Healthcare in India: Difference between revisions

{{Use Indian English|date=November 2015}}

{{Use dmy dates|date=April 2022}}

[[File:JIPMER admin block.jpg|thumb|[[Jawaharlal Institute of Postgraduate Medical Education and Research]] at [[Puducherry (union territory)|Puducherry]]]]

 

 

== National Health Policy ==

In practice however, the private healthcare sector is responsible for the majority of healthcare in India, and a lot of healthcare expenses are paid directly out of pocket by patients and their families, rather than through health insurance due to incomplete coverage.<ref>{{cite journal |last=Berman |first=Peter |date=2010 |title=The Impoverishing Effect of Healthcare Payments in India: New Methodology and Findings |journal=Economic and Political Weekly |volume=45 |issue=16 |pages=65–71 |jstor=25664359}}</ref>

 

 

 

=== 2018 ===

 

=== 2019 ===

In 2019, the total net government spending on healthcare was $36 billion or 1.23% of its GDP.<ref>₹2.6 trillion</ref> India had allocated 1.8% of its GDP to health in 2020–21.

 

=== Human Rights Measurement Initiative ===

 

==History==

{{See also|Ayurveda|Siddha medicine}}

 

== Healthcare system ==

=== Public healthcare ===

{{Further|Public health system in India}}

 

Different factors related to public healthcare are divided between the state and national government systems in terms of making decisions, as the national government addresses broadly applicable healthcare issues such as overall family welfare and prevention of major diseases, while the state governments handle aspects such as local hospitals, public health, promotion and sanitation, which differ from state to state based on the particular communities involved.<ref name="Chokshi-2016" /> Interaction between the state and national governments does occur for healthcare issues that require larger scale resources or present a concern to the country as a whole.<ref name="Chokshi-2016" />

Considering the goal of obtaining [[universal health care]] as part of [[Sustainable Development Goals#Goal 3: Good health and well-being|Sustainable Development Goals]], scholars request policy makers to acknowledge the form of healthcare that many are using. Scholars state that the government has a responsibility to provide health services that are affordable, adequate, new and acceptable for its citizens.<ref name="Dey-2014" /> Public healthcare is very necessary, especially when considering the costs incurred with private services. Many citizens rely on [[Subsidised healthcare|subsidized healthcare]].<ref name="Dey-2014" /> The national budget, scholars argue, must allocate money to the public healthcare system to ensure the poor are not left with the stress of meeting private sector payments.<ref name="Dey-2014" />

 

 

===Private healthcare===

Since 2005, most of the healthcare capacity added has been in the private sector, or in partnership with the private sector. The private sector consists of 58% of the hospitals in the country, 29% of beds in hospitals, and 81% of doctors.<ref name="Thayyil-2013" />

[[File:Max Building.jpg|alt=|thumb|[[Max Healthcare]] in [[Delhi]], [[India]]|252x252px]]

 

 

=== Financing ===

 

Despite being one of the most populous countries, India has the most private healthcare in the world.<ref name="Duggal-2007">{{cite journal |last1=Duggal |first1=Ravi |title=Healthcare in India: Changing the Financing Strategy |journal=Social Policy & Administration |date=August 2007 |volume=41 |issue=4 |pages=386–394 |doi=10.1111/j.1467-9515.2007.00560.x }}</ref> Out-of-pocket private payments make up 48% of the total expenditure on healthcare in 2018 while government and health insurance funds accounted for 62%.<ref name="Bhardwaj-2014">{{cite journal|last1=Bhardwaj|first1=Geeta|last2=Monga|first2=Anuradha|last3=Shende|first3=Ketan|last4=Kasat|first4=Sachin|last5=Rawat|first5=Sachin|date=1 April 2014|title=Healthcare at the Bottom of the Pyramid An Assessment of Mass Health Insurance Schemes in India|journal=Journal of the Insurance Institute of India|volume=1|issue=4|pages=10–22}}</ref> This is in stark contrast to most other countries of the world.<ref name="Bhardwaj-2014" /><ref name="moneycontrol.com" /> According to the [[World Health Organization]] in 2007, India ranked 184 out of 191 countries in the amount of public expenditure spent on healthcare out of total [[Gross domestic product|GDP]].<ref name="Bhardwaj-2014" /> In fact, public spending stagnated from 0.9% to 1.2% of total GDP in 1990 to 2010 and further increased to 3.2% of GDP in 2018.<ref name="Bhardwaj-2014" /><ref name="moneycontrol.com" />

