Terming the right to health as a fundamental right which includes affordable treatment, the Supreme Court said it is the duty of the state to make provisions for affordable treatment during this unprecedented pandemic. “Right to health is a fundamental right guaranteed under Article 21 of the Constitution of India. Right to Health includes affordable treatment. Therefore, it is the duty upon the State to make provisions for affordable treatment,” the court said. A three-judge bench of Justices Ashok Bhushan, R Subhash Reddy and MR Shah had taken up the issue of healthcare during the time of the pandemic on its own and also looked at instances where bodies of coronavirus casualties were not handled with dignity. The top court asked the government to devise a mechanism to give rotational break to doctors and healthcare professionals working continuously since April. On behalf of the Centre, Solicitor General Tushar Mehta assured the court that the government would take a decision in a day or two. The court also directed the authorities to conduct more testing and to declare correct facts and figures
- The unprecedented pandemic has exposed the weaknesses and inadequacies in the public health sector in India right from shortage of doctors, beds, emergency equipment and medicines.
- Finance: At about 1.3% of the national income, India’s public healthcare spending between 2008 and 2015, has virtually remained stagnant. This is way less than the global average of 6 per cent. It is a herculean task to implement a scheme that could potentially cost Rs 5 lakh per person and benefit 53.7 crore out of India’s 121 crore citizenry, or roughly about 44% of the country’s population. Over 70 per cent of the total healthcare expenditure is accounted for by the private sector.
- Crumbling public health infrastructure: Given the country’s crumbling public healthcare infrastructure, most patients are forced to go to private clinics and hospitals. There is a shortage of PHCs (22%) and sub-health centres (20%), while only 7% sub-health centres and 12% primary health centres meet Indian Public Health Standards (IPHS) norms.
- Approximately 70 per cent of the healthcare services in India are provided by private players. If private healthcare crumbles due to economic constraints or other factors, India’s entire healthcare system can crumble.
- High Out of Pocket Expenditure: Reports suggest that 70% of the medical spending is from the patient’s pockets leading to huge burden and pushing many into poverty. Most consumers complain of rising costs.
- Insurance: India has one of the lowest per capita healthcare expenditures in the world. Government contribution to insurance stands at roughly 32 percent, as opposed to 83.5 percent in the UK. The high out-of-pocket expenses in India stem from the fact that 76 percent of Indians do not have health insurance.
- Doctor-Density Ratio: India has a doctor-to-population ratio well below the level recommended by the WHO — 1:1,445, which adds up to a total of roughly 1,159,000 doctors. The WHO says the ideal ratio is 1:1,000.
- Shortage of Medical Personnel: Data show that there is a staggering shortage of medical and paramedical staff at all levels of care: 10,907 auxiliary nurse midwives and 3,673 doctors are needed at sub-health and primary health centres, while for community health centres the figure is 18,422 specialists.
- Rural-urban disparity: The rural healthcare infrastructure is three-tiered and includes a sub-center, primary health centre (PHC) and CHC. PHCs are short of more than 3,000 doctors, with the shortage up by 200 per cent over the last 10 years to 27,421. Private hospitals don’t have adequate presence in Tier-2 and Tier-3 cities and there is a trend towards super specialisation in Tier-1 cities.
- Social Inequality: The growth of health facilities has been highly imbalanced in India. Rural, hilly and remote areas of the country are under served while in urban areas and cities, health facility is well developed. The SC/ST and the poor people are far away from modern health service.
- Poor healthcare ranking: India ranks as low as 145th among 195 countries in healthcare quality and accessibility, behind even Bangladesh and Sri Lanka.
- Commercial motive: lack of transparency and unethical practices in the private sector.
- Lack of level playing field between the public and private hospitals: This has been a major concern as public hospitals would continue receiving budgetary support. This would dissuade the private players from actively participating in the scheme.
- As per the OECD data available for 2017, India reportedly has only 0.53 beds available per 1,000 people as against 0.87 in Bangladesh, 2.11 in Chile, 1.38 in Mexico, 4.34 in China and 8.05 in Russia.
- Scheme flaws: The overall situation with the National Health Mission, India’s flagship programme in primary health care, continues to be dismal. The NHM’s share in the health budget fell from 73% in 2006 to 50% in 2019 in the absence of uniform and substantial increases in health spending by States.
Indian healthcare on the cusp of a digital transformation:
- Healthcare has become one of India’s largest sector, both in terms of revenue and employment.
- Healthcare comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment.
- The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services and increasing expenditure by public as well private players.
- Indian healthcare delivery system is categorised into two major components – public and private.
- The Government, i.e. public healthcare system, comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centres (PHCs) in rural areas.
- The private sector provides majority of secondary, tertiary, and quaternary care institutions with major concentration in metros and tier I and tier II cities.
- India’s competitive advantage lies in its large pool of well-trained medical professionals. India is also cost competitive compared to its peers in Asia and Western countries.
- The cost of surgery in India is about one-tenth of that in the US or Western Europe. India ranks 145 among 195 countries in terms of quality and accessibility of healthcare.
- There is an immediate need to increase the public spending to 2.5% of GDP, despite that being lower than global average of 5.4%.
- It should be the duty of the state to provide affordable treatment which we have failed since last 70 years.
- The achievement of a distress-free and comprehensive wellness system for all hinges on the performance of health and wellness centers as they will be instrumental in reducing the greater burden of out-of-pocket expenditure on health.
- There is a need to depart from the current trend of erratic and insufficient increases in health spending and make substantial and sustained investments in public health over the next decade.
- Increase the Public-Private Partnerships to increase the last-mile reach of healthcare.
- India should take cue from other developing countries like Thailand to work towards providing Universal Health Coverage. UHC includes three components: Population coverage, disease coverage and cost coverage.
- Leveraging the benefits of Information Technology like computer and mobile-phone based e-health and m-health initiatives to improve quality of healthcare service delivery. Start-ups are investing in healthcare sector from process automation to diagnostics to low-cost innovations. Policy and regulatory support should be provided to make healthcare accessible and affordable.
- Leveraging AYUSH services in non-critical care as demonstrated during the pandemic can be vital to augment the capacity of the allopathic services.
- Primary health centres must be well-staffed, public health improved and supply chains should be made functional.
- The state must first realise that primary healthcare and public health are the government’s responsibility and must be guaranteed to all. The private sector can, at best, supplement this effort.