Healthcare in India follows a multi-payer universal health care model, and is paid for by a combination of public and government regulated private health insurances. Public hospitals are almost entirely tax-funded. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments for some services.
The 2022-23 Economic Survey highlighted that the Central and State Governments' budgeted expenditure on the health sector reached 2.1% of GDP in FY23 and 2.2% in FY22, against 1.6% in FY21. India ranks 78th and has one of the lowest healthcare spending as a percent of GDP. It ranks 77th on the list of countries by total health expenditure per capita.
History
The Portuguese and the East India Company were the first to introduce Western medicine to India, in the 16th and 17th centuries. By 1785, medical departments to look after military personnel and civilians were established in the Bengal, Madras, and Bombay presidencies. After the East India Company was dissolved, and the British Government came to power, several branches of organized medical services were set up.
In 1896, the Indian Medical Services (IMS) were formed, and the central government was responsible for medical departments until 1919, when the Montgomery-Chelmsford Constitutional Reforms transferred public health and sanitation responsibilities to the provinces.
Madras General Hospital, established in 1679, was the first hospital in India. Healthcare system Public healthcare
Public healthcare is free for every Indian resident. The Indian public health sector encompasses 18% of total outpatient care and 44% of total inpatient care.
The public healthcare system was originally developed to provide access to healthcare regardless of socioeconomic status or caste, however, reliance on private and public healthcare sectors varies significantly between states. Women and the elderly, as well as individuals with lower incomes, are more likely to use public healthcare.
More than 57% of households prefer private healthcare over public, and cite poor quality of care in the public sector. Much of the public healthcare sector caters to the rural areas, and the poor quality arises from the reluctance of experienced healthcare providers to visit the rural areas. Consequently, the majority of the public healthcare system catering to the rural and remote areas relies on inexperienced and unmotivated interns who are mandated to spend time in public healthcare clinics as part of their curricular requirement. Other major reasons are long distances between public hospitals and residential areas, long wait times, and inconvenient hours of operation.
Healthcare decision-making is divided between the state and national government systems, as the national government addresses broadly applicable healthcare issues such as overall family welfare and prevention of major diseases, while the state governments oversee local hospitals, and local sanitation. 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.
Considering the goal of obtaining universal health care as part of 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. Public healthcare is very necessary, especially when considering the costs incurred with private services. Many citizens rely on subsidized healthcare. 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.
Following the 2014 election which brought Prime Minister Narendra Modi to office, the government unveiled plans for a nationwide universal health care system known as the National Health Assurance Mission, which would provide all citizens with free drugs, diagnostic treatments, and insurance for serious ailments. In 2015, implementation of a universal health care system was delayed due to budgetary concerns. In April 2018 the government announced the Aayushman Bharat scheme that aims to cover up to 100,000,000 vulnerable families (approximately 500,000,000 persons – 40% of the country's population). This will cost around $1.7 billion each year. Provision would be partly through private providers.
In 2017, the Medical Technology Assessment Board and its secretariat Health Technology Assessment in India. The Health Financing and Technology Assessment (HeFTA) unit within the National Health Authority (NHA) in 2022 further enhanced evidence-based decision-making processes in prioritizing health benefits and demonstrating significant cost savings to the PM-JAY as a result of health technology assessment (HTA).
Public healthcare in India is primarily organized through a three-tier system: Sub-Centres and Primary Health Centres (PHCs) at the village level, Community Health Centres (CHCs) at the block level, and District Hospitals (DHs) at the district level. In addition to this structure, some states also operate Sub-District Hospitals (tehsil level), General Hospitals, Speciality Hospitals, and Government Medical College Hospitals (GMCHs), which provide tertiary care and function as teaching institutions. In addition to these, institutions offering alternative systems of medicine—such as Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (AYUSH)—are also part of the public healthcare network. These healthcare facilities are primarily funded and administered by the respective State or Union Territory governments, with additional financial and programmatic support from the Central Government.
