Monday, 28 December 2015

Health Care Burden in India-Neck breaking

Health Care is a difficult proposition in India. The agony of having to visit a hospital not withstanding, the ridiculous costs which ensue once securely on hospital bed is a bewildering experience.
The structure of health care sector consists of independent, privately-run hospital and health care centers.Private health care centers accounts for the major share. Nearly 63% of the total spend is accounted by the private health care sector.
Foreigners visiting india as medical tourists may be fine because for them it is still cheaper services but for the Indian middle and lower class it is simply not affordable.
Population ageing is increasing rapidly in India which means more and more rush at the hospital gates. India a country with a large population has a large number of people now aged 60 years or more. The 60+ age group has increased three times in the last 50 years and continues to do so.
Census 2001 concluded that older people were 7.7% of the total population, which increased to 8.14% in census 2011. In sheer numbers the population over 60 years in  2021 shall be 133.32 million. The increases in the elderly population are the result of changing fertility and mortality regimes over the last 40-50 years. Not only old age but lifestyle-related chronic diseases resulting from urbanization, sedentary lifestyles, changing diets, rising obesity levels, and widespread availability of tobacco products all are adding upto the rush.

There is a dual burden of disease to tackle. Urban India is witnessing a surge to the top in terms of incidence of Lifestyle related diseases such as cardiovascular diseases, diabetes, cancer, COPD etc and the Urban Poor and Rural India are struggling with Communicable Diseases such as tuberculosis, typhoid, dysentery etc. Rural India is also seeing a higher occurrence of Non-Communicable Life-style related diseases. Lack of Infrastructure and Manpower especially in rural areas adds to the chaos.
The pressure of sheer numbers is showing on the hospitals too. India is just not equipped enough to manage patient influx both in the government and private hospitals. The shortage of qualified medical professionals is another burning issue.
India’s ratio of 0.7 doctors and 1.5 nurses per 1,000 people is significantly lower than the WHO average of 2.5 doctors and 3.5 nurses per 1,000 people. Paramedical staff is also short on supply. Basically trained medical HR base falls far short of the requirement.
In case you want to get your patient admitted in a PGIMER or an AIMS the waiting is huge and you have to be a string puller to get accommodation. It is half the battle won. Even the influential people need to be in queue as their number is also staggering.
Roughly 8% of older Indians are confined to their home or bed. The proportion of such immobile or home bound people rose with age to 27% after the age of 80 years. However, very little effort has been made to develop a model of health and social care to take care of the patients. Lack of vision and responsibility has created a void. 
Institutions such as Helpage India are dots in the ocean trying to provide nursing and medical care by reaching the sick both in urban and rural areas on mobile units which in itself is challenging.
On-site services offer doctor consultation, diagnosis and detection/testing,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         medicines and home visits. Even specialist doctors are available. Team includes doctor, pharmacist, paramedic and patient facilitator, co ordinated by a qualified social worker.

Costs - Elderly patients who are unwell consume 13% of the family income annually on health including medicines. 65 years and above consume 21%. Even as India boasts of being the largest manufacturer of generic prescriptive drugs, still the healthcare expenses work out heavy.
The rate of increase of cost of healthcare has been a steady double the pace of growth or inflation in general. Increased house hold out of pocket expenditure on health has become the 2nd major cause of indebtedness in rural population, next to agriculture.

 Total health care spending is projected to rise at an annual rate of over 12 percent, from an estimated $96.3 billion in 2013 to $195.7 billion in 2018.
The average hospitalization cost in India is INR 24500 in urban and 15000 in Rural areas calculated for the year 2014.
Non-communicable diseases (NCDs) amongst old people are the main culprit causing disability and a pocket drain. Cancer treatment, joint replacements, heart surgery, neurosurgical procedures, dental implants, kidney dialyses or transplants are some of the richer man’s game only.
Highest hospitalization expenses incurred are in places such as Delhi INR 34750 with 45% people using public and 55% private hospitals. Assam tops the list with hospitalization expenses at INR 47050 with 51.5% using public and 48.5% private hospitals. States such as UP,Haryana,Madhya Pradeh and Karnataka are just little behind Delhi figures.
The high costs of healthcare also acts as a deterrent for poor people to visit medical centres with alacrity with such delays leading to further complicating the health of people. In urban India even basic
Heart surgeries can cost anywhere between 1.5 lacs to 3.00 lacs and with high medical cost inflation it could double in 5-6 years. India as a topper in heart ailment globally has a huge heart cost to deal with.

