Infrastructure in Health Care

Relevance: Mains: G.S paper II: Health

Health infrastructure is an important indicator for understanding the health care policy and welfare mechanism in a country. It signifies the investment priority with regard to the creation of health care facilities. Infrastructure has been described as the basic support for the delivery of public health activities. India has systematically improved health conditions.

• Life expectancy has doubled from 32 years in 1947 to 66.8 years at present.
• Infant Mortality Rate (IMR) has fallen to 50 per thousand live births.

Further, it is estimated that public funding accounts for only 22 per cent of the expenses on healthcare in India.  Most of the remaining 78 per cent of private expenditure is out-of-pocket expense.

 

Healthcare System and Structure:

• Healthcare has become one of India’s largest sectors–both in terms of revenue and employment. Healthcare comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment.
• 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 a major concentration in metros, 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.

Towards Universal Access to Health Care:

• Universal access to health care is a well-articulated goal for both global institutions and national governments.
• India’s National Health Policy, 2017 envisions the goal of attaining highest possible level of health and well-being for all at all ages through a preventive and promotive health care orientation health care services without financial hardship to the citizens.
• Under health related Sustainable Development Goal (SDG) No.3, (Good Health and well-Being), a commitment towards global effort to eradicate disease, strengthen treatment and healthcare, and address new and emerging health issues has been pronounced.
• The gains of India in many health related indicators helped the country to make progress in achieving MDGs.
• Ayushman Bharat Mission, world’s largest health scheme announced in the Union Budget 2018-19, is the latest initiative for expanding the health insurance net and targets 10 crore poor and deprived rural families.
• There has been a concerted effort to improve the health care infrastructure as well as delivery mechanism in the last couple of years.
• Several schemes, programmes and initiatives have been undertaken to bridge the gap to make the quantity as well as quality of the health services available to the last mile.

Major Government Initiatives:

• Government of India has taken some major initiatives to promote Indian healthcare industry.
• Government of India launched Pradhan Mantri Jan Arogya Yojana (PMJAY), to provide health insurance worth Rs.500,000 to over 100 million families every year.
• In August 2018, the Government of India has approved Ayushman Bharat-National Health Protection Mission as a Centrally Sponsored Scheme Contributed by both Centre and State governments at a ratio of 60:40 for all States, 90:10 for hilly North Eastern States and 60:40 for Union Territories with legislature. The Centre will contribute 100 per cent for Union Territories without legislature.

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY):

The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) has the objectives of correcting regional imbalances in the availability of affordable/ reliable tertiary healthcare services and also to augment facilities for quality medical education in the country.

PMSSY has two components:

(i)   Setting up of AIIMS like institutions.

(ii)  Upgradation of Government Medical College Institutions.

PMSSY also envisaged Up-gradation of several existing medical institutions in different stated in the country

Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (PMJAY)     

• One of the most ambitious health insurance programmes in the world today, the Pradhan Mantri Jan Arogya Yojana (PMJAY).
• Ayushman Bharat, gives India the chance to transform its healthcare and PMJAY aims to address the healthcare needs of India’s poorest 100 million households.
• The path to success, however, is strewn with several challenges.
• If these hurdles are overcome and if PMJAY succeeds, India’s largest health insurance scheme would also become its most effective healthcare initiative.
• PMJAY has the potential to institute reforms to the country’s healthcare and health insurance systems at a lower cost to the exchequer.
• If streamlined, health information and monitoring systems can arrest the possibility of over-provisioning and cost-inflation.
• The idea to shift away from a decaying system of government health care, governed by common principles and financed by low-cost health insurance-is a step in the right direction.

Kayakalp:

• The Swachh Bharat Abhiyan focuses on promoting cleanliness in public spaces.
• Public health care facilities are a major mechanism of social protection to meet the health care needs of large segments of the population.
• Cleanliness and hygiene in hospitals are critical to preventing infections and also provide patients and visitors with a positive experience and encourages moulding behaviour related to clean environment.
• As the first principle of healthcare is “to do no harm” it is essential to have our health care facilities clean and to ensure adherence to infection control practices.
• Swachhta Guidelines for Public Health Facilities have been issued separately. T
• o complement this effort, the Ministry of Health & Family Welfare, Government of India has launched a National Initiative to facilities that demonstrate high levels of cleanliness, hygiene and infection control.
• “Kayakalp” is an initiative to promote sanitation and hygiene in public healthcare institutions. Facilities which outshine and exceed the set measures are awarded and incentivized under Kayakalp.
• Till date, “Kayakalp” initiative has been able to encourage public health facilities in the country to work towards attainment of excellence in cleanliness and hygiene.
• “Kayakalp” is becoming instrumental in building confidence of the users in public health facilities.

