The document discusses the Indian healthcare system and its key challenges. It notes that the system faces substantial challenges in providing quality healthcare due to factors such as a fast growing population, changing disease profiles, a multilayered healthcare landscape, lack of infrastructure, shortage of manpower, low public expenditure on health, and inaccessibility of services - especially in rural areas. It also examines the disease burden in India and initiatives by the government to improve the system. However, it concludes that India still lags in key healthcare indicators and there is need for improved healthcare planning, resources, and financing to address the country's growing healthcare challenges.

1. Prof. (Dr.) Prashant Mehta
M.Sc, Ph.D. (Chemistry), MBA, Ph.D. (Management)
National Law University, Jodhpur
DECODING THE INDIAN HEALTHCARE SYSTEM
Challenging Problems

3. Key Growth Inhibitors
Delivery of qualitative healthcare services is considered a basic need irrespective of age, gender, and culture. Indian
healthcare system faces substantial challenges in providing qualitative healthcare.
The key growth inhibitors are:
1. Fastest growing population
2. Changing disease profile and Re-emerging diseases
3. Multilayered Healthcare System / Landscape
4. Lack of or Absence of Infrastructure
5. Paucity of Manpower (Doctors, Nurses, Paramedics)
6. Extremely Low Public Expenditure on Health and its Inefficiencies
7. Inaccessibility of Healthcare Services
Source: KPMG

4. Growing Population and Growing Urbanization
Source: UK/MED Source: Equity express.com

5. Changing Disease Profile: India
Shift towards biotech speciality therapies, increased R&D expenditure and acute disease segment will sustain strong growth
Source: IDFC Institutional Securities, Indian Pharma, 2010 Source: NSSO Morbidity & Healthcare Survey, McKinsey’s Analysis, 2004
Per 1000 cases

6. http://usf.vc/wp-content/uploads/2013/12/NCD-burden-India_PwC-copy.jpg
• India which makes up 16.5 percent of world’s population and faces a significant burden of diseases.
• It accounts for “a third of diarrheal diseases, tuberculosis, respiratory, parasitic infestations, prenatal conditions;
• A quarter of maternal ailments;
• A fifth of nutritional deficiencies;
• Second largest number of HIV/AIDS cases in the world;
FEDERATION OF INDIAN CHAMBERS OF COMMERCE AND INDUSTRY (FICCI), INDIA NEEDS TO SPENDS AROUND US $203 BILLION, IF
MISSION OF ACHIEVING “HEALTH FOR ALL” IS TO BE ATTAINED.

7. Multilayered
Healthcare Landscape
Source: Central Bureau of Health Intelligence

8. Lack of Healthcare Infrastructure
Source: Novartis, Arogaya Parivar, Health for Poor, 2010

9. Human Resources Shortages: India
Source: World Health Statistics, 2013, WHO, ICMR, Aranca Analysis

10. Human Resources Shortages: India
Indian healthcare expenditure has grown slower than the economy
Source: WHO, E&Y Analysis
http://cdn-www.ceicdata.com

11. Different Healthcare Parameters: India
Source: World Health Statistics, 2013, WHO, ICMR, Aranca Analysis

12. Inaccessibility of Healthcare Services: India
• Physical Reach / Accessibility of a healthcare facility which
is having an outpatient department (OPD) for common
ailments, and an inpatient department (IPD) for
hospitalization. These facilities may either be public or
private in nature within 5km from the place of residence
or work.
• Availability/Capacity means availability of the requisite
healthcare resources to provide patient treatment, i.e.
doctors, nurses, in-patient beds, diagnostics, consumables,
etc. it is governed by minimum specifications defined by
the Government of India for public healthcare facilities,
and WHO.
• Quality/Functionality means quality of the healthcare
resources available at the point of patient treatment.
• Affordability means the ability of a patient to afford
complete treatment for the illness or disease.
Source: IMS Institute for Healthcare Informatics, Understanding Healthcare Access in India, June 2013

