Healthcare in India – Policy & Perspective

June 11th, 2009

Round Table Discussion – ‘Healthcare in India – Policy & Perspective’ by Dr. Akhil Sangal – CEO, ICHA; Mr. P.K. Hota IAS (Retd.), Former Health Secretary, GOI & Director NIPI; Dr. Vijay Aggarwal – ED, Pushpanjali Healthcare chaired by Mr. Narendra Kumar – Chairman DPS Society; in India International Centre Annexe, Lodhi Road, New Delhi – 3.


  • In contrast to earlier times, the healthcare scenario today presents a very different syndrome. High tech medicine is available today at a high cost only to those who can afford to pay for it and it is regrettable that patients have to suffer on account of want of adequate healthcare because they cannot afford its rising costs. There is an all-pervasive need felt for improving healthcare delivery and all its dimensions.
  • Health is universally accepted as a fundamental right and the thrust of our attempts is to achieve certain benchmarks in National Health Bill 2009.
  • Healthcare, a smaller sub-section of health, encompasses both its technical as well as social aspects. For long, healthcare has been synonymous with only with doctors, though this is no longer true of modern healthcare, which encompasses a much broader perspective. The complexities of modern healthcare have seen it transcend the domain of doctors, rendering it more complex, unsafe and vulnerable.
  • There is a pyramidal structure of need-based healthcare systems, with tertiary care consuming most resources. The unfortunate part is that most of private healthcare, especially corporate healthcare shuns the primary sector, wanting the government to shoulder this basic responsibility.
  • Collaborative partnerships with patients and people who care are much needed, There is a need to upgrade nursing and pharmacy in the country and also to have adequately rained paramedics.
  • There is need for a paradigm shift in the concept of partnership. The corporate world needs to understand that the healthcare industry is a miniscule part of the total healthcare scenario.
  • The Right to Health Bill talks of multi-sectoral issues like the right to appropriate nutrition, housing, water and thus goes beyond health. It describes certain duties of the health sector and lays down conditions that the central and state governments must fulfil. The Right to Health Bill looks more like a statement of hopes, given the reality of the health situation and public administration of health.
  • While in absolute terms the monetary allocation for health has grown, the percentage has hovered around one percent of the government’s investment of GDP, a fact that needs to be taken cognizance of.
  • In multiple insurance products the challenge is to provide low-cost insurance. The country is still in the infancy of experimentations in public sector on health.
  • There is a need for decentralisation and delegation, with due importance to common day-to-day healthcare.
  • One of the biggest problems is not having enough people who can understand healthcare in a comprehensive way. Segregated or compartmentalised approaches to healthcare can no longer work and that policymakers need to recognize this fact.
  • As far as the private healthcare is concerned, the challenges in the field of healthcare is politics in the government, and lack of driving force and quality. Only 15 to 20% of healthcare is covered by the government, with tertiary care hospitals being present only in the metros and the towns. The main private investments are in the small nursing homes and hospitals providing primary and secondary care and not in the tertiary care segment. Only recently have some corporate entities entered healthcare.
  • As on profitability of private hospitals, the average PBIT margin of 128 hospitals was 6% and negative PBIT margin of sample hospitals was about 38%, indicating that these hospitals are not able to meet the interest burden on the money borrowed to finance operations. The ability to sustain future growth opportunities from internal resources in the hospital is extremely limited. Hospitals will need to raise funds from external sources to finance their future requirements.
  • The perception that most nursing home owners do well and lead a luxurious life needs to be juxtaposed against the reality that our younger generation which graduates in engineering or management earns more today than what a doctor earns after 30 or 40 years of his practice.
  • Associations and healthcare managers should lay down norms for minimum quality. Organisations like CGHS and the other government bodies need to keep on talking about quality and perhaps link quality and payment. Industrial houses must step forward to build hospitals.
  • Most private hospitals today make money by sacrificing norms thus jeopardizing patient safety. Patients too, become upset over trivial issues like televisions in the room not having all channels, which have nothing to do with treatment. This lack of focus obscures real issues of treatment, equipment safety and patient care.
  • How can we afford quality hospitals? What about the poor? There is no need for people who can afford to pay to be treated at government hospitals, because this is a waste of resources. If the private sector provides healthcare to poor, there should be adequate mechanism for compensation.


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