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ASSIGNMENT -17
HEALTH SCENARIO HCS
 BY – Lt Col Prakash Singh Dasauni
ASSIGNMENT: HEALTH SCENARIO IN INDIA(PRESENT) (LT COL PRAKASH SINGH DASAUNI)
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HEALTH SCENARIO IN INDIA(PRESENT)
Introduction
1. The growth of a nation is not just about tallying its industrial, agricultural and services balance sheets. It is equally about
tallying its performance on the human development indices. The state of its healthcare is one of the critical measures of
how a nation state is performing. For a country the size of India, that is even more important.
2. The healthcare ecosystem in India is at an inflection point. While the outlook for the healthcare industry is optimistic, there
is a need to move towards an integrated healthcare delivery system, which leverages technology and has the patient at
its center
Challenges for Health Care System in India
3. Dual Disease Burden. Even as the incidence of lifestyle diseases is steadily on the rise, a vast majority of rural and poor
patients still suffer from infectious and acute diseases.
4. Low Penetration of Insurance And Other Payer Mechanisms. The overall quantum of health insurance may have
increased, but it is largely limited to urban areas. In other areas, especially rural, people continue to spend from their own
pockets.
5. Inequity in Infrastructure. While the urban India is witnessing a mushrooming of world-class medical facilities, the rural
areas are bereft of even basic healthcare facilities. This has resulted in severe inequities between the urban and rural
areas across all major health indicators.
6. Low Levels of Healthcare Spend The per capita spend on healthcare (both public and private), as well as the healthcare
spend as a portion of the comparable economies, and way below global averages.
7. Increase in Lifestyle Diseases. Lifestyle-related diseases comprised 13 percent of total ailments in India, according to a
2008 data, and this number is expected to increase to 20 percent by 2018. This is expected to trigger an additional demand
for specialised treatment.
Positives For The Health Care Industry in India
8. Rising Affordability In the past decade, India has witnessed a rapid increase in levels of wealth and disposable incomes.
Coupled with a better standard of living and health awareness, this has led to an increase in spending on healthcare and
wellness.
9. Increase in Lifestyle Diseases. This will lead to increased margins for hospitals since these diseases lie at the high margin
end of the spectrum.
10. Health Insurance And Medical Tourism. While out-of-pocket spending remains the mainstay of healthcare expenditure,
health insurance is gaining momentum in India.The increasing penetration of health insurance is expected to significantly
increase the affordability of healthcare services, driving up the demand for preventive healthcare and curative services.
Medical tourism is also driving the healthcare market in India.The fact that the treatment for major surgeries in India costs
approximately 20 percent of that in developed countries; coupled with the high quality of care in Indian tertiary and
specialty hospitals makes medical tourism attractive for patients from developed as well as emerging economies.
11. Patient/Consumer Centric Healthcare. Given the nature of the healthcare ecosystem in
India, several hospitals and other health facilities are waking up to the need for ‘patient-centric care’. At the core of this
approach is the customer or the patient. It links multiple levels of care management, coordinates services and encourages
professional collaboration across a range of care delivery.
12. Conducive Demographics. While the population growth rate for India has steadily gone down, it is still at over 1.3 percent
and is not expected to go below one percent in the near future. Also, it is interesting to note that our population aged
above 60 years is projected to grow to around 193 million, compared with over 96 million in 2010. This change in the
population pyramid is expected to fuel the demand for healthcare in general, particularly lifestyle diseases.
Health Scenario in India
13. India’s public health care system is patchy, with underfunded and overcrowded hospitals and clinics, and inadequate
rural coverage. Reduced funding by the Indian Government has been attributed to historic failures on the part of the
Ministry of Health and Family Welfare (MHFW) to spend its allocated budget fully. This is despite increasing demand, due, in
part, to growing incidence of age- and lifestyle-related chronic diseases resulting from urbanization, sedentary lifestyles,
changing diets, rising obesity levels, and widespread availability of tobacco products. India’s health care sector witnesses
close to 50 percent spend on in-patient beds for lifestyle diseases, especially in urban and semi-urban pockets. India has
one the world’s highest numbers of diabetes sufferers, at more than 65 million individuals.This trend has resulted in the
mushrooming of super specialty hospitals to combat lifestyle diseases.
14. Out-Of-Pocket (OOP) Spending. The government’s low spending on health care places much of the burden on patients
and their families, as evidenced by the country’s out-of-pocket (OOP) spending rate, one of the world’s highest. According
to the World Health Organization (WHO), just 33 percent of Indian health care expenditures in 2012 came from government
sources. Of the remaining private spending, around 86 percent was OOP.

