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Challenges For The Government In Healthcare

With about 50 million migratory population which is 'intra-state', mainly residing in the metros & another 20-25 million 'inter-state' migratory population, the threat of 'health concerns raised by migration' looms large & a govt. intervention in an organised way only seems to be the solution in sight

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On this World Health Day, WHO's theme was on 'mental health' of the society, it is imperative to also have a hawk's eye on the Fiscal Health of the country's 'Healthcare System' of 1.3 billion population, which majorly depends on how our Govt. performs on this front. Swadeep Srivastava, a 'Health Communications' expert turned into 'Providing Teach-enabled solutions to Patient Journey Challenges', throws light on few of challenges at hand…

The Indian healthcare industry is marked by contrasts - by its strengths and by its weaknesses (challenge). The Indian healthcare industry's huge pool of highly competent professionals - doctors, nurses, and paramedical staff - combined with its cost-effective nature is among its greatest strengths. According to Deloitte Touche Tohmatsu India, the Indian healthcare market now valued at around $100 billion, could grow to $280 billion by 2020, at a Compounded Annual Growth Rate (CAGR) of 22.9 per cent. As for the negatives, according to the Central Bureau of Health Intelligence (CBHI), India had just seven doctors per 10,000 people in 2015. The comparative figure for the US is 25 and for the world is 13. Therein lies the first challenge for the government in providing adequate healthcare services to India's 1.3 billion strong population.

The dilemma still persists- Private or Govt. Healthcare & what's the right balance: The Indian healthcare industry's delivery system is divided into two -- Government hospitals and Private hospitals. In major cities and towns, the former has set up secondary and tertiary care institutions, while in the rural areas it dispenses medical services through primary healthcare centres (PHCs). Private hospitals, on the other hand, provide secondary, tertiary and specialised care institutions with major focus on Metros, and larger cities & towns. This type of break-up is based on the purchasing power of the people residing in these areas. Government hospitals provide free or near-free services, which are largely availed of by the rural folk and the urban poor, while private hospitals charge market rates for their services, which is affordable only by the middle and upper classes. Besides, penetration of health insurance cover plays a major role in the way the medical services industry is currently distributed in India, with little or no presence of this line of insurance service in rural areas (as a result of which people do not avail of paid medical services on a large scale), and steadily rising presence in towns, cities and Metros (as a result, the comfort level of people consulting doctors and paying for medical services is rising). So, this is one big challenge for the government - to increase the spread of the full bouquet of medical services to the last man in the village, and make it affordable to him, not through subsidies/handouts but by the spread of insurance and through innovative routes of bringing medical services to the remotest area.

India is estimated to require about 700,000 additional hospital beds in the next five years. This works out to an investment size of $25-30 billion. This investment size can be looked at both as a challenge and as an opportunity. Challenge - if the government alone is called upon to make this investment and set up the infrastructure. Opportunity - if the government prepares the groundwork for private players (private healthcare providers, Private Equity, Venture Capital, Pension Funds, College Endowment Funds, etc) to participate in setting it up.

"First, for the government to come up with such a huge amount is near-impossible. Second, government delivery systems in this country are infamous for their leakages. So, to expecting something on the lines of the healthcare delivery systems prevalent in say, some of the European countries would be expecting too much to say the least. We need to look at greater coordination between the government and private players to achieve such big goals." said Dr. Vivek Srivastava, Founder & CEO, Health Care At Home, India's leading home health services provider.

Universal Health Policy- good beginning but just a drop in the ocean: The National Health Policy 2017 envisages raising public health expenditure to 2.5 per cent of Gross Domestic Product (GDP) in a time-bound manner. This is being said from 2015 onwards, but healthcare spending continues to lag at around 1 per cent even now. India is one of the countries with the lowest public spending on healthcare. India needs to raise public spending on healthcare at a fast pace. And this spending needs to be focussed to reach those who cannot afford it, but need it badly. That is the biggest challenge for the government at this time. Taxation alone cannot help raise such gargantuan amounts. It has to come from both the government and private players. And for that, private players with deep pockets, who follow ethical manner of conducting business and who have a very long-term view, needs to be tapped. Of course, it should be made profitable for them too. So, to find the right mix is the biggest challenge of all for the government.

Migration & Health Impact- a dedicated Program need of the time: Another important factor, with rising urbanisation & the migratory population growing at a massive rate, a real plan need to be put by the Govt. to strengthen the Urban Health Mission with a great emphasis on the 'health of the poor' living in slums & newly developed habitations & have very less or no access to the Govt's PHCs/ CHCs & cannot afford the organised healthcare facilities provided by the Private sector. With about 50 million migratory population which is 'intra-state', mainly residing in the metros & another 20-25 million 'inter-state' migratory population, the threat of 'health concerns raised by migration' looms large & a govt. intervention in an organised way only seems to be the solution in sight.

Disclaimer: The views expressed in the article above are those of the authors' and do not necessarily represent or reflect the views of this publishing house. Unless otherwise noted, the author is writing in his/her personal capacity. They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency or institution.

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Swadeep Srivastava

The author is founder & Managing Partner of, personalized e-Valet for Medical Travellers

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