However Healthcare still remains low as an expenditure item in India. Expenses are just 4.5% of GDP a figure much lower than USA 15.70% of GDP and UK 8.2% .

The scenario is tailor made for foreign direct investment to flow in which is in fact picking up rapidly. In healthcare FDI is allowed upto 100%. There is a tax holiday for 5 years for hospitals springing up in rural areas. The sector will be bolstered with capital
investments, technology tie-ups, and collaborative ventures across various segments, including diagnostics, medical equipment, hospitals, and education and training.

Healthcare thus is already one the fastest growing service sector in India.

Still India’s public health care system remains bad. The whole map is characteristic of  under funded and overcrowded hospitals, clinics and inadequate rural coverage. Reduced funding by the Indian Government has been attributed to in excusable failures of the Ministry of Health and Family Welfare (MHFW) to exhaust its annual fund allocation despite increasing demand.

In such a situation urban Indians are adopting to health insurance or plans. These options offer cashless facilities against hospitalization and treatment including 30 critical illnesses and 80 surgical procedures, covering a large spectre of private and well equipped medical facilities.

The private sector has evolved a multi-dimensional approach to increase accessibility and penetration. It is tackling the issue of Lifestyle related diseases with the development of high-end tertiary care facilities. Also new delivery models such as Day-care centres, single specialty hospitals, end-of-life care centres, etc. have emerged.
The Public Sector is keen to continue to encourage private investment in the healthcare sector11 and is now developing Public – Private Partnerships.
Both sectors have also undertaken initiatives to improve functional efficiencies in the form of
Accreditations, Clinical research, outsourcing of non-core areas, increased penetration of healthcare
insurance and third party payers.


Silver Lining- Mass media has emerged as a  great medium to educate and spread awareness on health fitness and disease awareness. Current generation is much more aware and health conscious and wants to avoid medical situations at all costs perhaps the only way to save on costs.

People by and large have been affected by the health wave and practices such as Yoga, Alternate medicine such as naturopathy, Ayurvedic medication such as herbs and extracts, nutrition in foods, health supplements and life style changes have suddenly assumed meaning and visibility.

Morning parks are much fuller than previously or is it because of the sheer number game which India enjoys and sulks in at the same time.

There is greater stress on public hygiene and sanitation. The Government is also running a project to this effect and with fervour. Clean the Ganga type of projects also share a common objective apart from ecological ones. All such projects if implemented on ground can bring about radical changes in atleast the communicable disease incidence in rural and semi urban areas, although there is no internationally comparable metro in India as well in terms of cleanliness and infrastructure.

The effect of of all health sector reforms have improved the overall scenario from dismal to hopeful.
Primary Health Care Centres (PHCs) increased from 22,699 in 2006 to 24 448, Sub Centres (SCs) from 146,026 to 151 684 and Community Health Centres (CHCs) from 3910 to 5187 in
2013. Number of government hospitals and beds have not shown much advances in numbers except in 2012.
Average coverage of rural population by Sub Centres is 5,624 against the standard of 3,000-5,000, by PHCs 34,876 against the standard of 20,000-30,000 and by CHCs 173,235 against the standard of 80,000-120,000 indicating that at least there are enough health care centres to serve the population although they are grossly uneven in distribution.

International models and practices need to be adopted to increase throughput of the whole medical machinery, be it at any level. India has a complex structure of government institutions right from planning to implementation stage. The scenario needs to be that of adoption of internationally successful models and protocols rather than create magic out of a box with overnight fixes.

It is baffling as to why nothing affects us until it sticks in our throats like cancer.


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