15. Health Insurance Systems. Several public health insurance systems exist, such as state-level employee insurance for
industrial workers and the central government’s health care plan for civil servants. Several large companies also operate
employee health policies. While health insurance penetration in India is increasing, it has been proposed that better
accessibility to quality health care could be made possible by extending coverage to all employees in the private sector
and by offering inexpensive health plans for the poor. This way, people can have full coverage for themselves, their
families and elders.

16. Health Infrastructure. The statistics for India’s health infrastructure are below that of
other large countries. The U.S. has one bed for every 350 patients while the ratio for Japan is
1 for 85. In contrast, India has one bed for every 1,050 patients. To match bed availability to the standards of more developed
nations, India needs to add 100,000 beds this decade.
17. Health Care Information Technology (HIT). India’s expenditure on health care information technology (HIT) is
considerably low. Hospitals in India will need to increase their IT spend considerably to provide improved and patient-
centric service.
18. Qualified Medical Professionals. The shortage of qualified medical professionals is one of the key challenges facing the
Indian health care industry. India’s ratio of 0.7 doctors and 1.5 nurses per 1,000 people is dramatically lower than the WHO
average of 2.5 doctors and nurses per 1,000 people. Furthermore, there is an acute shortage of paramedical and
administrative professionals. The situation is aggravated by the concentration of medical professionals in urban areas,
which have only 30 percent of India’s population. Many patients, especially those living in rural and semi urban areas, are
still
receiving services from unqualified practitioners. The industry needs an additional 1.54 million doctors and 2.4 million nurses
to match the global average.
19. Mortality Rate. India’s health care professional and infrastructure shortage is one of the major reasons for the country’s
high mortality rate. Although there has been a consistent decline in the Infant Mortality Rate (IMR) and the Under-Five
Mortality Rate (U5MR).
20. Telemedicine. Telemedicine is a fast-emerging sector in India. In 2012, the telemedicine market in India was valued at $7.5
million, and it is expected to rise 20 percent annually, to $18.7 million by 2017. Telemedicine can bridge the rural-urban
divide by extending low-cost consultation and diagnostic facilities to the remotest areas.
21. Mobile Health (mHealth). India’s solid mobile technology infrastructure and the launch of 4G is expected to drive mobile
health (mHealth) adoption. Currently, there are over 20 mhealth initiatives for spreading awareness of family planning and
other ailments – the industry is expected to reach $0.6 billion by 2017.
22. Health Policy. Indian government has announced a new health policy(draft) to focus on reducing malnutrition,
improving the use of essential medicines, expanding immunization, modernizing public hospitals, and instituting a better
tobacco control program. The government wants a holistic health care system that is universally accessible, affordable,
and dramatically reduces OOP expenditures.
23. Regulatory Authority. India still doesn’t have a central regulatory authority for its health care sector. In 2011, a high-level
expert group constituted by the Planning Commission of India suggested setting up a National Health Regulatory and
Development Authority to monitor both government and private-sector health care providers. The group has also
proposed to establish a National Health and Medical Facilities Accreditation Authority (NHMFA) for defining health care
facility standards.
24. Public-Private Partnerships. India’s health care sector is capital-intensive, with long gestation and payback periods for
new projects. Land and infrastructure costs account for 60-70 percent of the capital expenditure for hospitals. Further, the
industry also requires capital for upgrade/maintenance/replacement of medical equipment and expansion. Availability of
capital at a reasonable cost remains a hurdle. One way to increase India’s health care funding and access is through
innovative public-private partnerships. While an appropriate model for partnerships at the primary, secondary, and
tertiary levels still remains a distant dream, participation by the government and private sector will help create a blueprint
for such partnerships to create an infrastructure for the future. One such example in India is SRL (Diagnostic), which has
partnered with the Himachal Pradesh State Government to set up and operate 24 labs in the large state-run hospitals in
various districts, thereby bringing superior diagnostics services to the doorstep of people in remote areas.
25. National Rural Health Mission/National Urban Health Mission (NUHM). These programmes are being implemented in
various areas in partnership with private entities to reach to the poorest section of people, with special emphasis to
women and children. Problem Areas
26.
27. Statistics. Some disturbing facts about Indian health situation are the chronic issue of Infant Mortality Rate and Maternal
Mortality Rate that is even lesser that many low-income countries.
28. Low bed density,doctor-to-patient ratio in rural areas.
29. Low budget expenditure.

29. Below standard infrastructure for a larger population.
30. Inadequate and under-trained staffs.
32. Lack of public private collaboration.

