The two sides to India’s hospital infrastructure – Shaan Ghosh, India

The Ahmedabad branch of Apollo Hospitals, an Indian medical corporation

The Indian government cut funding for public healthcare by 20% in last year’s budget, prompting inquiry into how the country really fares when it comes to the physical well-being of its citizens. Only about 1% of the Indian GDP is spent on health, and after paying the salaries of staff, it would seem that there is not enough left over to equip each hospital in the country, especially in rural areas.

As the government does not make spending on the provision of universal healthcare a priority, it is evident that it is the citizens who will bear the brunt of payment for any medical facilities. It is also a fact that less than 3% of Indians pay income tax, meaning that the cost of public facilities, rather than being spread out among the population, is shouldered mainly by the patients in their time of need. This is why sudden expenditure on medical emergencies or unanticipated ill-health is the single biggest reason for families falling below the poverty line.

However, simply increasing the government subsidy on hospital fees will not solve things, as the problem arises from an aversion of the populace towards the healthcare system. Especially in more backward parts of the country, people often put off visiting the doctor until the last possible moment, meaning that the costs are far higher than they would be if diagnoses were made before complications arose.

In fact, many people – 70% in urban areas and 63% in rural areas according to the third National Family Health Survey – opt to use private health services rather than government facilities. Private hospitals are thought to be more capable of providing care – and they are also more capable of providing services deemed illegal in India such as prenatal sex determination.

The terms and conditions of health insurance are often such that a claimant will not get reimbursement unless they are actually admitted for a hospital stay. Hospitals, however, are not keen on making a patient take up one of their beds even overnight if it can be helped, as hospitals around the country face a shortage of beds. This results in patients being charged out of their own pockets for many essential medical procedures.

While this is an issue for large numbers of Indians, there are many foreign patients for whom the costs associated with surgery and treatment are still relatively cheap. These patients come from countries such as USA and UK and travel to countries like India, Thailand and Singapore to be admitted to super-specialty hospitals which are run by multinational corporations and boast of doctors with unparalleled experience, especially in cardiology, orthopaedics, nephrology, oncology and neurosurgery. Unlike in the hospitals meant for the common citizens, here, patients can expect to be promptly seen, receive personal care and be monitored for the entirety of their treatment and recovery.

India has emerged as a key player in this industry despite ranking lower in health indicators than some of its neighbours (such as Sri Lanka) because of the prevalence of English-speaking doctors and high success rates in hospitals for the surgeries in which they specialise. The explanation behind the coexistence of ill-equipped hospitals and super-specialty hospitals in the same country lies in the structure of medical education in India.

States have often faced difficulty in managing schools which offer the qualifications such Bachelor of Medicine or Doctorate of Medicine, and have welcomed the intervention of private groups or individuals in setting up medical colleges. This means that an increasing number of aspiring doctors and nurses are obtaining their higher medical education in the private sector.
Under-5 Mortality Rate in India (per 1000 live births)

Under-5 Mortality Rate in India

However, inspections have uncovered corruption at every level of the private medical sector. Many medical colleges pay hefty bribes to the Medical Council of India to be registered despite the absence of sufficient facilities. The purpose of private establishments is to generate profits, even if they are not corrupt. As a result, these colleges charge exorbitant tuition fees and often require unofficial “donations” of lakhs of rupees for a candidate to be considered for enrolment. Medical students aiming for these colleges, unless they achieve an extraordinary rank in the all-India entrance tests, therefore must either be very rich or face crushing debt.

Consider the newly qualified doctors who graduate from such schools: if they have any other option, they are unlikely to accept a job in a government hospital (especially in a rural area) or in a small private hospital. These thus tend to be the very same hospitals that are chronically understaffed, or staffed with under-qualified, underpaid and overworked practitioners.

Graduates see specialisation as the best way to obtain a more lucrative position and pay off the debts of medical tuition. To prepare for entrance into postgraduate specialisation programmes, medical students spend years living at home and then several more years actually obtaining the degree, while the medical workforce is deprived of all these fresh graduates. Once they do enter the market, they are only willing to work in the super-speciality hospitals mentioned earlier.

There is clearly a dichotomy in the medical care sector of India and its basic cause is disparity in wealth. While foreign patients benefit from the best healthcare that India has to offer at much cheaper rates than in their native countries, a massive chunk of the Indian population is denied this standard of treatment because of the expenses involved. The country as a whole is not living up to its classification as a welfare state and this state of affairs is certainly not healthy.

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