Public health and hospitals is the subject matter of the State as per the Constitution of India. The primary responsibility to address healthcare challenges is that of the State Governments. But more or less it is now dominated by the private sector which is both good and bad for the masses. The private sector participation helps to increase the supply of the healthcare facilities at a faster rate but it is becoming unaffordable for the masses. The healthcare sector in India is growing at a faster pace due to the burgeoning population plagued with different kind of diseases and lack of healthcare infrastructure in the public sector domain. The need of the hour is to develop public sector healthcare infrastructure for one and all, regardless of the socioeconomic status of the citizens. Off late the government have not done enough to build the confidence in the masses that they would be taken care if fallen ill by serious ailments. Sandeep Sharma takes a look at the healthcare sector in India.
Healthcare in India has become a money minting proposition for many. Ethical issues are being debated across the length and breadth of the country. The nexus between the Pharma companies and the medical practitioners have lead to the loss of trust between the medical fraternity and the patients. The healthcare sector network is not good enough considering the ever increasing population. Lots need to be done to carry out the improvement in the existing healthcare services available as well as towards installation of the modern and efficient ones. The challenges lies in the constant rise in population vis-a-vis the supply of healthcare services, high prices of medicines not affordable by the poor, ambiguous policies and increase in dependence on the private sector players for whom healthcare is a business and not some social service. The patients-to doctor ratio in a largely populated country like India is one of the lowest in the world considering the rural areas.
Post independence, the country started with developing public sector healthcare infrastructure but switched to a decentralized healthcare system soon. The healthcare market composition in India comprises Government and Private hospitals, pharmaceuticals, diagnostics (imaging and pathology), medical equipment and supplies, medical insurance and telemedicine. The healthcare sector is dominated by the presence of Smaller hospitals and nursing homes. The challenge for the government is to transform the healthcare delivery network and ensure parity among small, mid, and large service providers in the industry.
According to investindia.gov.in, India is expected to rank amongst the top 3 healthcare markets in terms of incremental growth by 2020 and by the same time, the healthcare information technology market is expected to grow 1.5 times from current $1 bn. The diagnostics market is expected to grow at a CAGR of 20.4% to reach $ 32 bn in 2022 from $ 5 bn in 2012. The in-patient market is expected to grow at a CAGR of 13% by 2015-20.
J P Nadda, Union Minister of Health and Family Welfare has said couple of months back that India has made substantial progress on several indicators in the recent years and stated that our national health indicators like Infant Mortality Rate (IMR), Maternal Maternity Rate (MMR) and Total Fertility Rate (TFR) are declining faster a than the world pace. He added that India has shown impressive gains with 22% reduction in Maternal Mortality since 2013. “We must also appreciate that Uttar Pradesh with 30% decline has topped the chart in the reduction of Maternal Deaths,” he said.
The objective of the Government is to provide accessible, affordable and accountable quality healthcare facilities to all sections of society. The Government has to ensure that healthcare services are especially made available to the poorest section of the country without any cost. Due to government initiatives, the availability of Primary Health Centres, human resources, number of medical colleges and medical seats, have been increasing every year. The steps are taken for strengthening and upgrading district hospitals and making available tertiary health care services in the public sector. The Government has implemented programmes towards strengthening of the hospitals, establishment of AIIMS institutions in various States and up-gradation of existing Government medical colleges across the country. Transforming the healthcare system with optimization of resources is a huge challenge for the government. The Government of India has from time to time launched number of healthcare programs such as National Health Mission (NHM) comprising sub-components namely National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM).
NATIONAL HEALTH MISSION (NHM)
The National Health Mission (NHM) aims for attainment of universal access to equitable, affordable and quality health care services, accountable and responsive to people’s needs, with effective inter-sectoral convergent action to address the wider social determinants of health.
The objectives of NHM are summarised as under:
●Reduction in child and maternal mortality
●Prevention and control of communicable and non-communicable diseases, including locally endemic diseases.
●Access to integrated comprehensive primary health care.
●Population stabilisation, gender and demographic balance.