In terms of non-medical costs, distance can also prevents access to healthcare.<ref name="Balarajan-2011"/> Costs of transportation prevent people from going to health centers.<ref name="Dutta-2015"/> According to scholars, [[Outreach|outreach programs]] are necessary to reach marginalized and isolated groups.<ref name="Balarajan-2011"/>

 

 

There was a major gap between outreach, finance and access in India. However, with a growing economy, the state developed an enhanced fiscal capacity to cover most citizens and residents of the country with basic health insurance cover.<ref name="moneycontrol.com"/>

In 1970, the Indian government banned medical patents. India signed the 1995 [[TRIPS Agreement]] which allows medical patents, but establishes the [[compulsory license]], where any pharmaceutical company has the right to produce any patented product by paying a fee. This right was used in 2012, when Natco was allowed to produce Nexavar, a cancer drug. In 2005, new legislation stipulated that a medicine could not be patented if it did not result in "the enhancement of the known efficacy of that substance".

 

 

=== Mental healthcare ===

 

==Access to healthcare==

[[File:Kerala Institute of Medical Sciences Thiruvananthapuram.jpg|alt=|thumb|Institute of Medical Sciences in Thiruvananthapuram, [[Kerala]].]]

 

===Electronic health records===

 

 

 

=== Rural areas ===

Rural areas in India have a shortage of medical professionals.<ref name="Thayyil-2013" /> 74% of doctors are in urban areas that serve the other 28% of the population, leaving many with unmet medical needs.<ref name="Thayyil-2013"/> This is a major issue for rural access to healthcare. The lack of human resources causes citizens to resort to fraudulent or ignorant providers.<ref name="Thayyil-2013"/> Doctors tend not to work in rural areas due to insufficient housing, healthcare, education for children, drinking water, electricity, roads and transportation.<ref name="De Costa-2009"/> Additionally, there exists a shortage of [[infrastructure]] for health services in rural areas.<ref name="Thayyil-2013"/> In fact, urban public hospitals have twice as many beds as rural hospitals, which are lacking in supplies.<ref name="Balarajan-2011"/> Studies have indicated that the mortality risks before the age of five are greater for children living in certain rural areas compared to urban communities.<ref name="BARU-2010">{{cite journal|last1=BARU|first1=RAMA|last2=ACHARYA|first2=ARNAB|last3=ACHARYA|first3=SANGHMITRA|last4=KUMAR|first4=A K SHIVA|last5=NAGARAJ|first5=K|date=2010|title=Inequities in Access to Health Services in India: Caste, Class and Region|jstor=25742094|journal=Economic and Political Weekly|volume=45|issue=38|pages=49–58}}</ref> Due to these geographic barriers, limited healthcare infrastructure, and a shortage of healthcare professions, rural areas face unique challenges. Scholars believe that if healthcare providers are able to understand these cultural nuances, they may be able to provide culturally-sensitive services specifically tailored to the needs and preferences of these communities. Children face a myriad of health risks in relation to the healthcare challenges those in rural areas encounter. Across three different measuring points from 1992 through 2006, more developed states in India had a lower proportion of households with an underweight boy or girl than less developed states, which tend to contain more rural communities.<ref name="Cowling-2014">{{Cite journal |last1=Cowling |first1=Krycia |last2=Dandona |first2=Rakhi |last3=Dandona |first3=Lalit |date=2014-10-08 |title=Social determinants of health in India: progress and inequities across states |journal=International Journal for Equity in Health |volume=13 |issue=1 |pages=88 |doi=10.1186/s12939-014-0088-0 |issn=1475-9276 |pmc=4201685 |pmid=25294304 |doi-access=free }}</ref> Full [[immunization]] coverage also varies between rural and urban India, with 39% completely immunized in rural communities and 58% in urban areas across India.<ref name="BARU-2010" /> Vaccine illiteracy remains a significant obstacle in the path towards greater immunization coverage, often due to misinformation, unreliable healthcare, a lack of awareness among parents, and other social factors. Inequalities in healthcare can result from factors such as socioeconomic status and [[caste]], with caste serving as a social determinant of healthcare in India.<ref name="BARU-2010" /> One study showed more health disparities arise when comparing urban versus rural homes rather than between castes; using three rounds of the National Family Health Surveys, researchers calculated the Multidimensional Poverty Index, which is aimed at further elucidating the indicators and social determinants of health. Between urban and rural households, the headcount ratio difference was found to be 20-30% in 2005–2006, while between scheduled castes/scheduled tribes and other households the difference was only 10-15%.<ref name="Cowling-2014"/> Other critical social determinants of health in India include sanitation/hygiene, environmental pollution, nutrition, and more.<ref>{{Cite journal |last1=Braveman |first1=Paula |last2=Gottlieb |first2=Laura |date=January 2014 |title=The Social Determinants of Health: It's Time to Consider the Causes of the Causes |journal=Public Health Reports |language=en |volume=129 |issue=1_suppl2 |pages=19–31 |doi=10.1177/00333549141291S206 |issn=0033-3549 |pmc=3863696 |pmid=24385661}}</ref> Across all states, less than 50% (and in some less than 25%) of urban homes had unimproved sanitation, compared to over 50% (and in some over 75%) of rural homes, according to the 2007-2009 District Level Household Survey.<ref name="Cowling-2014" /> Sanitation and hygiene are directly linked to disease and overall rural health outcomes.

