An advanced nation has to have a strong healthcare system

The nation intends to celebrate its 100 years of independence in 2047 and transform into “Viksit Bharat,” or “Developed India.” It is predicted to surpass China, Germany, and Japan and reach a $35 trillion economy by then, making it the second biggest in the world after only the US. But in order to get there, it would need to increase by 9–10% annually for around three decades from its current growth rate of more than 7%, which already makes it the world’s fastest-growing major economy. For the time, putting aside the idea that such discourse is just electioneering hyperbole, it falls to those who construct scenarios to provide a course that explains the source of such persistently high growth.

The healthcare sector, in which India now performs badly by international standards, is one, but not the only, area in which this aim may be more easily attained. This is especially important as a developed nation has to have a robust healthcare system. A London-based think tank called the Legatum Institute has made it its mission to assess and rank healthcare systems worldwide according to how easy it is for their populace to get the treatment they need to stay healthy. Singapore is placed first, as predicted, and is followed (in that order) by Japan, South Korea, Taiwan, and China. Sri Lanka (47th) is even higher than the US (69th) in the rankings; India (112th) is not included in the top 100! Fortunately, India’s healthcare system does not rank among the worst ten in the world.

India’s healthcare spending increased in the most recent fiscal year (2022–2023), up from 1.6% of GDP in 2021–2022. However, according to World Bank data, even at this point, it remained the lowest among the BRICS nations (for 2019). With its 3 percent GDP expenditure at the time, India’s spending was lower than that of China (5.3%), Sri Lanka (4.1%), Brazil (9.6%), and Japan (10.7%). Bangladesh was the only country that lagged at 2.5%.

Thankfully, there seems to be a recognition on the part of the government that more has to be done in the area of healthcare, as seen by the Interim Budget, which has allocated a commendable 14% increase in healthcare spending to Rs 90,000 crore over the previous year. However, because healthcare accounts for roughly 11% of GDP, and retail inflation is around 4%, this will not have an impact on that percentage. But there’s more good news. After receiving almost little funding before, the pharmaceutical industry—which has elevated India to the status of a worldwide pharmacy by providing accessible and reasonably priced medications—has been given Rs 1,300 crore for development expenses.

There’s one more encouraging tendency. According to World Bank statistics, out-of-pocket health expenditures, which often push the impoverished into poverty, have decreased from a high of 69% in 2013 to 51% in 2020.

What can we infer from all these numbers? If India wants to become a developed nation, it still has a long way to go in terms of healthcare reform. That won’t be feasible if the next generation of workers isn’t competent and healthy enough to be able to significantly contribute to the workforce.

The Prime Minister’s Ayushman Bharat Jan Arogya Yojana (PM-JAY), which was introduced in 2018, is a crucial government effort aimed at advancing healthcare to benefit the impoverished. For the poorer half of society, it provides free access to health insurance. It offers free secondary and tertiary treatment in accredited public and private institutions, with a yearly coverage of Rs 5 lakh per family. Additionally, 1.5 lakh primary health centers and sub-centers will be upgraded into health and wellness centers, each of which will contain a medical officer, a nurse, a pharmacist, and a lab technician, in an effort to offer significantly better primary care.

Under the PM-JAY program, the Interim Budget has included anganwadi workers, who look after and feed preschool-aged children, and ASHA workers, who visit low-income families at home to provide vaccinations and maternity-related care. In order to get 90% complete immunization, the government will also introduce U-Vin, a platform for managing vaccinations. Additionally, it will promote cervical cancer vaccine among girls between the ages of 9 and 14.

One important initiative to increase access to tertiary care has also been highlighted in the Budget. By making use of the current tertiary care hospital infrastructure, it will aid in the establishment of medical colleges. Medical colleges have already begun to be established on the grounds of district hospitals. More trainee physicians and nurses are available around-the-clock when there is a medical college.

Many of the aforementioned are written plans. What is the actual situation on the ground? A poor family should be able to access secondary and tertiary care by having their sick member transported to the closest accredited hospital, whether it be public or private, where treatment may be given under a cashless system without charge. Official sources are happy to provide numbers to prove that the plan is functioning well, but anecdotal information indicates that there are many problems.

The state-owned General Insurance Corporation of India has introduced a scheme that allows policyholders to get treatment at any hospital under the cashless hospitalization service, making things easier for privately insured individuals. The hospital will pay the cost at the hospital even if it is not in the insurer’s network, allowing policyholders to get care without using cash. However, the Indian Medical Association’s Hospital Board of India has advised health centers against entering into “cashless everywhere” contracts with insurance companies or third party administrators (TPA) since doing so would negatively impact hospital finances and make it difficult to get reimbursement under insurance policies.

It will take a while until all people have access to healthcare, which is necessary for a nation to become developed. All we can say is that a start has been made, but the truth is that public hospitals are overcrowded, and the “private hospital and health insurance” route essentially entails admitting a patient with a sizable deposit, then negotiating with the TPA to get the remaining balance waived, often at the expense of many hospital-charged expenses.