●Revitalize local health traditions & mainstream AYUSH.
●Universal access to public services for food and nutrition, sanitation and hygiene and universal access to public health care services with emphasis on services addressing women’s and children’s health and universal immunisation.
●Promotion of healthy lifestyles.
National Rural Health Mission (NRHM) is now overarching National Health Mission (NHM), along with National Urban Health Mission (NUHM) as the other sub-Mission. It is implemented in all States /UTs in the country. NHM is a flagship Programme of the Ministry of Health & Family Welfare that continues to support the State Governments in strengthening their health systems.
Physical Progress under NUHM (FY2017-18)
●1067 cities/towns covered under NUHM for implementation
●25504 total staff in position against 35732 approved i.e. 124504 Clinical & Paramedical and 1000 Pragram management staff
●4048 Urban Primary Health Centres (U-PHCs) made operational against 4325 approved
●58810 ASHA engaged against 68922 approved
●67262 MAS formed against 110599 approved
NATIONAL HEALTH POLICY 2017
The Government has formulated the National Health Policy 2017 which has laid emphasis on the role of the Government in regulation, governance, and quality assurance, healthcare infrastructure and in leveraging information technology. The policy also envisages raising public health expenditure to 2.5% of the GDP in a time bound manner. This Policy looks at problems and solutions holistically with private sector as strategic partners. It seeks to promote quality of care; focus is on emerging diseases and investment in promotive and preventive healthcare. The policy is patient centric and quality driven. It addresses health security and make in India for drugs and devices. The main objective of the National Health Policy 2017 is to achieve the highest possible level of good health and well-being, through a preventive and promotive health care orientation in all developmental policies, and to achieve universal access to good quality health care services without anyone having to face financial hardship as a consequence. In order to provide access and financial protection at secondary and tertiary care levels, the policy proposes free drugs, free diagnostics and free emergency care services in all public hospitals.
AYUSHMAN BHARAT – PRADHAN MANTRI JAN AAROGYA YOJANA (AB-PMJAY)
With the aim to provide accessible and affordable healthcare to the common man, the Government of India has launched Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) on 23rd September, 2018. Under the vision of Ayushman Bharat, Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) shall be implemented so that each and every citizen receives his due share of health care. It’s the world’s largest government funded healthcare program which targets more than 50 crore beneficiaries.
J P Nadda, Union Minister of Health and Family Welfare has earlier said that Ayushman Bharat will provide comprehensive healthcare to the people as 1,50,000 sub-centres will be converted into Health and Wellness Centres (HWCs). “The H&WC would provide preventive, promotive, and curative care for non-communicable diseases, dental, mental, geriatric care, palliative care, etc.” He further stated that the Government has initiated universal screening of common NCDs such as diabetes, hypertension and common cancers along with Tuberculosis and Leprosy, which will eventually help in reducing the disease burden of the country. This will again change the Health Profile of the people in future.
FDI IN HEALTHCARE
100% FDI is allowed under the automatic route for Greenfield projects. For investments in Brownfield projects, up to 100% FDI is permitted under the government route.
The healthcare industry in India is moving in the fast lane mainly due to the rising demand and increased spending by the private sector. The Government is laying emphasis on strengthening public healthcare infrastructure across the country. According to Invest India, the hospital industry in India, accounting for 80% of the total healthcare market, is attracting both global as well as domestic investors. The hospital industry is expected to reach US$ 132 bn by 2023 from US$ 61.8 bn in 2017; growing at a CAGR of 16-17%. The medical tourism industry in India is expected to double its value to become a US$ 6 bn industry by 2018 from US$ 3 bn in 2017. The Medical tourist arrivals in India have increased by over 50% to 200,000 in 2016 from 130,000 in 2015. The diagnostics industry in India is currently valued at US$ 4 bn. The share of organized sector is almost 25% in this segment (15% in labs and 10% in radiology). The primary care industry is currently valued at US$ 13 bn. The share of organized sector is practically negligible in this case. Overall the Healthcare industry in India is projected to reach US$ 372 bn by 2022.