A New Era in Health Care in India

Syllabus: GS2/Health

Context

• India is now recognised globally for its world-class medical services, witnessing  profound transformations in the health-care sector and stands as a global health-care hub which signifies our medical prowess but also our economic resilience.

About India’s Health Sector: Recent Trends and Initiatives

• Government Health Expenditure and Primary Healthcare: Economic Survey 2023-2024 sheds light on several key aspects of India’s health sector.
  • Rise inGovernment Health Expenditure: The latest National Health Accounts (NHA) estimates reveal an increase in the share of Government Health Expenditure in the total GDP as well as the share of GHE in Total Health Expenditure.
  • Specifically, the share of primary healthcare expenditure has risen from 51.3% of Government Health Expenditure in FY15 to 55.9% of Government Health Expenditure in FY20.
  • The combined share of primary and secondary care in GHE has also increased significantly, from 73.2% in FY15 to 85.5% in FY20.
• Shift in Private Health Expenditure: Interestingly, the share of primary and secondary care in private health expenditure has declined during the same period (from 83% to 73.7%).
  • This shift is attributed to rising tertiary disease burden and increased utilisation of government facilities for primary healthcare.
  • It indicates a positive move towards strengthening public healthcare infrastructure and reducing reliance on private services.
• Social Security Expenditure on Health: The Survey highlights a significant increase in social security expenditure on health, growing from 5.7% in FY15 to 9.3% in FY20.
  • It reflects efforts to provide better healthcare access and financial protection to citizens.
• Medical Tourism and Cost Advantage: India’s healthcare system has become a hub for medical tourism. Patients from around the world seek treatment here due to cost advantages. For instance, the cost of surgery in India is approximately one-tenth of that in the US or Western Europe.

Health Indicators and Initiatives

• Infant Mortality Rate (IMR): IMR has declined from 39 per 1,000 live births in 2013 to 28 per 1,000 live births in 2020.
  • This reduction signifies progress in maternal and child health outcomes.
• Maternal Mortality Rate (MMR): MMR has also shown improvement, declining from 167 per lakh live births in 2014 to 97 per lakh live births in 2020.
  • Efforts to enhance maternal care and safe deliveries have contributed to this positive trend.

India: From Medical Tourism to Preferred Destination

• Economic Implications: Until the 1980s, medical tourism was the norm. Indians sought treatments abroad, but this trend has reversed.
  • Recent studies reveal that India now saves billions in foreign exchange annually because fewer Indians need to travel abroad for medical care.
  • The cost of treatment here is significantly lower than in western countries, while maintaining high-quality care.
  • This shift has not only conserved valuable foreign exchange but also positioned India as a cost-effective health-care destination.
• Boosting the Economy: International patients contribute significantly to our economy. The influx of medical tourists generates revenues of over $9 billion annually. Beyond health care, this also fuels related sectors such as hospitality, transportation, and pharmaceuticals.
  • The Prime Minister’s vision of “Heal in India” extends beyond rhetoric—it’s a strategic move to position India as a global health-care leader.
• State-of-the-Art Infrastructure: Our state-of-the-art hospitals, skilled medical professionals, and cost-effective treatments have made India a preferred destination for medical tourists.
  • Patients from across the globe come here for a wide range of treatments, from complex cardiac surgeries to advanced oncology.

A Comparative Overview of India’s Health Sector

• Today, India stands as a global health-care hub, attracting patients from over 147 countries. This evolution signifies not only our medical prowess but also our economic resilience.
• Health System Review by the World Health Organization (WHO):
  • Mixed Health System: India’s health system is diverse, reflecting varying levels of maturity across states. This diversity arises due to the country’s vast heterogeneity in health and development indicators.
  • Public Expenditure: One significant challenge is the low public expenditure on health, which remains below 1% of GDP. This contrasts sharply with developed countries where health spending is substantially higher.
  • Healthcare Infrastructure: India has made progress in healthcare infrastructure, but gaps persist. While urban areas boast modern facilities, rural regions often lack adequate healthcare access.
  • Human Resources: India faces shortages of healthcare professionals, including doctors, nurses, and paramedics. This scarcity affects service delivery.
• Selected Indicators and International Comparisons: A report titled “International Health Care Models – Overview of 10 Developing Nations” provides a comparative table of health indicators across different countries, including India.
  • Life Expectancy: India’s life expectancy has improved but still lags behind developed nations. Factors like nutrition, sanitation, and healthcare access play a crucial role.
  • Infant Mortality: India faces challenges in reducing infant mortality rates. Developed countries have significantly lower rates due to robust healthcare systems.
  • Healthcare Costs: India is cost-competitive compared to its peers in Asia and the West. The cost of medical services is significantly lower, leading to medical tourism.

