The paradox that is Indian healthcare

The best and the worst of facilities exist cheek by jowl. This glaring contradiction needs to be addressed



India is an ancient land, where the concept of Ayurveda evolved centuries ago, well before the allopathic branch of medicine was even discovered. Susruta and Charaka were pioneers in medicine in times when the concept of modern medicine was nowhere on the horizon.

However, in a remarkable irony, we have squandered our legacy of being innovators and are now considered as a developing country in healthcare.

As a developing nation, the demand for quality healthcare is growing fast. Therefore, it is imperative that the policymakers channelise the growth of healthcare services so that it caters to every section of our society.

For prevention

The first step towards this change should be a move from curative healthcare to preventive healthcare. This will not be an expensive affair; it will also help us reach out to a larger population base.

The Government needs to make a more effective intervention in the area of preventive and primary healthcare. Also, it needs to move away from being just a healthcare provider to an insurer at the tertiary level. It could refer to universal healthcare efforts such as the NHS in the UK or Medicare in the US.

Over the next five years the Government’s healthcare spend should increase to at least 5 per cent of the GDP compared to a little over 1 per cent now — which is low in relation to the developed nations.

India needs a major revamp of the healthcare infrastructure, which includes upgrading primary healthcare systems to provide preventive healthcare. Awareness on preventive healthcare measures, nutrition, prenatal care, vaccinations and counselling on the importance of hygienic practices — like sanitation and clean drinking water — should be pursued aggressively.

At one end of the spectrum we have high-end hospitals delivering healthcare comparable to any developed nation, (almost 22nd century kind of care); in sharp contrast to this just a few hundred kilometres away in the villages, one does not even have basic primary care (19th century kind of healthcare).

The tragedy of our healthcare system is that the gap between the ‘haves’ and ‘have-nots’ is increasing. Unless a radical change is made where affordable healthcare is available to all, we will have a social revolution on our hands.

A huge percentage of our 1.2 billion population still does not have any access to, or cannot afford, the modern healthcare service.

There is a massive deficit in healthcare facilities and personnel even though we are one among those who train the largest number of healthcare professionals in the world. We could easily build one hospital (600 beds) a day for the next 20 years and still not match the demand for beds in the country.

We do complex robotic surgery, heart and brain surgeries, and various transplants in some of our city hospitals but sadly we also have extremely high maternal and infant mortality rates in some of our poorly-run States, which are even worse than Sub-Saharan Africa.

Three-tier model

The Government should focus on promoting primary healthcare at all rural centres, secondary care hospitals at taluk levels and tertiary care establishments at district hospitals.

Supporting primary and secondary care could be predominantly the Government’s responsibility, while tertiary care could be promoted as a public-private partnership.

Universal availability of tertiary care to all citizens is still a mirage and even developed countries are finding it difficult to sustain this. For example, if we had to provide dialysis or transplant for all patients with kidney failure the cost would be almost $10 billion a year, which is more than our healthcare budget for all diseases.

Another paradox in our healthcare system is that we are expected to deliver world-class healthcare at third world costs. Many of these medical procedures (transplants and surgeries) in India are done at 10 per cent or the cost, or less, incurred in the US.

However, it is still deemed expensive by the common man because most of them pay for it from their pockets, unlike in the developed nations where the Government, insurance and social security net takes care of the costs.

The recent court rulings on awarding huge compensations in medical negligence may make it very difficult for smaller nursing homes, which probably deliver more than 70 per cent of rural and semi-urban healthcare, to continue functioning. These are issues we need to discuss at the highest levels and come to a reasonable consensus of what is ideal and what is practical and achievable in our set-up.

Need more hands

Another aspect that is vital is lack of nursing, para-medical personnel and doctors, both at the MBBS and post-graduate level.

We need to increase the availability of skilled healthcare workers at all levels. This calls for liberalisation of the medical education policy to allow for more doctors especially at the postgraduate level to be trained at corporate/private hospitals.

Opening medical colleges in every district and using the district hospital facilities would also be benefited if sourced from a PPP. This would bridge the demand-supply gap in medical services.

To make treatments more affordable we need to reduce the duty on all life-saving and critical medical devices along with encouraging and incentivising local production of these.

The concept of universal healthcare is encouraging but the cost of care has to be reasonable so that private players will come forward.

It is an absolute must in our country, where the private sector accounts for a large majority of healthcare, to have public- private participation.

Unfortunately, our country is categorised into two sections — the well-to-do Indian who can get the best of healthcare and the poor Indian who is relegated to 19th century healthcare, usually in semi-urban and rural India.

The greatest challenge is to bridge these two Indias.

The writer is the Medical Director of Manipal Health Enterprises

Published on July 31, 2014
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