Some weeks ago, one story that went viral on social media was of a US vlogger, Mackenzie, whose boyfriend, Keenan, fell seriously ill while travelling in India. Having lived in the US and the UK and weary of the long waiting list for tests and appointments, Mackenzie was apprehensive about the time and cost of treatment. She was pleasantly surprised to know that there was absolutely no waiting time for the diagnostic test. The pathology laboratory she contacted sent the nurse home, and the results were out the next day. Keenan completed tests, doctor’s appointment and medicines within 24 hours, and it cost them only $14 (approximately Rs 1,400)! Floored by the time, the cost and efficient treatment, Mackenzie said in a video, “I was completely blown away and now I know how India kept its 1.4 billion people alive.”
While these young tourists might have been fortunate for such proactive action, it is true that in the Indian health care system less is more. Modest fees, less turnaround time for lab tests and less waiting time in clinics, are a fact of life even in satellite towns. India ranks 112 out of 191 countries on the World Health Organization's ranking of global health care systems and there is tremendous potential for this ranking to improve.
In the last five years the Indian health care sector has been streamlined for the better and experienced rapid expansion. There have been several innovations and policy introductions to support this. To name a few, the setting up of the National Health Mission has improved the availability of medical equipment and devices. The availability of affordable generic medicines, affordable access through Ayushman Bharat to 55 crore Indians: almost 40 per cent of the population in the lower economic segment, providing coverage of upto Rs 5 lakh per family per year for secondary and tertiary care hospitalisations are some of the other significant measures.
Recently, the government announced its decision to extend health insurance to all Indian citizens above the age of 70, raising the bar on health care equity.
Digitalization of health care is another major step where telehealth has transformed health care delivery making it accessible to people who are challenged by traffic, self-mobility and remote locations.
All these services have helped India leapfrog into being a leader in health care. With the expertise of doctors and state of medical facilities offered by top hospitals, India has also emerged as a leading medical tourism destination bringing in the all-important revenue to make health care a growth driving sector.
With government efforts to increase the number of medical and nursing colleges and available seats, the number of doctors and nurses have also significantly gone up. According to National Medical Council (NMC) there are 13 lakh+ allopathic doctors, 36.14 lakh nurses and 5.65 lakh Ayush doctors. Given our population size, these numbers are not enough to provide a decent doctor: patient and nurse: patient balance, however with continued efforts by the public and private sector this gap is likely to shorten significantly over the next decade.
In the next five years, beginning with 2024, there is little doubt that health care in India is going to be one of the fastest growing sectors, poised for exponential growth and progress. There are many reasons for this.
Statistical data shows that the average life expectancy at birth in India has increased by approximately three years in the last decade. The Indian government spent two per cent of India's gross domestic product (GDP) on health care in financial year 2022 and is forecast to reach over 2.5 per cent of the GDP by 2025. We are hoping that this would be increased to five per cent of the GDP over the next five years.
In the financial year 2022, the government of India allocated approximately Rs 860 billion to the Ministry of Health and Family Welfare in the Union Budget.
The health tech sector in India secured private equity and venture capital investments worth nearly 1,740 million US dollars in 2021. India's health care sector was worth about $280 billion in 2020, and it was estimated to reach up to $372 billion by 2022. The country's health care market had become one of the largest sectors in terms of revenue and employment, and the industry was growing rapidly.
From 2022, the health care funding by the Central and state governments increased substantially to $74 billion from $34 billion in 2021. Since 2020, it is mandatory for private sector employees who are not affiliated to the employees’ state insurance to receive a government regulated (through the Insurance Regulatory and Development Authority health insurance regulator) health insurance plan through their employer while employees of the public sector receive it through the Central Government Health Plan.
India’s burgeoning start-up sector and health-tech innovation is also revolutionising the way health care is accessed by the mass population, all aimed at making care accessible and affordable. This also has the potential to plug some of the key challenges that the sector is facing. With the right talent and health tech interventions, India is creating the right intersection to generate the needed impact and progress. India has everything that is needed to emerge victorious in the health care space.