13. India and Its Neighbors
(SAARC Countries)
Source: http://thecalibre.in/wp-content/uploads/2013/01/Number-fetish.jpg

14. Healthcare Challenges: India
Low Government
Spending
India has a low level of
government spending
on healthcare, at 1% of
the GDP.
Business Monitor
International forecasts
that healthcare
expenditure in India
will increase from
US$49.7 billion to
US$86.9 billion
between 2009 .and
2014, a rise of 75%
Poor / Depleting
Infrastructure
Healthcare
infrastructure is poor,
compared to urban
areas.
The doctor patient ratio
in rural areas is
1:20,000, versus the
urban ratio of 1:2000.
The quality and
availability of medicines
in rural areas is
dubious, where
counterfeiting and
spurious drugs us is
rampant.
Limited
Affordability
Healthcare is a low
priority when it comes
to income allocation,
with average consumer
expenditure on
healthcare at just 7%.
80% of the rural
population is on a daily
wage, income levels are
as low as <US$1.78 per
day.
Low Awareness of
Disease and
Possible
Treatment
People here have lower
literacy levels and lack
awareness about
various diseases and
their treatment option.
They rely mainly on
alternative forms of
treatment such as
Ayurvedic medicine,
Unani, and
Acupuncture.
Poor Basic
Hygiene and
Living Conditions
33% of the diseases in
rural areas are related
to unsafe drinking
water and poor
sanitation.
This is because 80% of
rural inhabitants lack
adequate sanitation,
and 70% don’t have
safe drinking water.

15. Government Appointed Review & Its Findings
All reviews have pointed towards:
• Occurrence of major legislative gaps and poor
implementation
• Ineffective implementation of Laws and Policies
• Lack of rules and poor enforcement
• Fragmented and uncontrolled nature of private
healthcare delivery system
• Lack of uniform standards
• Non coverage of laboratories or diagnostic centres
• Also information about the number, role, nature,
structure, functioning, and quality of healthcare in
private hospitals remain inadequate or poor.
• Absence of national regulations regarding provider
standards and healthcare treatment protocols, over
diagnosis, over treatment, and maltreatment is
rampant practice.

16. Initiatives By Government
Rural-Urban
Difference
Developing more
equitable healthcare
infrastructure
between urban and
rural areas.
Convert Primary
Healthcare Centres
into Community
Healthcare Centres
Health Resource
and Infrastructure
Meeting global per
capita infrastructure
standards
Addressing variations
at the state level
Public Healthcare
Facilities and
Treatment Quality
Improving Critical
Care Facilities
Addressing Services
level in public
channels by effective
utilization of public
infrastructure.
Affordability
High proportion of
out of pocket
expenses and
relatively expensive
in-patient care.
Limited reach of
benefits to the
intended
beneficiaries.

17. Major Challenges
• Indian healthcare establishments have pitiable operational strategies, absence of documented
waste management and disposal policy, very poor budgetary support in the government run
hospitals, private hospitals ignore the rules for monetary consideration, untrained ward attendants,
and other supporting staff.
• There are no waste management committees at present in Indian hospitals which should essentially
be consist of the head of the establishment, all the departmental heads, hospital superintendents,
nursing superintendents, hospital engineers with a waste management officer along with an
environmental control advisor and an infection control advisor.
• Insufficient support and guidance from regulatory agencies further complicates the problem of
waste management. Regulations in the form of waste reduction and recycling targets, carbon credit
earnings, development of minimum energy efficiency standards for equipments are necessary for
prevention of pollution and reduction of environmental load on sustained basis.
• Adequate and requisite number of sanitary landfills is lacking in India.
• Resistance to change is often a barrier to implementation of new programmes.

