Health Care as an Issue at National Level

Under the constitutional mandate it is the primary duty of government to raise the level of nutrition and the standard of living of its people and the improvement of public health.  As per the report of World Bank, in 2015, total expenditure on health was 3.89% of the GDP, of which only 1% was the governmental health expenditure. Most of the healthcare expenses are paid directly out of pocket by patients, rather than through health insurance. Government health policy has encouraged expansion of private health care sector. Health care industry comprises hospitals, medical devices, medical applications, clinical trials, health insurance, telemedicine and health insurance. Health care system in India includes three components- public health care, private health care and Medication.

Public healthcare

It is stated that the government has a responsibility to provide health services that are affordable, adequate, new and acceptable for its citizens.  Public healthcare is essential, especially when considering the costs incurred with private services. Many citizens rely on subsidized healthcare.  Public health care involve primary healthcare centres in rural areas, scant secondary and tertiary care institutions in cities.  Public health care is free and subsidized for the people. Originally the public health care system was developed in order to provide a means to healthcare access regardless of socioeconomic status or caste. It is observed lower standard of living is using public healthcare more than middle and upper class individuals. 

Decisions related to public healthcare are taken by the state and national government separately. The national government deals with healthcare issues such as overall family welfare and prevention of major diseases, while the state governments handle local hospitals, public health, promotion and sanitation, which differ from state to state. 

To provide all citizens with free drugs, diagnostic treatments, and insurance for serious ailments, government showed its concern and formulates a policy in 2014 for a nationwide universal health care system known as the National Health Assurance Mission,.  In April 2018 the government announced the Aayushman Bharat scheme that aims to cover up to Rs. 5 lakh to 100,000,000 vulnerable families.

Private healthcare

Private healthcare Players provides majorly secondary and tertiary care facilities with more focus in Metros, Tier 1 and Tier 2 cities. Private healthcare providers offer high quality treatment at unreasonable high costs as there is no regulatory authority or statutory neutral body to check. In terms of healthcare quality in the private sector, a study by Sanjay Basu published in  PLOS Medicine, indicated that health care providers were more likely to spend a long time with the patients and carry out physical test as a part of the visit compared to those working in public healthcare.

There are several reasons for relying or giving preference to private health sector- main reason is poor quality of care in the public sector. Since experienced healthcare providers are reluctant to visit the rural areas and remote areas, public healthcare sector relies on inexperienced and unmotivated interns (who have to serve in public healthcare clinics as per t requirement of medical curriculum).  Apart from it long distances between public hospitals and residential areas, long wait times, and inconvenient hours of operation are the reasons for relying on private health sector. Less government expenditure on health over the years and the rise of private health care sector, the poor are left with fewer options than before to access health care services. 

Medication

India is biggest consumer of antibiotics per head. Many antibiotics are on sales which have not been approved in India or in the country of origin, although this is prohibited. In a survey it is found samples of the some medicines are either substandard or fake. Rules are made to list some medications in Schedule H1, means medicines cannot be sold without a prescription. Medical store or Pharmacist have to keep records of sales with the prescribing doctor and the patient's details.

Issues in health care system

Access to healthcare, Insufficient infrastructure in Indian health care, Underfunded public health care, Demand for specialty, super specialty and tertiary care hospital due to increasing Age and lifestyle chronic diseases, During seasonal disease, broad gap between availability of hospital beds and required beds, menstrual health or hygiene, rural health care, urban health care, Increasing Global health care organization etc.

Access to health care means the ability to receive services of a certain quality at a specific cost and convenience.  The healthcare system of India is lacking in 3 aspects related to access to healthcare- supply, utilization and attainment.  Utilization of healthcare facility and finally attainment of good health depends upon supply of healthcare facilities. However, there is a huge gap exists between these factors, leading to a collapsed system with insufficient access to healthcare.  Sometime access and entry into hospitals depends on socioeconomic status, education, wealth, and location of residence. Those are in more need often do not have access to healthcare.

Indian health care system has insufficient infrastructure to meet the healthcare demands particularly in rural areas and high concentrations of poor individuals. The public health care system is underfunded with overcrowded hospitals and clinics and inadequate rural coverage. This has resulted in supply demand imbalance. There is increasing incidence of age related and lifestyle related chronic diseases resulting from sedentary lifestyles and increases in carbohydrate rich diets. During spurt of seasonal disease, there is a broad gap between availability of hospital beds and required beds. Global health care organizations have opened their subsidiaries in India for the reason of cheap labour availability.

Rural areas in India have a scarcity of medical professionals. Around 74% of doctors serve in urban areas for 28% of the population. It is a main issue for rural access to healthcare. The lack of doctors in rural area causes citizens to resort to fraudulent or ignorant providers. Doctors do not want to work in rural areas due to insufficient housing, healthcare, education for children, drinking water, sanitation, electricity, shortage of infrastructure for health services roads and transportation. 

The problem of healthcare access arises not only in huge cities but in rapidly growing small urban areas. Here, there are fewer available options for healthcare services and organized governmental bodies are not much in number. Lack of accountability and cooperation in healthcare departments in urban areas is often found.  To survive in this environment, urban people use private services which are plentiful. However, these are often short-staffed, require triple times the payment as a public center, and commonly have bad practice methods. 

There is need to address all these issues in our national health policy from sickness to wellness and for healthy and wealthy India.