Key Concerns and Challenges

• Violences Against Healthcare Workers (VAHCW): These are alarmingly common in India. Over the last few months, there have been numerous incidents reported across various states, targeting doctors, nurses, and paramedics.
  • Statistics reveal an increasing pattern of aggression, particularly in public healthcare facilities. Younger and female professionals are disproportionately affected.
  • Lack of Uniformity and Loopholes in Existing Laws: The healthcare community has consistently called for robust laws to deter violence. However, as of 2020, only 19 states had implemented their statutes, each with varying provisions.
• Expenditure on Primary Healthcare: While private health expenditure has risen overall, the share allocated to primary and secondary care has declined. This shift—from 83% to 73.7%—is attributed to rising tertiary care costs.
  • It’s essential to prioritise investment in primary healthcare to ensure preventive and early intervention services.
• ‘One Health’ Approach for Emerging Diseases: Epidemics like Nipah virus outbreaks and Covid-19 often originate from non-human sources and cross over to humans.
  • Integrating human, animal, and environmental health is crucial for disease prevention and control.
• Health Inflation and Expenditure: The current annual rate of medical inflation stands at 15%, while overall inflation is 6-7% per annum.
  • Health expenditure currently accounts for 5% of India’s private final consumption expenditure.

Significant Initiatives

• Ayushman Bharat Digital Mission (ABDM): It aims to create a national digital health ecosystem that supports universal health coverage. It focuses on efficiency, accessibility, inclusivity, affordability, and safety.
  • The Ayushman Bharat Health Account (ABHA) Number facilitates digital access to health records. It allows interaction with healthcare providers and seamless receipt of lab reports, prescriptions, and diagnoses from verified professionals.
• CoWIN App: CoWIN (COVID Vaccine Intelligence Network) played a crucial role during the pandemic. It facilitated vaccine registration, appointment scheduling, and tracking of vaccination status.
  • By leveraging technology, CoWIN ensured efficient vaccine distribution and administration across the country.
• Aarogya Setu: Originally developed as a COVID-19 contact tracing app, Aarogya Setu has evolved into a comprehensive National Health App.
  • Through Aarogya Setu, individuals can register for an Ayushman Bharat Health Account (Digital Health ID). It enables interactions with healthcare providers and seamless access to digital health records.
• e-Sanjeevani and e-Hospital: These telemedicine platforms have revolutionised healthcare delivery. Patients can consult doctors remotely, receive prescriptions, and seek medical advice without physical visits.
  • e-Sanjeevani focuses on outpatient services, while e-Hospital caters to inpatient consultations.
• PM Jan Aushadhi Kendras: Providing affordable generic medicines.
  • AMRIT (Affordable Medicines and Reliable Implants for Treatment): Ensuring access to quality medicines and medical devices.
• Increased Budget Allocation: In the 2024-2025 budget, the Union Health Ministry received a 12.9% increase in funding, reaching Rs. 90,958.63 crore.
  • The budget also exempted customs duty on three cancer treatment drugs: Trastuzumab Deruxtecan, Osimertinib, and Durvalumab.
• Addressing Obesity and Mental Health: The Economic Survey highlighted rising obesity and mental health challenges.
  • Obesity is linked to processed food consumption, sedentary lifestyles, and micronutrient deficiencies. The survey emphasised the need for balanced diets.
  • Mental health, intertwined with overall well-being, received attention. The National Tele Mental Health Programme was allocated Rs. 90 crore.
• One Health Initiative: This cross-sectoral collaboration aims to improve health outcomes by addressing interlinked issues related to livestock health, human health, wildlife health, and the environment.
• Citizens’ Commission on Reimagining India’s Health System: A citizen-led initiative working towards achieving universal health coverage (UHC) in India. It emphasises collaboration across sectors and community involvement.

Way Forward: Room for Growth

• India’s Aspiration as a Global Health-Care Leader needs to foster an environment conducive to innovation by ensuring equitable access to quality health care, and prioritising the well-being of every individual.
• NITI Aayog emphasises affordable health care as a national priority, leveraging technology to reduce costs for all citizens.
• While India has made significant strides in medical tourism, there’s still room for improvement. Compared to our neighbouring countries, we can do more to enhance our health-care offerings.
• But the trajectory is promising, and with continued efforts, we can solidify our position as a global health-care leader.

Source: TH