DECODING THE INDIAN HEALTHCARE SYSTEM
Challenging Problems
Prof. (Dr.) Prashant Mehta
M.Sc, Ph.D. (Chemistry), MBA, Ph.D. (Management)
National Law University, Jodhpur
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
Growing Population and Growing Urbanization
Source: UK/MED Source: Equity express.com
Changing Disease Profile: India
Shift towards biotech speciality therapies, increased R&D expenditure and acute disease segment will sustain strong growth
Per 1000 cases
Source: IDFC Institutional Securities, Indian Pharma, 2010 Source: NSSO Morbidity & Healthcare Survey, McKinsey’s Analysis, 2004
• 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.
http://usf.vc/wp-content/uploads/2013/12/NCD-burden-India_PwC-copy.jpg
Multilayered
Healthcare Landscape
Source: Central Bureau of Health Intelligence
Lack of Healthcare Infrastructure
Source: Novartis, Arogaya Parivar, Health for Poor, 2010
Human Resources Shortages: India
Source: World Health Statistics, 2013, WHO, ICMR, Aranca Analysis
Human Resources Shortages: India
Indian healthcare expenditure has grown slower than the economy
http://cdn-www.ceicdata.com
Source: WHO, E&Y Analysis
Different Healthcare Parameters: India
Source: World Health Statistics, 2013, WHO, ICMR, Aranca Analysis
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
India and Its Neighbors
(SAARC Countries)
Source: http://thecalibre.in/wp-content/uploads/2013/01/Number-fetish.jpg
Healthcare Challenges: India
Low Awareness of
Poor Basic
Low Government Poor / Depleting Limited Disease and
Hygiene and
Spending Infrastructure Affordability Possible
Living Conditions
Treatment
Healthcare
India has a low level of infrastructure is poor,
government spending compared to urban Healthcare is a low People here have lower
areas. 33% of the diseases in
on healthcare, at 1% of priority when it comes literacy levels and lack
rural areas are related
the GDP. The doctor patient ratio to income allocation, awareness about
to unsafe drinking
Business Monitor in rural areas is with average consumer various diseases and
water and poor
International forecasts 1:20,000, versus the expenditure on their treatment option.
sanitation.
that healthcare urban ratio of 1:2000. healthcare at just 7%. They rely mainly on
80% of the rural This is because 80% of
expenditure in India The quality and alternative forms of
population is on a daily rural inhabitants lack
will increase from availability of medicines treatment such as
wage, income levels are adequate sanitation,
US$49.7 billion to in rural areas is Ayurvedic medicine,
as low as <US$1.78 per and 70% don’t have
US$86.9 billion dubious, where Unani, and
day. safe drinking water.
between 2009 .and counterfeiting and Acupuncture.
2014, a rise of 75% spurious drugs us is
rampant.
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.
Initiatives By Government
Public Healthcare
Rural-Urban Health Resource
Facilities and Affordability
Difference and Infrastructure
Treatment Quality
Developing more High proportion of
equitable healthcare Meeting global per out of pocket
Improving Critical
infrastructure capita infrastructure expenses and
Care Facilities
between urban and standards relatively expensive
rural areas. in-patient care.
Addressing Services
Convert Primary Limited reach of
level in public
Healthcare Centres Addressing variations benefits to the
channels by effective
into Community at the state level intended
utilization of public
Healthcare Centres beneficiaries.
infrastructure.
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.
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.
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)
References
CORPORATE RESEARCH REPORTS: SUMMARIES:
• HEALTHCARE IN INDIA: A REPORT BY BOSTON ANALYTICS, JANUARY 2009 • INADEQUATE REGULATIONS UNDERMINE INDIA'S HEALTHCARE: BY: MUDUR GANPATI: BMJ 2004;
• GLOBAL INFRASTRUCTURE: TREND MONITOR INDIAN HEALTHCARE EDITION: OUTLOOK 2009 –2013 BY 328;124- DOI:10.1136/BMJ.328.7432.124-A
KPMG • HEALTH CARE IN INDIA: LEARNING FROM EXPERIENCE: BY THE WORLD BANK GROUP
• STRATEGIES FOR PROVIDING EQUITABLE HEALTHCARE, BY ECS LIMITED, MARCH 2008 • HEALTHCARE INDICATORS: BY MS. MUKHERJI SRIMOTI, COMMERCIAL SPECIALIST, THE U.S.
