Economic and Accessibility Issues in Indian Healthcare
Healthcare in India is notoriously lacking in quality and accessibility, due to the lack of health centers, understaffing, and the lack of essential medicine and other necessities. These issues have roots in the health economy and things like government spending, as the health industry in India relies mainly on the private sector rather than the public sector funded by the government. The rise of illness and disease in India over time is coupled with increasing healthcare costs and the lack of resources, contributing to an overall weak healthcare infrastructure. This article discusses the healthcare economy, accessibility, and awareness.
The Healthcare Economy
India has a healthcare industry of around $41 billion, which is expanding because of declining infant mortality, longer life expectancy, increasing population, and other factors. The public health expenditure in India is also expected to increase to 2.5% by 2025, with 30% of it from the public sector. The part of the health expenditure in India from the public sector is lower than in other major countries across the world, implying that individual consumers in India bear the cost of their healthcare.
The Department of Health and Family Welfare’s allocation has increased from $152.096 million to $9732.214 million from 2006-2022 with a 13% compound annual growth rate. The Department is expected to exceed its budget by 21% in 2021, with $1941.417 million used for COVID-19 emergencies and vaccinations. Indian households directly pay for their healthcare (25% of out-of-pocket expenditure (OOPE) goes towards medications - which implies that households have limited financial protection towards healthcare expenditures), as public spending on healthcare mainly concerns the delivery of allopathic medications. Overall, only 14% and 19% of rural and urban areas respectively are covered by health insurance schemes, which pushes nearly 7% of India’s population below the poverty line annually. The diagram below represents different parts of OOPE graphically in a flow chart.
Overall, the healthcare infrastructure of India has not been keeping pace with economic growth and its health, equity, and quality indices are not great. The burden of OOPE must also be reduced by increasing healthcare spending. Government expenditure on healthcare in India is around 2.9%, while it is 18.9% in the United States, 17.3% in Germany, and 15.9% in the United Kingdom. Compared to other nations, the private health expenditure of India exceeds government expenditure, which largely contributes to OOPE. Rather than the public sector, the private sector for a large part of outpatient services, so efforts must be made in India to increase government spending on healthcare in the public sector.
Almost 75% of healthcare expenditure in India comes from the pockets of households as the private sector dominates healthcare expenditure. However, extreme healthcare costs in India greatly contribute to impoverishment, as well as the lack of regulation in the private sector which causes a variation in healthcare service quality and costs. Public sector healthcare, which is more affordable, is seen as unreliable with indifferent quality, so Indian consumers usually turn to private sector services. The healthcare sector needs to be wary of cost by avoiding wasteful expenditure and unnecessary tests. Furthermore, medical students need to be exposed to healthcare economics and learn to understand the economic perspective of the healthcare industry in India so that they can take steps to better it.
Healthcare Awareness
The Indian population has a low awareness about important problems that regard their own health. The awareness seems to be divided across age groups as well. For example, adequate knowledge about breastfeeding was found in only ⅓ of antenatal mothers in two studies. Another study in urban Haryana found that only 11.3% of adolescent girls had enough knowledge of key reproductive issues. These low awareness levels may be due to several factors, including low educational status, inadequate functional literacy, less emphasis on education within the healthcare system, and even the low priority of health in the general population.
Although awareness levels in India about health issues are really low, efforts to raise them have been made and proven effective. One example of this is outlined in a study in Bihar and Jharkhand that showed improvements in awareness and perception levels about abortion after a behavioral change intervention. This showed the effectiveness of interventions on adolescent and reproductive health, which boosted the awareness in girls with regard to knowledge about health issues, environmental health, nutritional health, and reproductive and child health.
Healthcare Accessibility & Quality
According to the Oxford Dictionary, access to healthcare is “the right/opportunity to use or benefit from healthcare.” Access is crucial for somewhat well-conditioned urban and rural populations, and is affected by multiple variables such as availability, supply, and the utilization of healthcare services. Some obstacles limiting healthcare access in India include those of financial, social, cultural, and organizational nature. These can limit the use of services in places where they are available, leading to a lower accessibility rate.
A 2012 study in six Indian states showed that many primary health centers (PHCs) lack basic infrastructural facilities such as beds, wards, toilets, drinking water, clean labor rooms, and even electricity. Even if healthcare is physically available in Indian regions, its quality cannot be guaranteed, limiting healthcare access in those areas. The quality of healthcare in India is spread across a wide spectrum, with hospitals that have globally recognized healthcare quality to those that have unacceptably low quality and lack basic hygienic necessities. Although efforts to improve healthcare quality are feasible, they are limited by the lack of reliable information and data on quality due to the technical difficulties in measuring it. Although India is home to global medical innovators and top-notch surgeons, many Indians, especially the poor and those under the poverty line, receive inhumanely low-quality primary and hospital care. Furthermore, the ongoing rise of chronic diseases in India makes the issue of low-quality healthcare in India even more critical.
In order to resolve the access barriers to healthcare, we must encourage discourse on the topic and identify obstacles to access in financial, geographic, social, and system-related domains. We need to push our medical students to think about the problem of access to good healthcare in order to resolve it. Additionally, to enhance the quality of healthcare in India, “governance issues must be resolved, including public-sector management, institutional capacity building, and data-driven policies.” Governments, health facilities, and researchers in India should all work together to use approaches backed by evidence and things like administrative data and household surveys/self-reports to improve the overall quality of healthcare and hopefully push it to the higher end of the spectrum.
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