18. Major Challenges
• It is the ethical, social responsibility, and duty of state, legislators, hospitals, healthcare professionals,
and the general public to make sure that environmentally acceptable waste disposal techniques is
introduced and implemented effectively.
• At present we have good enactments of laws, but political will is lacking to enforce these laws.
• There is no forum for ordinary citizen to approach for compensation.
• The present system provides only one remedy, that is, to go to ordinary civil courts, which are
overburdened with heavy pendency, and it may take decades to get relief to compensate the loss
caused by the medical wastes under the head of public nuisance.
• There is no effective tribunal like consumer forum to provide a speedy remedy for the persons
infected with disease by medical waste. The Environmental Tribunals have to be constituted.
• Training Development of safe and effective system of bio-medical waste management along with
handling protocols, detailed institutional plans, strict policies, appropriate training and feedback
programs for all the healthcare workers is very important.

19. Conclusion: General
• India lags behind in in key healthcare indicators
• There is Growing Burden of Disease and Disease Mix
• Inadequate and Poor Healthcare Planning (Top Down)
• Inequitable distribution of resources between different States as well as Urban Rural settings
• Shortfall of Physical Infrastructure
• Shortfall of Trained Manpower (Doctors, Nurses, Para-medics)
• Miniscule Healthcare Budget by Governments
• High Cost of Advanced Treatments
• Low Insurance Penetration
• Unregulated Private Sector (Only 244 hospitals in India are accredited by NABH)

