Public Health in Democratic India:

Along with its freedom, India inherited a crippling economy, booming population and a deep
healthcare crisis. It should be noted that right before India’s independence, a 20 member
committee was formed headed by Sir Joseph Bhore. The Bhore committee conducted the first
ever and probably the most extensive probe into the healthcare system of India then. The Bhore
committee discovered that the availability of hospitals in India was 0.24 per 1000 population, the
committee made several suggestions for improving the healthcare system in India, however,
within a year of the submission of the said report, British empire, exited India forever. Two five
years plans, following independence, allocated INR 770 crore to develop healthcare but to no
avail. By the third five year plan, the then government decided to conduct another study on
understanding the healthcare problem in India.

This group formed in 1966, also studied the Mudaliar and Bhore reports, along with the
Healthcare Act of 1935, through its understanding of the acts and reports and their shortcomings,
this new group led to the development of the new model of healthcare in India which was a
structured strategy involving ground workers, PHCs, Tertiary Care Centres and Urban Hospitals.

The Indian government also recognized Homeopathy, Ayurveda, Yoga and Naturopathy, Unani
and Siddha as valid alternative approaches to medicine

Timeline of Healthcare in India:

India’s medical history is very interesting because it is the only culture, which wasn’t lost in time
or wiped out to the point of extinction by those who took over like what happened with its
contemporary civilizations in Greece or to the Red-Indian tribes in America. Thus, Indian culture
had the opportunity to assimilate and grow. The current healthcare system in India is a robust one
boasting of supporting modern medicine along with Ayurveda, Yoga and Naturopathy, Unani,
Siddha, and Homeopathy. Here is a brief timeline of the development of healthcare in India:
[table id=41 /]

Healthcare Challenges in India:

Healthcare in India faces several challenges, the biggest challenge being the availability of
quality healthcare. While the India population is concentrated more in rural areas, hospitals and
healthcare centers are concentrated more in urban centers. While several people have correctly
identified India’s healthcare crisis to be multi-pronged:

1. Lack of awareness among people

2. Shortage of trained medical and para-medical practitioners
3. Lack of appropriate infrastructure and equipment
4. Lack of preventive care
5. Delay in appropriate healthcare leading to deaths that could have been prevented
6. The rise of communicable diseases as well, as non-communicable diseases, especially
those related to lifestyle.
 7. Lack of awareness and use of Health Insurance (Private or Government).

The one thing which hasn’t been accounted for is the rapid technological development witnessed
by the world. In our previous post on population and its impact on healthcare, we have discussed
in detail, how the population boom is overburdening the healthcare system in India. Now, with
private sector hospitals offering better pay to doctors and nurses, most medical professionals are
gravitating towards the private sector.

The other bits of the problem are slower government processes, while the world is zooming into
the future, policies that are being followed have not been revised effectively. Thus, quality and
quantity of services suffer at the hands of slow policy development.

India needs a revamping of the healthcare system, there has to be a robust and dynamic policy in
place which could be competitive to private players, the government can at least make the
playing field level for both private and public hospitals. In addition, an intensive awareness
campaign is required to encourage people to seek healthcare from public systems than going to
local faith healers.

Is Healthcare in India Growing?

Healthcare in India has improved substantially since the British period, in fact, India had
successfully achieved a polio-free status in its course of development. In fact, despite being in
the developmental stage, healthcare facilities in India attract several foreigners who seek holistic
healing at cheaper rates. In fact, Kerala has become the capital of ayurvedic treatment which is
both exotic as well wholesome in its process. India is emerging as a hub for quality health
tourism with individuals from developing and developed nations seeking healthcare here.

However, infrastructural development is just one part of the development of the Indian
healthcare sector. The other is the emergence and rise of Online Pharmacies, as the Government
of India is still formulating an exclusive policy for the regulation of online pharmacies. The
online pharmacies in question are flourishing and following strict quality practices on their own.
Though the market share of these pharmacies is less than 5%, the emerging trends indicate that
these e-pharmacies will rise to dominate nearly 30% of the market in the coming years.

How the Internet of Things is Transforming Healthcare:

India’s IT sector is booming, it was but a matter of time before it entered the healthcare system in
India. While the private sector has embraced this technological advancement with open arms, the
public sector is slowly catching up with its private counterparts.

Most private hospitals have launched their apps, here the patients are guided through the
consultation and treatment processes. Patients could select the doctor of their choice and book
appointments according to their comfort.

Online pharmacy apps, like Medlife.com, provide quality medicines at low costs on the patient’s
doorstep, as well as, provide customers with credible information on diseases. Blood tests and
other diagnostic sample collection can be ordered at home through online apps, at incredible
discounts. Doctor consultation for common ailments is available online at a minimum price.

Even the mental healthcare system has been brought online with several sites offering online,
text, call or video based counseling and support to those suffering from medical illnesses like
depression and anxiety.

In fact, more technology is being developed to help patients track their health records and
medicine history. It is postulated that this kind of tracking can help identify the possibility of
disease development, making it easier to have a preventive map.

Health Insurance Policy by Government of India:

Ever since independence and over the course of years the Government of India of the time
realized that more needs to be done to encourage better healthcare and a part of that more was
ensuring that the deprived have enough resources to support the financial aspect of healthcare for
themselves and their loved one:

1. Employees’ State Insurance Scheme (1952):

Employees’ State Insurance Scheme (ESIS) was launched in the year 1952 and has been a social
welfare scheme since then. The scheme covers free medical services for the worker and persons
depending on him or her. Apart from providing wholesome healthcare benefits, the scheme also
provides other cash benefits to employees. This scheme initially covered factories with 10 or
more workers, however, the same has been extended to hotels and restaurants and other places of
work. The current wage limit to be covered under this act is Rs 15,000 per month. Union
Territories like Delhi and Chandigarh, as well as all states apart from Manipur, Sikkim,
Arunachal Pradesh, and Mizoram, offer this scheme.

