-specialty and multi-specialty care services, medical colleges as well as medi-cities in the urban and semi-urban areas.
•Increase penetration of private health insurance and community based health insurance schemes in the rural and semi-urban market. At the same time prevent misuse of the existing government funded/sponsored schemes by considering provision for selective user charges.
•The central government must intervene in the manufacturing, procurement and distribution of the pharmaceutical drugs industry. This can be done through stricter regulations, and monitoring and supervision, which would help to control the prices of essential drugs.Though the costs involved in the complete upgrade of the healthcare sector are huge, there are enormous pay-offs in long-term investments in this sector. This will not only raise the quality of life for all but can also make the healthcare industry in India, a key enabler for economic growth.