 Mission Indradhanush:

• The Government of India has launched Mission Indradhanush with the aim of improving coverage of immunisation in the country.
• It aims to achieve at least 90per cent immunisation coverage by December 2018 which will cover unvaccinated and partially vaccinated children in rural and urban areas of India.

Private sector in Health Care:

• The Supreme Court in a recent judgement directed government hospitals in Delhi to refer poor patients to private hospitals.
• This decision has been described as a pro-poor decision which aims at bringing the poor rural patients at pat with the urban rich patients who till now had been the sole beneficiaries of such private institutions.
• The private institutions would provide medical care free of cost to the poor, pending preparation of a scheme which would involve private players in treating the poor.
• The appeal was filed against an earlier decision of the Delhi High Court whereby, the High court had directed certain private hospitals to ensure free treatment to 10 percent in-patients and 25 percent outpatients, this mandatory ruling was given on the ground that the land for construction was given on an undertaking which bound the private players to provide free health care to people who belong to economically weaker sections of the society.
• The apex court directed that the Delhi Government and Private Health institutions should come together and draw up a plan for serving the poor.
• This decision would go a long way in strengthening the public health system. The issues of access to quality health care may be addressed by collaboration between State Governments and private players.

Market size expansion:

• The healthcare market can increase three fold to Rs 8.6 trillion (US 133.44 billion) by 2022.
• India is experiencing 22-25% growth in medical tourism and the industry is expected to double its size from present by 2018.
• There is a significant scope for enhancing healthcare services considering that healthcare spending as a percentage of Gross Domestic Product (GDP) is rising.
• The government’s expenditure on the health sector has grown to 1.4 per cent in FY18F. The government of India is planning to increase public health spending to 2.5 per cent of the country’s GDP by 2025.

Investment:

The hospital and diagnostic centers attracted Foreign Direct Investment (FDI) worth US 5.25 billion between April 2000 and June 2018, according to data released by the Department of Industrial Policy and Promotion (DIPP).

Achievements:

• In 2017, the Government of India approved National Nutrition Mission (NNM), a joint effort of Ministry of Health and Family Welfare (MoHFW) and the Ministry of Women and Child Development (WCD) towards a lifecycle approach for interrupting the intergenerational cycle of under nutrition.
• The world’s largest government funded healthcare scheme, Ayushman Bharat was launched. Million patients were benefitted from Affordable medicines and Reasonable Implants for Treatment (AMRIT) Pharmacies.
• The Government of India approved the National Medical Commission Bill 2017. It aims to promote medical education reform.

Road Ahead: Healthcare infrastructure and services:

• India’s healthcare industry is one of the fastest growing sectors and it is expected to reach 280 billion by 2020. The country has also become one of the leading destinations for high end diagnostic services with tremendous capital investment for advanced diagnostic facilities, thus catering to a greater proportion of population. Besides, Indian medical service consumers have become more conscious towards their healthcare upkeep.
• Indian healthcare sector is much diversified and is full of opportunities in every segment which includes providers, payers and medical technology. With the increase in the competition businesses are looking to explore for the latest dynamics and trends which will have positive impact on their business.
• India’s competitive advantage also lies in the increased success rate of Indian companies in getting Abbreviated New Drug Application (ANDA) approvals.
• India also offers vast opportunities in R&D as well as medical tourism. To sum up, there are vast opportunities for investment in healthcare infrastructure in both urban and rural India.
• Public healthcare service in India should ensure three “Es- Expand – Excellence”.
• Access to adequate health care would need expansion of tertiary care facilities.
• Tertiary care should be equitably distributed to different segments of population.
• The setting up of new facilities will have to address imbalances at three levels- regional, specialities, and ratio of medical doctors to nurses and other healthcare professionals.