India’s Healthcare
By Shivaji Sarkar
A dignitary in Delhi on his indisposition rushes to a government hospital, AIIMS or RML. In West Bengal, Chief Minister Mamata Banerjee, after her accident at Nandigram, instead of moving to any local government or private facility rushes to Kolkata’s famous and most credible SSKM or formerly Presidency Hospital. And there would be innumerable such cases.
It’s an irony. India’s healthcare sector is emerging as one of the largest, both in terms of revenue and employment but exceptions apart most brands are not reliable for a multiple factors. COVID-19, illusory or real, has exposed the healthcare chinks. Ultimately, the government health facilities took up the challenge but during the panic peak barred treatment for all other diseases.
In some cases, the private sector came up to treating supposed COVID-19 patients. Again the credibility in terms of care and cost dipped low. There were complaints of extraneous ways as dead bodies were not given to the families. The billing system is extortive and inhumane.
Despite rise in private facilities their credibility has neither risen nor do they enjoy the esteem that a government doctor commands. So was it for this reason that Mamata Banerjee preferred to be driven almost 300 km away to Kolkata? It’s a tell-tale incident of how the healthcare industry is developing across the country and lacks trust. It is just contrary to some of the charitable or missionary hospitals that were known for their services and dedication in pre-liberalisation era.
A dignitary does not trust a system that often a common man is forced to use. It is an issue of concern for the ethics, services, expertise and treatment by a nascent private sector.
New developments in the healthcare market cater to rise in lifestyle diseases, ageing population, demand for affordable healthcare services, health monitoring through diet, nutrition, and wellness testing as well as technology penetration and government incentives. Rising income levels contribute to market growth though not the credibility.
The low trust level is reflected in a survey of 2 lakh persons by GoQII fitness device survey, India Fit 2018. It says 92.3 per cent of citizens do not trust the healthcare system in India, which includes doctors, hospitals, pharma, insurance companies and diagnostic labs.
The survey says that 74 per cent people do not trust hospitals, 62.8 per cent have no faith in pharma and insurance companies, 52.6 per cent in medical clinics, 50.6 per cent in doctors and 46.1 per cent in diagnostic labs. The major reasons cited are series of failures, negligence and lack of transparency. Banerjee’s unsaid concerns possibly are summed up.
It is serious not only for the health of the people but also for booming investment destination that is allowed 100 per cent FDI. According to Dezan Shira & Associates, a firm assisting foreign investors, the hospital industry accounts for 80 per cent of the total healthcare market in India and in the last five years has seen huge investor demand. By 2022, the sector is likely to reach $ 132.4 billion from $ 61.8 billion in 2017 and has combined annual growth (CAGR) or 16 to 17 per cent. The medical tourism market is rising and there are proposals to increase public health spending. The good news is not so good because it is either for hi-end people or for fun that pass on as medical tourism.
So once again despite need for medical facilities for the common man, the burden is thrust on the government. The 2021-22 Central budget is stated to have given an ‘exponential’ boost. But is that really so?
Data from the last National Sample Survey (NSS) on health conducted in 2017-18 show that the public health system caters to the needs of less than a third of the population. The rest depend on private medical care (including small informal medical care-givers). That unravels the realities for trust deficiency though the government systems, even by users of private facilities, are considered more trustworthy.
But the public investment is woefully inadequate. In 2020-21, the Budget allocated Rs 69,000 crore for health sector, including Rs 6400 crore for PM Jan Aushadhi (PMJAY). Another Rs 35,600 crore is given for nutrition-based programmes making the total to Rs 94,452 crore.
It is shown as rising 137 per cent to Rs 2.23 lakh crore in 2021-22 Union budget. The parliamentary standing committee headed by Ram Gopal Yadav (Samajwadi Party) notes that it is just 32 per cent of the actual funds and not 137 per cent increase as the Union Finance Minister Sitharaman projected. The fund, committee notes, includes the budget for ministry of health and family welfare, AYUSH, departments of research, drinking water, package for vaccination, nutrition and Finance Commission grants for water and sanitation.
It notes that the pandemic exposes the inadequacy of the healthcare infrastructure. It called for an increase in health expenses to 2.5 per cent of GDP in the next two years and 5 per cent by 2025. It points out that Indian expenses are poorest in comparison to the Sweden, Japan, Germany, Norway and the US. It does not delve into the quality or credibility.
The UN Foundation in an October 23, 2020 report mentions that private hospitals do not treat the people below poverty line though it is mandatory as they get many concessions including land at especially low rates. Another Scroll report mentions how on June 13, 2020, a Delhi private hospital gave Rs 16.94 lakh bill for COVID-19 treatment with a flat Rs 2.9 lakh charged for PPE (personal protective equipment).
Nothing is hunky dory with the healthcare. The Economic Survey 2020-21 says, “India was ranked 145th out of 180 countries (Global Burden of Disease Study 2016) on the quality and access of healthcare. Only few sub-Saharan countries, some Pacific islands, Nepal and Pakistan were ranked below India”.
Window dressing of government allocations to project 137 per cent increase to atrocious private services takes the people nowhere. The NDA government is supposed to be more rationale than others. It should look into its full gamut to implement the recommendation of the parliamentary panel and build a universal humane and credible healthcare. The funds are necessary but if approach is convoluted not much should be expected and not just a dignitary but everyone would have to travel hundreds of miles to get the minimum. — INFA