20. References
CORPORATE RESEARCH REPORTS:
• HEALTHCARE IN INDIA: A REPORT BY BOSTON ANALYTICS, JANUARY 2009
• GLOBAL INFRASTRUCTURE: TREND MONITOR INDIAN HEALTHCARE EDITION: OUTLOOK 2009 –2013 BY
KPMG
• STRATEGIES FOR PROVIDING EQUITABLE HEALTHCARE, BY ECS LIMITED, MARCH 2008
• PHARMACEUTICAL OFFSHORING LANDSCAPE, ZINNOV MANAGEMENT CONSULTING, SEPTEMBER 2008
• INDIAN PHARMACEUTICAL INDUSTRY ON COURSE OF GLOBALIZATION, DEUTSCHE BANK RESEARCH,
APRIL 2008
• HEALTHCARE IN INDIA: EMERGING MARKET REPORT 2007 BY: PRICEWATERHOUSE AND COOPERS (PWC)
• HEALTHCARE OUTLOOK, TEN INDUSTRY TRENDS 2007, A QUARTERLY REPORT BY TECHNOPAK, FEBRUARY
07 / VOLUME 1
• HEALTHCARE OUTLOOK, NEW PARADIGMS IN HEALTHCARE DELIVERY 2007, A QUARTERLY REPORT BY
TECHNOPAK, FEBRUARY 07 / VOLUME 2
• HEALTHCARE OUTLOOK, TRENDS IN HEALTHCARE DESIGN 2007, A QUARTERLY REPORT BY TECHNOPAK,
FEBRUARY 07 / VOLUME 3
• HEALTHCARE, MARKET OVERVIEW, INDIA BRAND EQUITY FOUNDATION (IBEF) OCTOBER 2007
• OVERVIEW OF THE HEALTHCARE INDUSTRY IN INDIA, THE INDO ITALIAN CHAMBER OF COMMERCE AND
INDUSTRY, APRIL 2007
• HEALTHCARE REPORT: BY ERNST & YOUNG, INDIAN BRAND EQUITY FOUNDATION (IBEF), 2006
• BOOMING CLINICAL TRIAL MARKET IN INDIA: RNCOS REPORT, NOVEMBER 2007
• DRAFT NATIONAL PHARMACEUTICALS POLICY, 2006, PART - A (CONTAINS ISSUES OTHER THAN
STATUTORY PRICE CONTROL), DEPARTMENT OF CHEMICALS AND PETROCHEMICALS, GOVERNMENT OF
INDIA, DECEMBER 28, 2005
• HEALTH ATTAINMENTS AND DEMOGRAPHIC CONCERNS: NATIONAL HUMAN DEVELOPMENT REPORT,
2001: CHAPTER 5
• THE STATE OF HUMAN DEVELOPMENT: NATIONAL HUMAN DEVELOPMENT REPORT, 2001: CHAPTER 1
• HEALTHCARE IN INDIA, CARING FOR MORE THAN A BILLION: BY SRIVATHSAN APARAJITHAN Y, MATHUR
SHANTHI, MOUNIB EDGAR L., NAKHOODA FARHANA, PAI ADITYA AND BASKARAN LIBI, IBM INSTITUTE
OF BUSINESS VALUE, IBM GLOBAL BUSINESS SERVICES
• CASE STUDY ON MANIPLE CURE & CARE: INDEGENEOUS CONCEPT THAT COMBINES HEALTHCARE AND
RETAIL IN A SINGLE FORMAT: BY PRICE WATER HOUSE AND COOPERS(PWC) AND DYNAMIC VERTICAL
SOLUTIONS
• INDIAN PHARMACEUTICAL INDUSTRY: ISSUES AND OPPORTUNITIES: RESEARCH AND MARKETS REPORT (
http://www.researchandmarkets.com/reports/35229)
SUMMARIES:
• INADEQUATE REGULATIONS UNDERMINE INDIA'S HEALTHCARE: BY: MUDUR GANPATI: BMJ 2004;
328;124- DOI:10.1136/BMJ.328.7432.124-A
• HEALTH CARE IN INDIA: LEARNING FROM EXPERIENCE: BY THE WORLD BANK GROUP
• HEALTHCARE INDICATORS: BY MS. MUKHERJI SRIMOTI, COMMERCIAL SPECIALIST, THE U.S.
COMMERCIAL SERVICE IN INDIA, THE AMERICAN CENTER, NEW DELHI
• INDIA’S NATIONAL HEALTH SYSTEM PROFILE: WHO
• OPPORTUNITIES IN HEALTHCARE: “DESTINATION INDIA”: FICCI AND ERNST & YOUNG.
• RURAL HEALTH CARE SYSTEM: THE STRUCTURE AND CURRENT SCENARIO
• INTRODUCTION TO NURSING AND HEALTH CARE DELIVERY SYSTEM IN INDIA
• A POLICY FRAMEWORK FOR REFORMS IN HEALTH CARE, PERSPECTIVES ON HEALTH CARE IN INDIA: BY
PRIME MINISTER’S COUNCIL ON TRADE AND INDUSTRY
• FAILURE OF PUBLIC HEALTHCARE SYSTEM: CJ: BY SINGH CHANDRA SHEKAR, FEBURARY, 2008
• FINANCING THE HEALTH CARE SECTOR IN INDIA: BLOG BY DR SINGH HARMEET, MBA (BIRMINGHAM)
• IN CHINA, INDIA, HEALTH CARE BURDEN SHIFTS TO POOR, GROUND-LEVEL IMPLEMENTATION 'IS SIMPLY
NOT THERE': BY POWELL ALVIN, HARVARD NEWS OFFICE
• STRENGTHEN THE INDIAN HEALTHCARE INDUSTRY (RECOMMENDATIONS): MODE 1 GATS REPORT INDIA
PAGE 83, 84
• ROLE OF PRIVATE SECTOR IN HEALTH CARE IN INDIA CHALLENGES, OPPORTUNITIES & STARTEGIES: BY
LATH G K, CEO, APOLLO HOSPITAL BILASPUR, MP
• UNHEALTHY PRESCRIPTIONS: THE NEED FOR HEALTH SECTOR REFORM IN INDIA: BY SUNIL NANDRAJ,
INFORMING REFORMING, THE NEWSLETTER OF THE INTERNATIONAL CLEARING HOUSE OF HEALTH
SYSTEM REFORM INITIATIVES ICHSRI, APRIL-JUNE 1997, PP. 7-11.
• MEDICAL TOURISM IN INDIA: ISSUES AND CHALLENGES: BY CHACKO PHEBA, THE ICFAI UNIVERSITY
PRESS.
• HEALTH INSURANCE IN INDIA: OPPORTUNITIES, CHALLENGES AND CONCERNS: BY MAVALANKAR DILEEP
AND BHAT RAMESH, IIM AHMEDABAD
• INDIA BRAND EQUITY FOUNDATION (IBEF), MARCH 2013, AUGUST 2013 REPORT (WWW.IBEF.ORG)
• HEALTHCARE INDIA SECTOR NOTES, MAY 2014, (WWW.IIMJOBS.COM)
• INDIAN HEALTHCARE SYSTEM – OVERVIEW AND QUALITY IMPROVEMENTS, DIRECT RESPONSE, 2013:04,
SWEDISH AGENCY FOR GROWTH POLICY ANALYSIS , WWW.GROWTHANALYSIS.SE
• INDIAN PHARMA, INC.: CAPITALIZING ON INDIA’S GROWTH POTENTIAL, www.pwc.com/India
• INDIAN PHARMA INC. CARING FUP OR NEXT LELVEL OF GROWTH, www.pwc.com/India