• PHARMACEUTICAL OFFSHORING LANDSCAPE, ZINNOV MANAGEMENT CONSULTING, SEPTEMBER 2008 COMMERCIAL SERVICE IN INDIA, THE AMERICAN CENTER, NEW DELHI
• INDIAN PHARMACEUTICAL INDUSTRY ON COURSE OF GLOBALIZATION, DEUTSCHE BANK RESEARCH, • INDIA’S NATIONAL HEALTH SYSTEM PROFILE: WHO
APRIL 2008 • OPPORTUNITIES IN HEALTHCARE: “DESTINATION INDIA”: FICCI AND ERNST & YOUNG.
• HEALTHCARE IN INDIA: EMERGING MARKET REPORT 2007 BY: PRICEWATERHOUSE AND COOPERS (PWC) • RURAL HEALTH CARE SYSTEM: THE STRUCTURE AND CURRENT SCENARIO
• HEALTHCARE OUTLOOK, TEN INDUSTRY TRENDS 2007, A QUARTERLY REPORT BY TECHNOPAK, FEBRUARY • INTRODUCTION TO NURSING AND HEALTH CARE DELIVERY SYSTEM IN INDIA
07 / VOLUME 1 • A POLICY FRAMEWORK FOR REFORMS IN HEALTH CARE, PERSPECTIVES ON HEALTH CARE IN INDIA: BY
• HEALTHCARE OUTLOOK, NEW PARADIGMS IN HEALTHCARE DELIVERY 2007, A QUARTERLY REPORT BY PRIME MINISTER’S COUNCIL ON TRADE AND INDUSTRY
TECHNOPAK, FEBRUARY 07 / VOLUME 2 • FAILURE OF PUBLIC HEALTHCARE SYSTEM: CJ: BY SINGH CHANDRA SHEKAR, FEBURARY, 2008
• HEALTHCARE OUTLOOK, TRENDS IN HEALTHCARE DESIGN 2007, A QUARTERLY REPORT BY TECHNOPAK, • FINANCING THE HEALTH CARE SECTOR IN INDIA: BLOG BY DR SINGH HARMEET, MBA (BIRMINGHAM)
FEBRUARY 07 / VOLUME 3 • IN CHINA, INDIA, HEALTH CARE BURDEN SHIFTS TO POOR, GROUND-LEVEL IMPLEMENTATION 'IS SIMPLY
• HEALTHCARE, MARKET OVERVIEW, INDIA BRAND EQUITY FOUNDATION (IBEF) OCTOBER 2007 NOT THERE': BY POWELL ALVIN, HARVARD NEWS OFFICE
• OVERVIEW OF THE HEALTHCARE INDUSTRY IN INDIA, THE INDO ITALIAN CHAMBER OF COMMERCE AND • STRENGTHEN THE INDIAN HEALTHCARE INDUSTRY (RECOMMENDATIONS): MODE 1 GATS REPORT INDIA
INDUSTRY, APRIL 2007 PAGE 83, 84
• HEALTHCARE REPORT: BY ERNST & YOUNG, INDIAN BRAND EQUITY FOUNDATION (IBEF), 2006 • ROLE OF PRIVATE SECTOR IN HEALTH CARE IN INDIA CHALLENGES, OPPORTUNITIES & STARTEGIES: BY
• BOOMING CLINICAL TRIAL MARKET IN INDIA: RNCOS REPORT, NOVEMBER 2007 LATH G K, CEO, APOLLO HOSPITAL BILASPUR, MP
• DRAFT NATIONAL PHARMACEUTICALS POLICY, 2006, PART - A (CONTAINS ISSUES OTHER THAN • UNHEALTHY PRESCRIPTIONS: THE NEED FOR HEALTH SECTOR REFORM IN INDIA: BY SUNIL NANDRAJ,
STATUTORY PRICE CONTROL), DEPARTMENT OF CHEMICALS AND PETROCHEMICALS, GOVERNMENT OF INFORMING REFORMING, THE NEWSLETTER OF THE INTERNATIONAL CLEARING HOUSE OF HEALTH
INDIA, DECEMBER 28, 2005 SYSTEM REFORM INITIATIVES ICHSRI, APRIL-JUNE 1997, PP. 7-11.
• HEALTH ATTAINMENTS AND DEMOGRAPHIC CONCERNS: NATIONAL HUMAN DEVELOPMENT REPORT, • MEDICAL TOURISM IN INDIA: ISSUES AND CHALLENGES: BY CHACKO PHEBA, THE ICFAI UNIVERSITY
2001: CHAPTER 5 PRESS.
