‘EMERGING OPPORTUNITIES AVAILABLE TO INDIA AND
STRATEGIES TO MATERIALIZE THEM’
India is a developing country, where a large section of population is below
poverty and health and hygiene as such is not up to the mark. It is reported
that in India about 20 lacs infants and children die from preventable
illnesses, one lac mothers die during the childbirth and five lacs people die
from tuberculosis. Also around 5 million peoples die from HIV Aids and
numerous others die by diarrhea and malaria.
The plight of the least advantaged is increased because of the poor public
health systems. The Government Hospitals and health care centers do not
completely address the needs of the poor people. On the other hand the
private health care institutions charge exorbitant money, which automatically
renders them beyond the reach of many. However, it needs to be realized
that private health care sector in India is definitely flourishing at the cost of
However, according to some critics the national policy of the country lacks
specific measures to achieve the stated goals. For instance, there is no
integration of the health services with the wider socio-economic and social
development, there is a lack of nutrition support and sanitation and there is
poor participation of the people and government officials at the local level.
The central government adopts the strategy of improving the health systems
through Five-year plans. It cooperates with the State Government for the
purpose and for sponsoring major health programmes. The Central and State
Governments share the expenditure they need on providing healthcare to the
people. In mid 1990’s the Government spent 6% of the GDP on health, which
is one of the highest levels of the expenditure in the developing nations.
According to the World Bank Study the per capita spending on health in India
is around Rs. 320/- per year, with a significant input of 75% from private
households. The State Government contribute 15.2%, Central Government
5.2%, third party employers 3.3% and the Municipal Government and
Foreign donors provide 1.3% of the total spending of which 58.7% goes to
primary healthcare and 38.8% is spent on the secondary and tertiary ones.
However, despite of the State and the Central Government efforts, the health
care in India is in a bad condition because of several factors, of which the
important ones are :
1. The rapidly increasing population of the country
2. High level of indifference in Government and Non-Government
health care organizations.
3. Lack of awareness amongst the people.
However in the context of globalization there are certain developments,
which have a far reaching consequence. As a result of this a paradigm shift is
taking place because of the certain inevitable socio economic considerations.
With the developed countries finding themselves over-burdened with the task
of providing cost effective healthcare, India has emerged as a popular global
health care tourism destination. Medical institutions in India are providing for
an estimated 20,000 to 30,000 doctors and nurses each year complimented
with medical facilities driven by advanced technology and high-quality
procedures at par with hospitals in developed nations such as USA or
European Union and at a price that could be a fraction of what they would
spend in their country.
Interestingly apart from the specific health care issues Indian approach is a
holistic approach. India is well known for alternative therapies and post
treatment travel destinations.
Medical Tourism in India as such is growing by 30 per cent each year. The
health care sector in India resultantly has witnessed a phenomenal growth in
infrastructure in the private and voluntary sector. The private sector is a
flourishing industry and it is equipped with the most modern state-of-the-art
technology at its disposal. An added plus had been that India has one of the
largest pharmaceutical industries in the world. It is self sufficient in drug
production and exports drugs to more than 180 countries.
As one of the key players in medical tourism there is a growing need for
accredited hospitals, to ensure best practices in a safe environment.
It therefore is imperative that for the purposes of ensuring quality
assurance and the quality standards incorporated therein, the
statutory enactment to that effect is necessary. This will not only
entail incorporation of quality assurances, which will augment
quality services but will also re-assure patients who otherwise intend
to seek treatment abroad.
With the advent of globalization increased numbers of people are traveling to
other countries to get treated abroad. In this context quality is the primary
factor. However cost involved in procuring quality health care that could be
surgical and non-surgical in nature is yet another most important
Constraints such as high costs and long waiting lists for treatment or surgery
are prompting people to look at the effective options. Developing countries in
which India turns out to be a key players is resultantly has turned out to be a
key health treatment destination amongst people in developed countries like
USA, UK etc. as India offers high quality treatment at minimal costs with
minimal waiting period.