Having said that, one cannot ignore the shortfalls and deficiencies. If India wants to be a leader in health care and fulfill the promise of health care equity as enshrined in United Nations Sustainable Development Goals of leaving no one behind by dispensing social justice, it needs to bridge many gaps.
The public health care infrastructure is poor and tilted heavily in favor of cities, while primary and tertiary care in rural areas remains largely neglected. While public health care cost is lower for every Indian resident this sector encompasses only 18 per cent of total outpatient care and 44 per cent of total inpatient care. This is where strong public-private partnerships can help.
The private sector can be encouraged to build hospitals and clinics in rural areas and follow the template of a hub and spoke model. This would mean designated one hospital in a satellite city among a cluster of small towns as the main hub with each cluster having a large nursing home/clinic. The centralised administration from such a regional hospital can help run the clinics and link them up via digital and telemedicine to form a cohesive model. People from these rural areas may not require migrating to cities for health care but travel to the main regional hub.
The second most crucial and dire situation is the shortage of doctors, nurses and allied healthcare professionals. India is one of the 57 nations with a clear shortage of health resource shortage. The WHO recommends 44.5 doctors, nurses, midwives per 10,000 inhabitants, whereas the national density in India was found to be 20.6 per 10,000 inhabitants.
The private sector can play a proactive two-pronged role in carrying out a recruitment drive from the large pool of high school or higher secondary pass men and women, empowering them with skills in subjects such as emergency, first aid, CPR, midwifery, wet nursing and the like. Tapping into the large population and upskilling them will not only resolve employment issues but help bridge the shortage of healthcare staff. Introducing stringent training will also help improve clinical governance standards, which, at present, are not streamlined.
Strategy for tackling with serious health care challenges
India is currently grappling with a high incidence of communicable and non-communicable disease. The communicable such as HIV, Tuberculosis spread owing to population density and a lack of adequate awareness drive on hygiene and sanitation. The non communicable diseases such as obesity, diabetes, heart disease, hypertension and cancer are on the rise owing to more dispensable incomes, wrong eating habits, lack of proper fitness routines and use of oral tobacco and smoking.
Prevention is the best medicine
Preventive health care is not really practiced as people visit doctors only when sick. The concept of health checkups monthly or quarterly is almost not present in the community. Health care needs to be made more accessible by investing in mobile clinics, initiating public awareness campaigns on diseases such a breast, cervical and lung cancer, preventive screenings for these, plus stronger immunization drive against communicable diseases to provide a level of herd immunity to the community.
The government also needs to encourage the use of telemedicine for mental health awareness and to increase its reach for monitoring the health of people in villages. India has a large pool of alternative medicine practices such as ayurveda, unani, naturopathy, siddha and homeopathy where people are less apprehensive of taking treatment. Insurance companies can provide coverage to the recognised stream of medicines, and this can encourage some form of preventive screening.
Apart from this, there is a need to launch awareness and educational campaign in all communities to transcend cultural, language, gender barriers and social biases and undertake preventive measures.
The hospital sector in India was valued at Rs 7,940.87 billion in FY21 in terms of revenue and is expected to reach Rs 18,348.78 billion by FY 2027, growing at a CAGR of 18.24 per cent. Over the next 10 years, National Digital Health Blueprint can unlock the incremental economic value of over $200 Bn for the health care industry in India.
These and many more gaps in the health care system pose a tough challenge but there is nothing that cannot be overcome with a multifaceted strategy comprising policy interventions, greater investments, and thorough reforms.
The story of India’s health care sector is a progressive one, one that has tremendous potential to set benchmarks for the world to follow. It is only through collaboration and collective efforts that we would be able to maintain the momentum for health care to be the fastest growing economic sector in India.