21. References
Websites:
• www.technopak.com
• www.kpmg.com/infrastructure
• www.ibef.org
• www.dbresearch.com
• www.dynamicverticals.com
• www.bostonanalytics.com
• www.ibm.com/healthcare/hc2015
• www.pwc.com/globalhealthcare
• www.wikepedia.com/healthcare
• www.ficci.com
• www.timeswellness.com
• www.fortishealthworld.com
• www.whoindia.org
• www.who.int
• www.mohfw.nic.in
• www.crisil.com
• www.pharmabiz.com
• www.pharma.org
Journals
• JOURNAL OF THE ACADEMY OF HOSPITAL ADMINISTRATION
• INDIAN JOURNAL FOR THE PRACTICING DOCTOR
• JOURNAL OF HEALTHCARE AND MEDICAL TECHNOLOGY AND MANAGEMENT
• INDIAN JOURNAL OF MEDICAL ETHICS
• THE PHARMA REVIEW AND PHARMA TIMES
• JOURNAL OF HOSPITAL PHARMACY
Other Publications:
• MINISTRY OF HEALTH, GOVERNMENT OF INDIA
• INDIAN MEDICAL COUNCIL & INDIAN DENTAL COUNCIL
• EXPRESS HEALTHCARE MANAGEMENT
• INDIAN HEALTHCARE FEDERATION
• MEDICA: PHARMACEUTICAL INDUSTRY PUBLICATIONS
• MEDICA: HEALTHCARE SERVICES PUBLICATIONS
Chapters:
• COMPETITION CONCERNS: THE PHARMACEUTICAL INDUSTRY BY CUTS INTERNATIONAL
• CHAPTER 10: DRUG PRICE DIFFERENTIALS ACROSS DIFFERENT RETAIL MARKET SETTINGS: AN ANALYSIS
OF RETAIL PRICES OF 12 COMMONLY USED DRUGS: BY GODWIN S K AND VARATHARAJAN D., HEALTH
ADMINISTRATOR VOL: XIX NUMBER 1: 41-47
• HEALTHCARE POLICY AND ADMINISTRATION IN INDIA: BY SAPRU R K, STERLING PUBLICATION, II
EDITION, CHAPTER 15, PAGES 228-249.
My Books:
• Indian Health Sector and Healthcare System: A critical Insight, LAP Lambert Academic Publishing,
Germany, 2012, ISBN-10: 3659268895, ISBN-13: 978-3659268892, Prashant Mehta
• Indian Retail Analytics: An In-depth Study of Indian Retail Market, its Dimensions, Opportunities,
Problems, and Prospects, LAP Lambert Academic Publishing, Germany, 2012, ISBN-10: 3659147303,
ISBN-13: 978-3659147302 Prashant Mehta
My Publications:
• Legal Provisions and Management Perspectives of Biomedical and Hospital Waste in India. Journal
Club for Management Studies (JCMS),1(II), 11-36 (2014).Dr. Prashant Mehta. ISSN No : 2394 - 3033, V –
1, I – 2, 2014
• Biomedical Waste Disposal: Indian Perspective: Scholasticus, Journal of National Law University,
Jodhpur Vol. 5 No. 1, September 2007, Prashant Mehta, ISBN: 0975-1157, Indexed