 

 

==== Case study in Rural India ====

The distribution of healthcare providers varies for rural versus urban areas in North India.<ref name="De Costa-2007">{{cite journal|last1=De Costa|first1=Ayesha|last2=Diwan|first2=Vinod|title=Where is the public health sector?|journal=Health Policy|volume=84|issue=2–3|pages=269–276|doi=10.1016/j.healthpol.2007.04.004|pmid=17540472|year=2007}}</ref> A 2007 study by Ayesha De Costa and Vinod Diwan, published in ''[[Health Policy (journal)|Health Policy]],'' conducted in [[Madhya Pradesh]], India examined the distribution of different types of healthcare providers across urban and rural Madhya Pradesh in terms of the differences in access to healthcare through number of providers present.<ref name="De Costa-2007" /> The results indicated that in rural Madhya Pradesh, there was one physician per 7870 people, while there was one physician per 834 people in the urban areas of the region.<ref name="De Costa-2007" /> In terms of other healthcare providers, the study found that of the qualified paramedical staff present in Madhya Pradesh, 71% performed work in the rural areas of the region.<ref name="De Costa-2007" /> In addition, 90% of traditional birth attendants and unqualified healthcare providers in Madhya Pradesh worked in the rural communities.<ref name="De Costa-2007" />

 

 

Other previous studies have also delved into the influence of gender in terms of access to healthcare in rural areas, finding gender inequalities in access to healthcare.<ref name="Pandey-2002" /> A 2002 study with data taken from June 1998 to May 1999 was conducted by Aparna Pandey et al., published in the ''Journal of Health, Population, and Nutrition,'' analyzed care-seeking behaviors by families for girls versus boys, given similar sociodemographic characteristics in [[West Bengal]], India.<ref name="Pandey-2002" /> In general, the results exhibited clear gender differences such that boys received treatment from a healthcare facility if needed in 33% of the cases, while girls received treatment in 22% of the instances requiring care.<ref name="Pandey-2002" /> Furthermore, surveys indicated that the greatest gender inequality in access to healthcare in India occurred in the provinces of [[Haryana]], and [[Punjab, India|Punjab]].<ref name="Pandey-2002" />

 

=== Targeted Populations ===

==== Healthcare for the Unemployed ====

 

==== Healthcare for the Employed ====

 

 

 

Employers are responsible for paying for an extensive package of services for private sector expatriates (through one of the public or private funds) unless they are eligible for the [[Employees' State Insurance]] or the [[Employees' Provident Fund Organisation]], which most foreign workers are.

