CHALLENGES OF HEALTH CARE SYSTEM

INTRODUCTION TO HEALTH
Health is a fundamental human right. So every State Government has a primary responsibility for the
health of its people.
The constitution of India states that “the state shall regard the raising of level of nutrition & standard of
living of its people & the improvement of public health as among its primary duties.”

INTRODUCTION TO HEALTH CARE CHALLENGES

Over the last 50 years India has achieved a lot in terms of health improvement. But still India is way
behind many fast developing countries such as China, Vietnam and Sri Lanka in health indicators (Satia et
al 1999). In case of government funded health care system, the quality and access of services has always
remained major concern. A very rapidly growing private health market has developed in India. This
private sector bridges most of the gaps between what government offers and what people need. However,
with proliferation of various health care technologies and general price rise, the cost of care has also
become very expensive and unaffordable to large segment of population.
Forecasting the future of health care & health policy is an imperfect science. Among the
predictions made in the mid-1980s were that there would be a physician surplus, a growing number of
elderly people, & an increase in the number of people in managed care plans, restructured health benefits,
new technologies, more for-profit health care delivery, rising health care costs, & a restrained federal
government role. All of these issues-with the exception of a physician surplus, which is still being
debated-turned out to have an impact on health policy.
Several of these will continue to challenge policymakers during the next decade, and new or
reemerging issues will also pose challenges.

COMMON HEALTH CARE CHALLENGES OF PRESENT ERA

1. Rising health care costs- India spends about 6% of GDP on health expenditure. Private health care
expenditure is 75% or 4.25% of GDP and most of the rest (1.75%) is government funding. At present,
the insurance coverage is negligible. Most of the public funding is for preventive, promotive and
primary care programmes while private expenditure is largely for curative care. Over the period the
private health care expenditure has grown at the rate of 12.84% per annum. Number of private
doctors and private clinical facilities are also expanding exponentially. Indian health financing scene
raises number of challenges, which are:
÷ Increasing health care costs,
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÷ High financial burden on poor eroding their incomes,

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÷ Increasing burden of new diseases and health risks and
÷ Neglect of preventive and primary care and public health functions due to underfunding of the
government health care.
2. The tiering (rank/division) of health care- Historically, disparities in access to health care and health
outcomes were seen between insured and uninsured people. However, the new approach to cost
containment, which asks individuals to pay more for their own health care, is going to lead to tiering,
in which those with higher incomes will be able to afford a wider range of health care services than
much of the middle class and those with lower incomes. This trend is already visible. Several studies
have found that middle-class insured people experience more problems getting care that are related to
cost than do people with higher incomes. In addition, middle-class people are substantially more
worried than those with higher incomes about paying for health insurance and health.

3. A Shortage of Physicians, particularly ones who are willing to hang up a shingle (work in all type of
situations) in rural and remote areas of the country. “Every year, about 27 000 graduate doctors from
Indian medical colleges. But, more than 75% of Indian doctors are based in cities, whereas about 70%
of patients in this Country are village-based,” says Dr. Swapan Jana, secretary of the Society for
Social Pharmacology, an Indian nongovernmental organization.According to the Government of
India, the doctor-population ratio was a sparse 1:1722 in 2005

4. Growing numbers of elderly people- During the next decade, the proportion of citizens who are age
75 or older will grow from 17 million to 19 million. Death rates are steadily decreasing, while life
expectancy has been increasing. These trends suggest a rapid increase in funding for long-term care
and the development of alternatives to nursing homes. But reduced State budgets, employer
reductions in retiree health benefits, and slow growth in the private long-term care insurance market
suggest that the nation's older elderly will experience tiering in health care and shortages of some
services. Individuals with higher incomes and private long-term care insurance coverage have a wide
variety of options available to them. But because of both insufficient financing and a lack of available
services, middle-class people and those who rely on publicly financed programs faces a restricted
number of choices and may not get the services they need.

5. The uninsured- Health insurance can be defined in very narrow sense where individual or group
purchases in advance health coverage by paying a fee called "premium". But it can be also defined
broadly by including all financing arrangements where consumers can avoid or reduce their
expenditures at time of use of services.
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 Health insurance is very well established in many countries. But in India it is a new concept except
for the organized sector employees. In India only about 2 per cent of total health expenditure is funded by
public/social health insurance while 18 per cent is funded by government budget.
A substantial body of research has shown that the uninsured do not receive the same amount of care
as those with insurance; suffer serious health consequences as a result of being uninsured, and face
serious financial problems when they do get care.

