Is India’s Universal Healthcare System Truly Universal?

In 2018, the WHO proclaimed that true universal health coverage serves “everyone, everywhere.” Despite India’s implementation of a universal healthcare model, healthcare in India remains largely inaccessible. India’s current healthcare system fails to reach the true ideals sought after by universal health coverage because of the public healthcare sector’s neglect of economically challenged populations in rural areas. This article will explore India’s private and public healthcare sectors to identify key issues leading to inaccessibility.

Private vs. Public Healthcare

Standards of care vary widely between India’s private and public sectors. Public healthcare is free for every Indian resident, however, the public sector has become notorious for its poor quality of care and corruption. Patients complain of long waits, dirty surroundings, poorly equipped inventories for medicines and tests, and patient to doctor ratios that can exceed a hundred patients to a single doctor in a single outpatient session. Several public hospitals lack basic infrastructural facilities such as beds, wards, toilets, drinking water, regular electricity, or clean labor rooms. Many patients have even reported that doctors illegally advised them to “meet them privately” for a higher quality of care. According to a survey conducted by Transparency International, 30% of patients that visited government hospitals have used bribes to skip lines for treatment, obtain better doctors, or be placed in clean bedsheets.

The private healthcare system consists of small practices and large corporations. Due to a lack of regulation or inspection, many small independent clinics and practices are run by doctors without proper accreditation. On the other extreme of the Indian healthcare system lies large corporations that build hospitals with clean conditions and high-tech medical equipment to profit off the poor quality of care provided by India’s public sector. In fact, India’s private hospitals have attracted a notable amount of foreigners from many countries in Africa, the Middle East, Pakistan, and Bangladesh because of the access to complex surgeries such as pediatric or liver transplants. Many patients even come from Europe and North America for quick, efficient, and cheap coronary bypass procedures and orthopedic surgeries. A surgery that costs $10,000 with several months of waiting in the UK can cost as little as $1000 with a wait time of ten days in India. India’s private healthcare sector generates billions of dollars annually from medical tourism.

The contrasting nature of India’s healthcare landscape presents a troublesome predicament for patients deciding if and where to receive medical treatment.

Key Factors Leading to Inaccessibility

A core issue in Indian healthcare is the asymmetry in proximity to healthcare facilities. Urban populations have several options from both the public and private sectors, while rural populations face far fewer options. In rural areas, only 37% of people are able to access inpatient facilities within a 5 km distance, and only 68% of people have access to out-patient facilities. Healthcare facilities are significantly more concentrated in urban areas, which poses a large problem as only 30% of India’s population resides in an urban community.

Another fundamental factor is affordability. Even when patients have access to a government health facility, a vast majority of individuals decide to opt for a privately-owned healthcare facility if there is one in the locality. According to several studies, a persistent negative attitude toward government health facilities exists throughout India. While this attitude may have a legitimate basis in urban communities, this attitude proves to be ironic in rural populations. When evaluated, the competency of doctors in terms of knowledge and practice of knowledge scored higher in rural public facilities than in rural private facilities. This ill-informed trend in patient preference for privately-owned facilities incurs a large financial burden on patients in rural communities comprised of primarily impoverished individuals. Healthcare expenditure averages 14.3% of total income for India’s lowest income quintile. As a result of out of pocket healthcare expenditure, around 50 million households fall below the poverty line ($1 per day) annually. When faced with the prospect of immense financial burden, many individuals avoid seeking medical treatment for minor and major illnesses. In fact, in a survey conducted among those who decide not to seek medical treatment in India, around 28% consist of rural households that cited financial constraints as the primary factor.

Potential Solutions

India’s healthcare system is riddled with a myriad of complexities. No solution can be all-encompassing in its impact, but certain measures can be taken to make sure that the healthcare system is accessible to all that it is attempting to serve.  In order to achieve true universal health coverage, the government must look to expand existing infrastructure and change public perceptions of hospitals in the public sector.

The first priority must be to increase government spending in the healthcare sector. Investing to expand the physical reach of its medical facilities to rural areas should allow for a greater number of individuals to be able to access hospitals they can afford and reduce congestion in existing hospitals. Additionally, investing in facility upgrades and better pay for medical professionals should increase the quality of medical treatment in government-provided medical centers. This better quality of treatment should help shift the public’s perception and instill more faith in the public sector.

Another emerging solution that may mitigate the impact of inaccessibility to public healthcare is Telemedicine. Internet penetration in India stands at around 50 percent in 2020. This percentage is only projected to increase in the coming years. An increase in investment in existing government-led telemedicine initiatives could provide many with an alternative source of medical advice if they do not have a convenient healthcare facility in their locality.

Conclusion

Poor housing conditions, unsafe drinking water, and exposure to environmental odds are a common reality for many rural Indian households. These conditions lead rural populations to have a higher prevalence of disease and illness, meaning India’s healthcare system is inefficiently serving the population that needs it most. Unless the Indian government makes key adjustments, India’s universal healthcare model cannot be used for “everyone, everywhere.”