31. Insufficient incentives
Suggestions For Improvement.

34 Government must provide effective health insurance to the poor, along with payments or incentives through social
welfare programmes.
35. Resources required for the emancipation of this sector, such as number of trained doctors and medical staffs, as well as
infrastructure gap must be taken seriously. Also, generic medicines availability must be made more rampant.
36. Proper payment to AYUSH, SHG, ASHA or other medical practitioners must be made mandatory for far outreach of health
awareness and prevention.
37. Any malpractice or treatment discrepancies must be strictly punishable and monitored at any cost.
38. Increase in the health budget allocation, to cover the entire population in need.
39. government should focus on establishing more medical colleges and training institutes to provide the requisite doctors,
dentists, nurses and paramedics.

40. Government should leverage information technology (IT) to create patient-centric healthcare systems that can improve
response times, reduce human error, save costs, and impact the quality of life.
41. The government should invest in preventive and social medicine by promoting health education and preventive health-
care concepts.
National Health Policy
43. Health policyrefers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a
society. An explicit health policy can achieve several things: it defines a vision for the future which in turn helps to
establish targets and points of reference for the short and medium term.
National Health Policy 2015 Draft
44. Goal. The attainment of the highest possible level of good health and well-being, through a preventive and promotive
health care orientation in all developmental policies, and universal access to good quality health care services without
anyone having to face financial hardship as a consequence.
45. Key Policy Principles.

46. Equity. Public expenditure in health care, prioritizing the needs of the most vulnerable, who suffer the largest burden of
disease, would imply greater investment in access and financial protection measures for the poor. Reducing inequity
would also mean affirmative action to reach the poorest and minimizing disparity on account of gender, poverty, caste,
disability, other forms of social exclusion and geographical barriers. Universality: Systems and services are designed to
cater to the entire population- not only a targeted sub-group. Care to be taken to prevent exclusions on social or
economic grounds.
47. Patient Centered & Quality of Care. Health Care services would be effective, safe, and convenient, provided
with dignity and confidentiality with all facilities across all sectors being assessed, certified and incentivized to
maintain quality of care.
48. Inclusive Partnerships. The task of providing health care for all cannot be undertaken by Government, acting
alone. It would also require the participation of communities – who view this participation as a means and a goal, as a
right and as a duty. It would also require the widest level of partnerships with academic institutions, not for profit
agencies and with the commercial private sector and health care industry to achieve these goals.
49. Pluralism. Patients who so choose and when appropriate, would have access to AYUSH care providers
based on validated local health traditions. These systems would also have 14 Government support and supervision to
develop and enrich their contribution to meeting the national health goals and objectives. Research,
development of models of integrative practice, efforts at documentation, validation of traditional practices and
engagement with such practitioners would form important elements of enabling medical pluralism.
50. Subsidiarity. For ensuring responsiveness and greater participation, increasing transfer of decision making to as
decentralized a level as is consistent with practical considerations and institutional capacity would be promoted.
(Nothing should be done by a larger and more complex organization which can be done as well by a
smaller and simpler organization.
51. Accountability. Financial and performance accountability, transparency in decision making, and elimination of
corruption in health care systems, both in the public systems and in the private health care industry, would be
essential. Professionalism, Integrity and Ethics: Health workers and managers shall perform their work with the
highest level of professionalism, integrity and trust and be supported by a systems and regulatory environment that
enables this.
52. Learning and Adaptive System. constantly improving dynamic organization of health care which is knowledge and
evidence based, reflective and learning from the communities they serve, the experience of implementation itself, and
from national and international knowledge partners.
53. Affordability. As costs of care rise, affordability, as distinct from equity, requires emphasis. Health care costs of a
household exceeding 10% of its total monthly consumption expenditures or 40% of its non-food consumption
expenditure- is designated catastrophic health expenditures- and is declared as an unacceptable level of
health care costs. Impoverishment due to health care costs is of course, even more unacceptable.
46. Objectives.
47. Improve population health status through concerted policy action in all sectors and expand preventive, promotive,
curative, palliative and rehabilitative services provided by the public health sector.
48. Achieve a significant reduction in out of pocket expenditure due to health care costs and reduction in proportion of
households experiencing catastrophic health expenditures and consequent impoverishment.
49. Assure universal availability of free, comprehensive primary health care services, as an entitlement, for all aspects
of reproductive, maternal, child and adolescent health and for the most prevalent communicable and non-
communicable diseases in the population.
50. Enable universal access to free essential drugs, diagnostics, emergency ambulance services, and emergency
medical and surgical care services in public health facilities, so as to enhance the financial protection role of public
facilities for all sections of the population.
51. Ensure improved access and affordability of secondary and tertiary care services through a combination of public
hospitals and strategic purchasing of services from the private health sector.
52. Influence the growth of the private health care industry and medical technologies to ensure alignment with public
health goals, and enable contribution to making health care systems more effective, efficient, rational, safe, affordable
and ethical.
53. Policy Directions.
54. The National Health Policy accepts and endorses the understanding that a full achievement of the goals and
principles as defined would require an increased public health expenditure to 4 to 5% of the GDP.
However, given that the NHP, 2002 target of 2% was not met, and taking into account the financial
capacity of the country to provide this amount and the institutional capacity to utilize the
increased funding in an effective manner, this policy proposes a potentially achievable target of
raising public health expenditure to 2.5 % of the GDP. It also notes that 40% of this would need to come from
Central expenditures. At current prices, a target of 2.5% of GDP translates to Rs. 3800 per capita,
representing an almost four fold increase in five years. Thus a longer time frame may be
appropriate to even reach this modest target.
55. The major source of financing would remain general taxation. With the projection of a promising
economic growth, the fiscal capacity to provide this level of financing should become available. The
Government would explore the creation of a health cess on the lines of the education cess for raising the
necessary resources. Other than general taxation, this cess could mobilise contributions from
specific commodity taxes- such as the taxes on tobacco, and alcohol, from specific
industries and innovative forms of resource mobilization. Extractive industries and development projects
that result in displacement, or those that have negative impacts on natural habitats or the resource
base can be considered for special taxation thereby allowing investment and job opportunities in
education and health for affected communities.
56. Since about 50% of health expenditure goes into human resources for health, an equitous
growth of health and education sectors would also lead to increased employment in many areas
and communities, which do not otherwise benefit from the economic growth rate, particularly where jobless
growth is a phenomenon. High public investment in health care is one of the most efficient ways of
ameliorating inequities, and for this reason, this commitment to higher public expenditures is essential.
57. Corporate social responsibility has now been made mandatory- and this avenue should be maximally
leveraged. Though actual CSR flows to health care may be modest in comparison to needs, these could
be leveraged for well-focused programmes, communities or geographies with special levels of vulnerability
which require special attention.
Conclusion.
48. Having reviewed the health scenario in India, it becomes evident that concerted efforts have to be made by the
government and the community for improving the quality of life of people. While one can notice a considerable
progress in certain fronts; in the field of health, all is not so well.
49. We will have to ensure equitable distribution of health services for ensuring equity for health. Location of health services
and facilities should be such that these are easily accessible and available to people, especially the under-privileged
sections of the society. Regionalization of health care services with clear-cut geographical demarcation for use of
facilities along with proper two-way referral system would go a long way to ensure equitable distribution of health
services to all.
50. Strengthening of international partnership in health by integrated involvement of international organisations and
agencies in important national health programmes and having a common platform for sharing experiences and
expertise in health among various countries especially in the South East Asian countries are important requirements.
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HOME ABOUT SUBJECTS STUDENT GALLERY RESEARCH PAPERS