Frankly speaking, health care and tourism may seem prima-facie
contradictory to each other but realistically people have been traveling to
distant lands for re-juvenation packages. The efforts therefore should be to
institutionalize medical treatment for all kind of health care areas including
the super speciality fields in the medical sciences.
In this context it is imperative that we take into consideration the influences
under which the health care arrangements are required to evolve, primarily
they are :
1) population health status
2) health infrastructure and its management
3) fairness in financing costs and care
4) defining health perceptions of people, professionals and planners
Other than these four important influences, yet another influence, which has
significant impact, is the foreign aid from the developed world. As a open
democratic society India had always been influenced by the dominant
international paradigm on health care be it WHO, UNICEF, UNDP, World Bank
etc. This has resulted in re-direction of the public health priorities in a
substantial way. As a result of this one direct consequence is that the burden
of treatment has become disproportionately regressive for the poor- and a
tendency exaggerated by both compression of public expenditure and
unregulated private factors including the blatant commercialization.
It is therefore imperative that a crystallized policy frame is evolved
towards regulation of the private sector in medicine. As a result of
which the quality would be blended with accountability and fairness
in care through strict adherence to the criteria for accreditation,
transparency in fee, medical audit, accountable record keeping and
credible grievance procedures.
As a matter of fact such accreditation, standard setting and licensure
systems are best done under self regulation, but self regulation system in
India in Indian medical practice have been deficient in many respects
creating problems in credibility.
‘Acute care’ has become the key priority and continues to attract manpower
and investment into related speciality education and facilities for
technological improvement. Common treatments, any expensive diagnostic
procedures and family medicine stand replaced. Tertiary hospitals had been
given concessional land, customs exemption and liberal tax rates against the
commitment for reserve beds for poor patients for the treatment. However,
no effective procedures exist to monitor this and the disclosure systems are
far from transparent. Redressal of patient grievances is poor and allegations
of cuts and commissions to promote needless procedures are common.
The bulk of corporate private entities such as nursing homes are run by
Doctors and Doctor entrepreneurs have remained unregulated either in terms
of facilities for competent standards for quality accountability of practice and
sometime operate without systematic medical records and audits.
Medical education has become more expensive and with a rapid technological
advances in medicine, specialization has more attractive rewards. The
responsibility of private sector in clinical and preventive public health services
have not yet been specified. As a result of which, their roles in this domain
even till date remain questionable.
Situations and circumstances blended with technological advancement has
resulted in growth of telemedicine with treatment from distance and rapid
second experts opinion becoming a matter of routinity.
Therefore in order to have a full potential growth in the context of
globalization for articulating and effective health care delivery system, it is
necessary that following strategies are given diligent thoughts :
a) A sensible mixture of external regulation and professional self
regulation can be devised in consultation with the professionals to
ensure competence, quality and accountability.
b) Role and relevance of Indian systems of Medicine need to be
specifically articulated in the context of need basis and also the cost
c) The desirable level of public expenditure towards health services
need to be deciphered with clarity and augmentation of the same
should be worked out through a strong political will to actualize the
real concept of ‘welfare state’.
d) Evolve accreditation standards for all health care agencies to
build up the concept of quality assurance as a genuine modality
towards fulfillment of legitimate expectations of the all relevant
e) The qualitative incorporation in medical institutions in terms of
infrastructure, teaching and training personnel, relevant curricula,
matcheable training and technological availment should be worked
out, whereby effective trained health manpower is generated not
only for the national but also for the global requirements and
f) The planned efforts need to be undertaken for the purposes of
institutionalization of medical tourism in India, which is a testimony
of the quality of health care services and also the generated
g) The role and relevance of the private capital in the health care
services needs to be crystallized and also to be regulated so as to
ensure that they play a decisive role in subsidized public health care
systems, so that the needs and interests of the marginalized sections
of the society are also catered to.
By Dr. Vedprakash Mishra
Member Executive Committee,
Medical Council of India &
Former Chairman Postgraduate
Medical Education Committee,
Medical Council of India