 

===== Employees' State Insurance =====

 

===== Employees' Provident Fund Organisation =====

 

===== Additional Health Insurance by Employers =====

 

People also receive additional complementary health insurance coverage by their employers through either one of the four main public health insurance funds which are the:

* [[National Insurance Company]]

* [[New India Assurance]] or a private insurance provider.

 

 

==== National Rural Health Mission ====

 

==== National Urban Health Mission ====

 

==== Pradhan Mantri Jan Arogya Yojana (PM-JAY) ====

 

PM-JAY provides insurance cover up to Rs 5 lakh per annum to the 100 million families in India for secondary and tertiary hospitalization. For transparency, the government made an online portal (Mera PmJay) to check eligibility for PMJAY.

 

'''National Policy of Older Persons of 1999'''

In the most successful PPP ventures, the World Health Organization found that the most prominent factor, aside from financial support, was ownership of the project by state and local governments.<ref name="Bhat-2007" /> It was found that programs sponsored by the state governments were more effective in achieving health goals than programs set by national governments.<ref name="Bhat-2007" />

 

 

== Quality of healthcare ==

[[File:Hospital .jpg|alt=|thumb|A community medical provider in Kerala which promotes traditional Indian medicine, or Ayurveda.]]

Non-availability of diagnostic tools and increasing reluctance of qualified and experienced healthcare professionals to practice in rural, under-equipped and financially less lucrative rural areas are becoming big challenges.

 

 

=== South India ===

In general, the perceived quality of healthcare also has implications on patient adherence to treatment.<ref name="Mekoth-2015">{{cite journal |last1=Mekoth |first1=Nandakumar |last2=Dalvi |first2=Vidya |title=Does Quality of Healthcare Service Determine Patient Adherence? Evidence from the Primary Healthcare Sector in India |journal=Hospital Topics |date=3 July 2015 |volume=93 |issue=3 |pages=60–68 |doi=10.1080/00185868.2015.1108141 |pmid=26652042 |s2cid=44984389 }}</ref><ref name="Sharma-2011" /> A 2015 study conducted by Nandakumar Mekoth and Vidya Dalvi, published in ''Hospital Topics'' examined different aspects that contribute to a patient's perception of quality of healthcare in [[Karnataka]], India, and how these factors influenced adherence to treatment.<ref name="Mekoth-2015" /> The study incorporated aspects related to quality of healthcare including interactive quality of physicians, base-level expectation about primary health care facilities in the area, and non-medical physical facilities (including drinking water and restroom facilities).<ref name="Mekoth-2015" /> In terms of adherence to treatment, two sub-factors were investigated, persistence of treatment and treatment-supporting adherence (changes in health behaviors that supplement the overall treatment plan).<ref name="Mekoth-2015" /> The findings indicated that the different quality of healthcare factors surveyed all had a direct influence on both sub-factors of adherence to treatment.<ref name="Mekoth-2015" /> Furthermore, the base-level expectation component in quality of healthcare perception, presented the most significant influence on overall adherence to treatment, with the interactive quality of physicians having the least influence on adherence to treatment, of three aspects investigated in this study.<ref name="Mekoth-2015" />

 

 

=== North India ===

According to Health and health systems ranking of countries worldwide in 2021, by health index score India was ranked 111 out of 167 countries.

 

 

==See also==

* [[Women's health in India]]

* [[Health insurance in India]]

 

==References==

{{Health care}}

{{World topic|Healthcare in|title=Health care by country|noredlinks=yes|state=show}}

{{Social issues in India}}

{{Health in India}}