HEALTH SCENARIO HCS

 BY – Lt Col Prakash Singh Dasauni

ASSIGNMENT: HEALTH SCENARIO IN INDIA(PRESENT) (LT COL PRAKASH SINGH DASAUNI)

HEALTH SCENARIO IN INDIA(PRESENT)

Challenges for Health Care System in India

patients still suffer from infectious and acute diseases.

areas across all major health indicators.

Positives For The Health Care Industry in India

end of the spectrum.

Health Scenario in India

mushrooming of super specialty hospitals to combat lifestyle diseases.

sources. Of the remaining private spending, around 86 percent was OOP.

families and elders.

nations, India needs to add 100,000 beds this decade.

to match the global average.

Mortality Rate (U5MR).

other ailments – the industry is expected to reach $0.6 billion by 2017.

women and children. Problem Areas

Mortality Rate that is even lesser that many low-income countries.

28. Low bed density,doctor-to-patient ratio in rural areas.

29. Low budget expenditure.

32. Lack of public private collaboration.

Suggestions For Improvement.

awareness and prevention.

dentists, nurses and paramedics.

National Health Policy

National Health Policy 2015 Draft

anyone having to face financial hardship as a consequence.

45. Key Policy Principles.

maintain quality of care.

smaller and simpler organization.

from national and international knowledge partners.

households experiencing catastrophic health expenditures and consequent impoverishment.

communicable diseases in the population.

and ethical.

53. Policy Directions.

appropriate to even reach this modest target.

education and health for affected communities.

ABOUT US QUICK LINK SUBJECTS CONTACT INFO

Dear visitor you are welcome to this

various sources whether it be books or Research papers Principles of  info@mastertutorials.org

online search engines. This website Coordination.

expert faculties who are specialized in

their respective subjects and have vast

experience in education sector.

Copyrights 2017 www.mastertutorials.orgDesign and development by Intlum

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