An effective healthcare ecosystem is an essential prerequisite for ensuring adequate levels of health and wellness in a country. The Indian healthcare industry has registered double digit growth in the last few years. From 2010 to 2016, the Indian healthcare sector grew at the rate of 16% and is expected to reach USD 280 billion by 2020 (Figure 1).
Increase in disposable incomes, expansion of health insurance coverage, rising burden of lifestyle diseases, increasing life expectancy and a booming medical tourism sector continue to be the key factors driving the growth of the Indian healthcare sector.
Despite growing demand and faster growth, the healthcare sector continues to face a number of challenges, particularly with respect to providing quality and affordable healthcare services to all. While the Metros and the Tier 1 cities have good infrastructural facilities, the rural areas still lack access to sufficient and good quality care.
The CII-Deloitte Report “Medical Technology: Shaping Healthcare for All in India” highlights several of these challenges faced by the Indian healthcare sector.
Number of Hospital beds per 1000 people in 2014: India has 0.7 beds per 1000 people, well below the 3.5 beds per 1000 people recommended by the World Health Organization (WHO), and will need an additional 3.6 million beds to reach the recommended capacity (Figure 2).
Number of Physicians per 1000 people in 2014: A major constraint impeding the future growth potential of the health sector is the lack of service providers, especially in the rural areas. India is at half the global average of 1.5 physicians per 1000 people, with only 0.7 physicians per 1000 people.
Total Health Spending as a Percent of GDP in 2015: Share of healthcare expenditure as a percent of GDP has remained low over the past few years and was at 4.8% in 2015. The share is substantially lower, when compared to other countries of the world such as China and Russia (Figure 3)
Lack of Adequate Manpower and Infrastructure: Health infrastructure in India is highly skewed in favour of the urban areas while the rural areas continue to face acute shortage of health centres as well as specialised doctors. There is a 22% shortage of primary health centres (PHCs) and 32% shortage of community health centres (CHC’s) in rural India. As a result, a majority of the beneficiaries in rural India are forced to travel large distances to access quality care.
Affordability of Healthcare Services: A weak public healthcare system and low insurance coverage drives up the average cost of healthcare to families, especially for those with limited resources. Overall health insurance penetration in the country is low – total number of persons covered under any form of insurance is around 359 million, which is only 27% of the total population in India.
Out of Pocket Expenditure as Percent of Total Health Expenditure in 2014: Compared to the world average of 18.2%, out-of-pocket expenditure in India stands at 62.4% of the total health care expenditure in the country. It is estimated that around 60 million people are pushed below the poverty line every year due to the burden of unplanned health expenditure.
Quality of Healthcare Services: Patient safety and quality of healthcare services are growing concerns in the Indian healthcare sector. India suffers from high rates of infant mortality rate (IMR) – the highest among BRICS nations – maternal mortality rates (MMR), readmission rates, medication errors, morbidity rates, etc. (Figure 4).
The ‘National Quality Assurance Guidelines’ prescribe a minimum set of standards that each state should meet to improve the quality of service delivery in public facilities. However, adoption of these standards have been slow and variable across the country.
Healthcare for all in India and the National Health Policy
The government has acknowledged these challenges and attempted to tackle these challenges with the help of various strategies over the years. In March 2017, the government released the National Health Policy 2017 with the vision of “Healthcare for all in India”.
The National Health Policy of 2017 has refreshed the goals and principles in the context of Universal Health Coverage*. The key principles emphasised in the policy include equity, universality, affordability, care quality, leveraging technology/digital health and focus on preventive and promotive health among others. Of these, technology has an important role to play in addressing some of the issues of accessibility, affordability and quality care. Disruptive technological solutions have the potential to leapfrog over some of the challenges and guide the country towards a more affordable and reliable healthcare system in the foreseeable future.
In the next part, the blog elaborates on the role of Medical Technology in the Indian healthcare system and how it can help the sector achieve the principles of the National Health Policy 2017.
*Government defines Universal Healthcare Coverage as “ensuring equitable access for all Indian citizens, resident in any part of the country, regardless of income level, social status, gender, caste or religion, to affordable, accountable, appropriate health services of assured quality (promotive, preventive, curative and rehabilitative) as well as public health services addressing the wider determinants of health delivered to individuals and populations, with the government being the guarantor and enabler, although not necessarily the only provider, of health and related services.