2. Central Government Health Scheme (1954):

The Central Government Health Scheme was launched in 1954 and provides insurance cover to
all central government employees along with their dependents. The scheme is currently
functional in nearly all state capitals and offers cover under Allopathy as well as AYUSH
systems of healthcare.

3. Janashree Bima Yojana (2000):

The Janashree Bima Yojana was launched to replace two other health insurance schemes under
the names of Rural Group Life Insurance Scheme, and Social Security Group Insurance Scheme.
The scheme identified 45 occupations including Lady Tailors, Brick Kiln Workers, Safai
Karamcharis and so on. Individuals between the ages of 18 years to 59 years and living either
Below Poverty Line (BPL) or slightly above BPL, and following any of the 45 listed occupations
can avail the benefits of this Yojana.

4. Universal Health Insurance Scheme (2003):

The Universal Health Insurance Scheme was designed to provide healthcare support along with
subsidised healthcare to BPL. All public sector insurance companies have been successfully
providing this scheme. This scheme offers INR 30,000 hospitalization benefits, which could be
floated to all members, a compensation of INR 25,000 in case of death and INR 50 per day to the
employee for 15 days, in case he/she loses employment due to sickness.

5. Aam Aadmi Bima Yojana (2003):

The Aam Aadmi Bima Yojana was launched to cover the rural landless poor. The head of the
family or an earning member of the family can avail this scheme, a premium of INR 200 per
person, per annum is divided between the State and Central governments equally. The scheme
provides a lump sum cover of INR 30,000 on natural death, INR 75,000 on death/permanent
disability due to the accident and INR 37,500 on partial permanent disability. The individual
availing this scheme should be between the age of 18 yrs to 59 yrs.

Note: It should be noted that in 2013, Janashree Bima Yojana and Aam Aadmi Bima Yojana were
merged together to form Aam Aadmi Bima Yojana.

6. Rashtriya Swasthya Bima Yojana (2008):

The Rashtriya Swasthya Bima Yojana (RSBY) was launched in 2008 and designed specifically to
protect BPL from health-related shocks. The scheme provides beneficiaries, hospitalization
benefits of up to INR 30,000 with the registration fee of only INR 30. However, the most unique
feature of this scheme was that it was designed to suit all stakeholders. This scheme also saw the
use of IT, as all beneficiaries were given a unique identification code, which would enable them
to avail benefits, as well as filter out fraudulent individuals.

7. Ayushman Bharat Yojana (2018):

As covered in our previous detailed piece, The Ayushman Bharat Yojana was announced 2018,
and is proposed to be launched on August 15, 2018. The scheme is a pan India holistic healthcare
scheme which aims to cover 10.70 Cr Indian families or 40% of the Indian population. This
scheme is the most ambitious scheme taken up by any nation. It seeks to provide a health
insurance of INR 5,00,000 to all beneficiaries, with premiums being shared between the state and
center. Wellness Centres will also be launched as a part of this scheme.

In India’s case it is difficult to ascertain what would be considered as its first hospital, the ones
the British opened or the ones that King Ashoka ran to help his subjects. This is the legacy
India’s healthcare carries forward, in fact, even technology is getting effectively assimilated into
the vast healthcare universe of India. The future is probably pointing to ancient practices coupled
with the technological precision of today, something, the Medlife Essentials Range is bringing to
the fore anyhow. After all, we must peek back to move forward.

News on Indian Health Care System:

Why is India rejecting Govt. Health Care?
     – 17th Aug 2018

The National Health and Family Survey marks out some interesting observations about patient
healthcare option pattern. Despite the fact that in the past year both private and public hospitals
have failed its patients, with Fortis facing a lawsuit for overcharging the treatment of a 7 year old
dengue patient and a government hospital in Uttar Pradesh, reporting the death of 23 children
because of lack of oxygen, nearly 52% of Indians still prefer private medical institutions over
public institutions. This preference for private institutions is higher in urban areas where the
number of private healthcare centres is also high. However, this survey has highlighted the core
issues behind this preference scheme, despite being cheaper, public healthcare centres are not
preferred because of longer waiting line, lack of proper resources, constant absence of medical
staff, lack of infrastructure, and quality of healthcare services offered/provided. Even rural
population now prefers to go to urban centres for their healthcare needs, this has prompted the
current government to convert PHCs, into “Wellness Centres”, giving them the facelift and
revamp, they needed. The most shocking data emerges from states, which are seemingly poor or
comparatively less developed than other Indian states, nearly 80% people in Uttar Pradesh prefer
to go to private hospitals for their healthcare needs. Uttar Pradesh is followed by Bihar at 77.6%,
and Punjab at 72.9%.

Apart from this another problem is that despite the AYUSH department’s efforts only 0.5% of the
urban population and 1.2 % of the rural population opts for alternative medicines. The National
Commission Medical Bill, 2017, has proposed of a bridge course for Indian traditional medicine
practitioners, which will allow them to prescribe allopathic medicines for basic health issues,
however, this move is being contested by allopathic and homeopathic practitioner alike and is up
for debate.