6. New technologies- New technologies pertaining to health care are coming out daily in the market and
it ultimately increase the Government budget of health care by providing these facilities to people for
their health care.

7. The challenge of caring for a billion- India is the second most populous country in the world. The
death rate has declined but birth rates continue to be high in most of the states. Health care structure
in the country is over-burdened by increasing population. Family planning programs need to be
(re)activated.

8. New and reemerging infectious diseases- The recent emergence of severe acute respiratory
syndrome, the steady increases in HIV/AIDS domestically and its rapid growth worldwide and the
emergence of multidrug-resistant bacteria have challenged the health care system. It is now clear that
infectious diseases remain a threat, which will likely lead to greater interest in specialization in
infectious disease and in rebuilding the public health system.

9. The threat of terrorism- The health care system faces increasing challenges in preparing to deal with
the aftermath of terrorist attacks. In many cases, these preparations require the diversion of other
resources.

10. Rediscovery of lifestyle-related health issues- It is found during surveys that people of India are
not following the right lifestyle practices to prevent or to control various health issues. Till now they
are following the traditional practice of eating though they have adopted the recent sedentary
lifestyle. The reason may be lack of knowledge but some inspite of having the knowledge neglect this
crucial part.

11. High Burden of Diseases- India faces high burden of disease because of lack of environmental
sanitation and safe drinking water, under-nutrition, poor living conditions, and limited access to
preventive and curative health services. Lack of education, gender inequality and explosive growth of
population contribute to increasing burden of disease. Full impact of the HIV epidemic and tobacco
related diseases is yet to be felt.
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12. Human Development Indicators: A challenge for all- Longevity, literacy and GDP per capita are
the main indicators of human development. Longevity is a measure of state of health, and is linked to
income and education. Weakness in health sector has an adverse effect on longevity. India ranks low
(115th) amongst world nations judged by HDI.

13. Economic development, Education and Health- Economic deprivation in a large segment of
population results in poor access to health care. Poor educational status leads to non-utilization of
scanty health services and increase in avoidable risk factors. Both are closely related to life
expectancy and IMR. Advances in medicine are responsible for no more than half of the observed
improvement in health indices.

14. Smoking, diabetes and childhood obesity are among the major threats to health- Although
many such lifestyle issues have been important to public health since the 1970s, we see Government
becoming increasingly involved in trying to change behaviors, in order to keep health care costs
down. The infant mortality rate, meanwhile, is around 60/1000 live births per year, or close to the
world average of 56/1000 (Indian J Pediatr 2007;74:454). Saha says that among other challenges are
oropharyngeal, cervical or breast cancer, as well as problems like “cataract, iodine deficiency
disorder, arsenic contamination in water, anemia, malnutrition and other noncommunicable
conditions.” — Sanjit Bagchi MBBS, Kolkata, India
Based on the experiences of the past decade, the biggest challenge facing the health care system, however,
does not appear to be any of those listed above. Rather, it is the continued failure of decision makers to
reach a consensus on how to address the major health care problems facing the country. Several factors
contribute to this failure including the declining levels of civic participation.
If this impasse could be broken during the next decade, then the health care system could see solutions to
many of these problems.
Other health care system challenges are as---
ó Serious imbalance between the rural and urban areas.
ó Status & role of the Director of Health Services.
ó Absence of comprehensive legislation.
ó Medical education not oriented to rural needs.
ó Lack of Community health & Community Health Administrative Research Scheme.
ó Absence of well designed management information system.
ó Inadequate financial resources.
ó Non-availability of dedicated doctors to serve in the villages.
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ó Under- utilization of indigenous systems of medicine.
ó Poor nutrition status of the people.
ó Unsatisfactory management of ESI scheme.

BIBLIOGRAPHY
1. Blendon, Robert J, Desroches, Catherine. Future Health Care Challenges. Issues in Science and
Technology
2. Bagchi S. Growth generates health care challenges in booming India. CMAJ. 2008 April 8; 178(8):
981–83.
3. Dhaar GM, Robbani I. Foundations of Community Medicine. 2 nd ed. New Delhi: Elsevier; 2008. p.
929-930.
4. Gumber A., Kulkarni V. Health Insurance for Informal Sector: Case Study of Gujarat. Economic and
Political Weekly 2000 Sep. 30.
5. www.iimahd.ernet.in/~dileep/PDF%20Files/Insurance.pdf
6. www.supercourse.cn/new_scc/ppt/ppt

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