• THE STATE OF HUMAN DEVELOPMENT: NATIONAL HUMAN DEVELOPMENT REPORT, 2001: CHAPTER 1 • HEALTH INSURANCE IN INDIA: OPPORTUNITIES, CHALLENGES AND CONCERNS: BY MAVALANKAR DILEEP
• HEALTHCARE IN INDIA, CARING FOR MORE THAN A BILLION: BY SRIVATHSAN APARAJITHAN Y, MATHUR AND BHAT RAMESH, IIM AHMEDABAD
SHANTHI, MOUNIB EDGAR L., NAKHOODA FARHANA, PAI ADITYA AND BASKARAN LIBI, IBM INSTITUTE • INDIA BRAND EQUITY FOUNDATION (IBEF), MARCH 2013, AUGUST 2013 REPORT (WWW.IBEF.ORG)
OF BUSINESS VALUE, IBM GLOBAL BUSINESS SERVICES • HEALTHCARE INDIA SECTOR NOTES, MAY 2014, (WWW.IIMJOBS.COM)
• CASE STUDY ON MANIPLE CURE & CARE: INDEGENEOUS CONCEPT THAT COMBINES HEALTHCARE AND • INDIAN HEALTHCARE SYSTEM – OVERVIEW AND QUALITY IMPROVEMENTS, DIRECT RESPONSE, 2013:04,
RETAIL IN A SINGLE FORMAT: BY PRICE WATER HOUSE AND COOPERS(PWC) AND DYNAMIC VERTICAL SWEDISH AGENCY FOR GROWTH POLICY ANALYSIS , WWW.GROWTHANALYSIS.SE
SOLUTIONS • INDIAN PHARMA, INC.: CAPITALIZING ON INDIA’S GROWTH POTENTIAL, www.pwc.com/India
• INDIAN PHARMACEUTICAL INDUSTRY: ISSUES AND OPPORTUNITIES: RESEARCH AND MARKETS REPORT ( • INDIAN PHARMA INC. CARING FUP OR NEXT LELVEL OF GROWTH, www.pwc.com/India
http://www.researchandmarkets.com/reports/35229)
References
Websites: Other Publications:
• www.technopak.com • MINISTRY OF HEALTH, GOVERNMENT OF INDIA
• www.kpmg.com/infrastructure • INDIAN MEDICAL COUNCIL & INDIAN DENTAL COUNCIL
• www.ibef.org • EXPRESS HEALTHCARE MANAGEMENT
• www.dbresearch.com • INDIAN HEALTHCARE FEDERATION
• www.dynamicverticals.com • MEDICA: PHARMACEUTICAL INDUSTRY PUBLICATIONS
• www.bostonanalytics.com • MEDICA: HEALTHCARE SERVICES PUBLICATIONS
• www.ibm.com/healthcare/hc2015
• www.pwc.com/globalhealthcare Chapters:
• www.wikepedia.com/healthcare
• www.ficci.com • COMPETITION CONCERNS: THE PHARMACEUTICAL INDUSTRY BY CUTS INTERNATIONAL
• www.timeswellness.com • CHAPTER 10: DRUG PRICE DIFFERENTIALS ACROSS DIFFERENT RETAIL MARKET SETTINGS: AN ANALYSIS
• www.fortishealthworld.com OF RETAIL PRICES OF 12 COMMONLY USED DRUGS: BY GODWIN S K AND VARATHARAJAN D., HEALTH
• www.whoindia.org ADMINISTRATOR VOL: XIX NUMBER 1: 41-47
• www.who.int • HEALTHCARE POLICY AND ADMINISTRATION IN INDIA: BY SAPRU R K, STERLING PUBLICATION, II
EDITION, CHAPTER 15, PAGES 228-249.
• www.mohfw.nic.in
• www.crisil.com My Books:
• www.pharmabiz.com
• www.pharma.org • Indian Health Sector and Healthcare System: A critical Insight, LAP Lambert Academic Publishing,
Germany, 2012, ISBN-10: 3659268895, ISBN-13: 978-3659268892, Prashant Mehta
Journals • 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,
• JOURNAL OF THE ACADEMY OF HOSPITAL ADMINISTRATION ISBN-13: 978-3659147302 Prashant Mehta
• INDIAN JOURNAL FOR THE PRACTICING DOCTOR
• JOURNAL OF HEALTHCARE AND MEDICAL TECHNOLOGY AND MANAGEMENT My Publications:
• INDIAN JOURNAL OF MEDICAL ETHICS
• THE PHARMA REVIEW AND PHARMA TIMES • Legal Provisions and Management Perspectives of Biomedical and Hospital Waste in India. Journal
• JOURNAL OF HOSPITAL PHARMACY 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
