India: Some Data on Healthcare

Healthcare and education facilities still are dismal and nightmarish in rural India. Even if one has strong emotional attachment to his or her sweet village home in rural India, he or she can’t execute the call of the heart because of almost totally missing healthcare facility that is the cause of many avoidable deaths. Who will like to go for a suicide because of certain love of a place? At least this is the condition in all the villages I know in Bihar even after nine years of Nitish Kumar rule.

1. India spends around 5.9% of GDP on health care. The country’s health care industry is estimated to be worth around US$65 billion, is growing at a 15% compound annual growth rate and is expected to be a US$250 billion opportunity by 2020.
2. The primary health care sector in India is around US$39 billion in size. The country has around 26,000 government-run primary health care centers and 615 district-level hospitals.
3. There are around 200,000 privately-owned general physician clinics, mostly single physician with basic MBBS qualification, in the country.
4. Around 80% of the population in India turns to private care-providers and more than 75% of their health care spending is out of their own pocket.
5. Hospital admissions reduce by 40% and health care costs reduce by 30% if a country’s primary health care system is strong.
6. The capital expenditure required to build a typical clinic costs anywhere from US$30,000 to US$45,000 or more, while operating costs are upward of US$2,500 a month.
7. By 2020, the average Indian will be only 29 years of age, compared with 37 in China and the U.S., 45 in Western Europe, and 48 in Japan. India will experience an age advantage for at least three decades, through 2040.
8. There are 328 million pregnancies every year, but we see 56,000 maternal deaths.
9. Only 30.80 per cent of rural households have access to tap water. About 22 per cent of rural households have to fetch drinking water from sources that are more than 500 metres away from their premises.
10. The public sector actually provides only about 20% of actual care services. Several infectious diseases and vaccine-preventable childhood diseases still contribute 30% of the disease burden in India as measured in “disability adjusted life years lost.”
11. India has the world’s greatest burden of maternal, newborn and childhood deaths. India also has the greatest number of undernourished children.
12. Healthcare expenditures exacerbate poverty, with about 39 million people falling into poverty every year as a result of such expenditures.
13. As much as 80% of Indian healthcare is privately provided, and that care is increasingly funded by insurance programmes.
14. Financial protection against medical expenditures is far from universal with only 10% of the population having medical insurance.
15. Aarogyasri Health Insurance scheme in Andhra Pradesh has networked 241 private and 97 government hospitals to provide cashless treatment of 938 hospital procedures for more than 70 million people. The government pays the premium of R439 per family per year and there is no co-payment by the families.
16. In twenty years, the cost of heart surgery has come down by nearly 50%.But this care is reaching perhaps less than 20% of the population. 80% of people really do not have such access. A few hospitals have sufficiently large infrastructure to do about 30 to 35 heart surgeries a day. According to Dr. Devi Shetty, last year they implanted the largest number of heart valves in the world – so the valve companies give us a better price on the valves.
17. In the past five decades life expectancy has increased from 50 years to over 64 in 2000. IMR has come down from 1476 to 7. Crude birth rates have dropped to 26.1 and death rates to 8.7.
18. Only 48 per cent of the 1.35 million beds are functional and relevant and about 65 per cent of these are located in the top 20 cities.
19. The most optimistic estimates put this number at less than 5 lakh. More than 65 per cent of the operational beds are in the private sector, and more than 80 per cent of the spending on healthcare in India is accounted for by the private sector even though over 65 per cent of India’s population is below the poverty line or living just on its fringes. No wonder that on an all-India basis, an Indian has to travel an average of 77 km to access basic secondary care services.
20. Heart diseases, diabetes, and cancer are expected to show a combined average decadal growth of 47 per cent in future.
21. India has only 0.6 doctors per 1,000 people, and the majority of the practitioners are based in urban areas. In addition, Indians cover 75% of their medical expenses from their own pockets, rather than with insurance.
22. Citizens in India spent Rs 1,650 billion, or 3.16 percent of the GDP (in 2011-12), on health care, whereas the government spent only 1.04 percent.In other words, a family of four spends nearly Rs 10,000 per year on health care. “Surprisingly, hospitals are treated on a par with the entertainment industry for tax calculation. We have a shortage of more than 1 million doctors. But we make such stringent rules in running a medical college that no one can start medical colleges in this country; even if one starts, it costs over Rs 200-300 crore, whereas anywhere in the world one can start a medical college with any building. They don’t need 25 acres of land and teachers retiring at 60,” said Dr. Setty, the famous cardiologist.
23. Today, a nurse who has worked in hospitals for 20 years cannot give a paracetamol tablet legally. Doctors such as Devi Shetty are speaking about some change in regulation for alternative medical specialists and nurses can look at primary care for almost a decade, everyone thinks it’s a great idea, but nothing happens in reality, because medical lobbies are very powerful.

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