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 63% of the hospitals in the country, 29% of beds in hospitals, and 81% of doctors.
According to National Family Health Survey-3, the private medical sector remains the primary source of health care for 70% of households in urban areas and 63% of households in rural areas. The study conducted by IMS Institute for Healthcare Informatics in 2013, across 12 states in over 14,000 households indicated a steady increase in the usage of private healthcare facilities over the last 25 years for both Out-Patient and In-Patient services, across rural and urban areas. In terms of healthcare quality in the private sector, a 2012 study by Sanjay Basu et al., published in PLOS Medicine, indicated that health care providers in the private sector were more likely to spend a longer duration with their patients and conduct physical exams as a part of the visit compared to those working in public healthcare. However, the high out of pocket cost from the private healthcare sector has led many households to incur Catastrophic Health Expenditure, which can be defined as health expenditure that threatens a household's capacity to maintain a basic standard of living. Costs of the private sector are only increasing. One study found that over 35% of poor Indian households incur such expenditure and this reflects the detrimental state in which Indian health care system is at the moment. With government expenditure on health as a percentage of GDP falling over the years and the rise of private health care sector, the poor are left with fewer options than before to access health care services. Private insurance is available in India, as are various through government-sponsored health insurance schemes. According to the World Bank, about 25% of India's population had some form of health insurance in 2010. A 2014 Indian government study found this to be an over-estimate, and claimed that only about 17% of India's population was insured. Private healthcare providers in India typically offer high quality treatment at unreasonable costs as there is no regulatory authority or statutory neutral body to check for medical malpractices. In Rajasthan, 40% of practitioners did not have a medical degree and 20% have not completed a secondary education. On 27 May 2012, the popular show Satyamev Jayate did an episode on "Does Healthcare Need Healing?" which highlighted the high costs and other malpractices adopted by private clinics and hospitals.
According to Huffington Post, doctors spoke about the problems with "corporate hospitals" and senior surgeons being told to sell surgeries to their patients even if they weren't needed. In one instance, a doctor was told he would be sacked if he didn't have enough patients to operate on. The majority of India's private, for-profit hospitals charge exorbitant costs for medical services and supplies, which has put a strain on the country's public finances.
Medication
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".
Indians consumed the most antibiotics per head in the world in 2010. A 2017 survey determined that 3.16% of the medicines sampled were substandard and 0.0245% were fake. Access to healthcare As of 2013, the number of trained medical practitioners in the country was as high as 1.4 million, including 0.7 million graduate allopaths. Yet, India has failed to reach its Millennium Development Goals related to health.
Developed countries have been able to adapt to the changing needs of a growing elderly population faster than India and other countries with similar socioeconomic conditions and have developed models for over seventy years to address these needs, through more inclusive care and health insurance. The definition of 'access is the ability to receive services of a certain quality at a specific cost and convenience.
The healthcare system of India is lacking in three factors related to access to healthcare: provision, utilization, and attainment. Provision, or the supply of healthcare facilities, can lead to utilization, and finally attainment of good health. However, there currently exists a huge gap between these factors, leading to a collapsed system with insufficient access to healthcare. Differential distributions of services, power, and resources have resulted in inequalities in healthcare access. Access and entry into hospitals depends on gender, socioeconomic status, education, wealth, and location of residence (urban versus rural). Furthermore, inequalities in financing healthcare and distance from healthcare facilities are barriers to access.
Additionally, there is a lack of sufficient infrastructure in areas with high concentrations of poor individuals. Large numbers of tribes and ex-untouchables that live in isolated and dispersed areas often have low numbers of professionals.
Finally, health services may have long wait times or consider ailments as not serious enough to treat. Those with the greatest need often do not have access to healthcare.
Electronic health records
In 2013, the government unveiled a National Health Portal and came out with guidelines for Electronic health record (EHR) standards in India to enable medical data being portable and easily transferable.