Editorials of the Day: India@75, Looking@100-Preventive Healthcare (Indian Express)

Exam View: Indian Health Sector’s Potential, Ayushman Bharat, PM National Dialysis Programme, Rashtriya Bal Swasthya Karyakram (RBSK), National Health Mission, Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Issues related with the Health Sector in India.

In News: Preventative healthcare should become the focus in the next 25 years. India has historically prioritized curative medicine above preventive care. However, preventive care has become more important in India as a result of the COVID-19 pandemic.

• Preventive healthcare means the measures taken to prevent diseases rather than treating them. In India, the preventive healthcare segment is on rising curve. India’s total preventive healthcare market now estimates over $800 million.
• Healthcare industry comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment.
• India’s healthcare delivery system is categorised into two major components – public and private.
• The 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 a majority of secondary, tertiary, and quaternary care institutions with major concentration in metros, tier-I and tier-II cities.

The ‘Strategy for New India @ 75’ had three Key Messages for New India

1. Development must become a mass movement, in which every Indian recognizes his/her role and also experiences the tangible benefits accruing to him/her in the form of better ease of living.
2. Development strategy should help achieve broad-based economic growth to ensure balanced development across all regions and States and across sectors.
3. The strategy when implemented will bridge the gap between public and private sector performance.

The Indian Health Sector’s Potential

• Healthcare sector in India is expected to grow to reach a size of $50 bn by 2025. The Indian healthcare sector is expected to record a three-fold rise, growing at a CAGR (Compound Annual Growth Rate) of 22% between 2016–22 to reach USD 372 billion in 2022 from USD 110 billion in 2016. In the Economic Survey of 2022, India’s public expenditure on healthcare stood at 2.1% of GDP in 2021-22 against 1.8% in 2020-21.
• Ayushman Bharat: 1,50,000 Ayushman Bharat centres, which aim at providing primary health care services to communities closer to their homes, are operational in India.
• The Indian medical tourism market was valued at USD 2.89 billion in 2020 and is expected to reach USD 13.42 billion by 2026.
• India has all the essential ingredients for the exponential growth in this sector, including a large population, a robust pharma and medical supply chain, 750 million plus smartphone users, 3rd largest start-up pool globally with easy access to VC (Venture Capital Fund) funding and innovative tech entrepreneurs looking to solve global healthcare problems.
• One of the Largest employers: as it employs a total of 4.7 million people. The sector has generated 2.7 million additional jobs in India between 2017-22 – over 500,000 new jobs per year.
• Well trained professionals and Cost competitiveness: 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.

Issues Faced by the Healthcare Sector in India

• Low Budget: India’s public expenditure on healthcare is only 2.1% of GDP in 2021-22 while Japan, Canada and France spend about 10% of their GDP on public healthcare.
• Medical Research: Medical research in the country needs to be focused on drugs and vaccines for tropical diseases which are normally neglected by international pharmaceutical companies on account of their limited profitability potential.
• Poor insurance penetration: India has one of the lowest per capita healthcare expenditures in the world. Government contribution to insurance stands at roughly 32 per cent, as opposed to 83.5 per cent in the UK.
  • The high out-of-pocket expenses in India stem from the fact that 76 per cent of Indians do not have health insurance.
• High Out of pocket expenditure: According to the latest National Health Accounts (NHA) estimates released in March 2021, patients bear a big chunk of health expenses, as high as 61 per cent of the total health expenditure, by themselves.
  • Even the poor are forced to opt for private healthcare, and, hence, pay from their own pockets. As a result, an estimated 63 million people fall into poverty due to health expenditures, annually.
• Shortage of Medical Personnel and supply of services: There is a massive shortage of medical staff, infrastructure, and last-mile connectivity in rural areas. Ex. Doctor: Population 1:1800 and 78% of doctors cater to urban India (population of 30%). Massive shortages in the supply of services (human resources, hospitals, and diagnostic centres in the private/public sector) are made worse by grossly inequitable availability between and within States.
• Lack of Preventive Care: Preventive care is undervalued in India, despite the fact that it has been shown to be quite beneficial in alleviating a variety of difficulties for patients in terms of unhappiness and financial losses.
• Policymaking: Policymaking is undoubtedly crucial in providing effective and efficient healthcare services. In India, the issue is one of supply rather than demand, and policymaking can help.

Way Forward

• The establishment of a network of Health and Wellness Centres (HWCs) should be complemented with public health programmes through soft touch governance, using targeted messaging and mobilizing the youth.
• Universal access to basic healthcare can be achieved rapidly through e-Health projects and telemedicine. The popularity of personal health and wellness technologies can be leveraged by supporting innovation in manufacturing of low-cost solutions.
• There is an urgent need to improve the infrastructure of public hospitals, which are overburdened as a result of India’s large population.
• Most clinical, preventive, and primary care will be taken over by technology-based solutions and paramedical personnel.
• Clinicians will need to be trained to provide secondary and tertiary care or carry out research to aid policy changes.

NITI Aayog created the ‘Strategy for New India @ 75’released in 2018. This strategy is all the more essential in transforming the nation in the post-pandemic world. For India @ 100 to address all these woes humanely, efficiently and adequately, the need of the day is a revolution to make India a world leader in health. With the motto of “Country First and Always”, this is the opportunity of a lifetime for every Indian to give back to the nation.

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