Health is wealth, mostly for rich

For more than 1,900 citizens, only one qualified doctor. For over 3,000 people one hospital bed. New government hospitals and medical colleges are a rare sight. Private corporate hospitals which cater mostly to those with deep pockets and corporate patients with full medical cover, are expanding at a mind boggling pace. This is India, 66 years after its independence, the country which before the global community had pledged towards the end of last century that it would provide basic health for all by 2000 AD. In the last 13 years, the healthcare availability gap between the rich and the poor has further widened.

The country is now 50 per cent behind its healthcare target. The recently organised 10th India Health Summit by the Confederation of Indian Industry (CII) stressed the need for a gigantic investment of over Rs. 1,50,000 crore to meet the physical healthcare infrastructure gap in keeping with future demand and integrated solutions. But, who will bell the cat? The government has little money to spend on health and education. Both fields have been thrown open to the private sector which is oriented more towards maximisation of return on investment than service to citizens. The catchy slogan, ‘health for all’, is meant to gather dust in the Planning Commission’s steel almirah.

 India, a major supplier of doctors and nurses to the outside world, is highly short of medicos to attend on its own suffering people. According to an official estimate, the country needs to produce nearly one lakh doctors and five lakh nurses and paramedics per year. For this, it should set up scores of medical colleges, training centres for nurses and paramedics. The number of hospital beds has to increase proportionately. Making available an adequate number of qualified teaching doctors poses a big challenge since few well-qualified specialist physicians and surgeons are interested in high-skilled, low-earning teaching jobs leaving their ‘big private practice.’

 Paradoxically, despite the big shortage of doctors and healthcare infrastructure, this is also a country that boasts the No. 1 global position in cosmetic surgery in terms of number of cases handled. More and more wealth hunting doctors are specialising in cosmetic surgery, a money-spinner, while other areas of specialisation get neglected. More men, women and children are being allowed to die in communicable diseases for want of doctors and medicines. The business is more concerned about lifestyle diseases – obesity, hypertension, diabetes, heart, lever and kidney. The obsession about looking pretty, younger and sexy among millions of the country’s wealthy is driving more and more otherwise healthy individuals to aesthetic medicine and surgery. Liposuction, breast augmentation, hair transplant and rhinoplasty or nose job seem to be getting precedence over general surgery. Plastic surgery is a low risk, big money procedure.

India’s Rs. 3,00,000-crore-plus healthcare business is probably the only unregulated sector of its size anywhere in the world. It is also chaotic and very poorly managed, especially in the state-owned area, where patients are often treated as helpless guinea pigs, neglected as also exploited. The society as a whole is losing trust in both the private and public healthcare systems which guarantee neither cure, nor fair billing to a patient. Consumer complaints against doctors and healthcare establishments in India are now only second to real estate fraud cases listed before the court of justice. And, all this is because of a huge demand-supply mismatch in the healthcare sector and the growing expectation of an increasingly informed society from the sector.

Official healthcare stats are as depressing as scary. India has only one doctor per nearly 2,000 citizens, as against the global average of a little over 700. The World Health Organisation stipulates a minimum ratio of 1:1,000. The Union Health Ministry claims that there are about 6-6.5 lakh doctors in India. However, the truth is about 27 per cent of India’s registered doctors and almost 63 per cent nurses aren’t active anymore. The ministry’s presentation to the Parliamentary Consultative Committee, admitted to some worrying trends in human resources in health.

 Globally, the nurse to doctor ratio is 3:1, India’s count stands at 1.5:1. It is said that India would need about four lakh more nurses by 2020 – 50,000 for public health centres; 0.8 lakh for community health centres; 1.1 lakh for 5,642 sub-centres and another 0.5 lakh for medical college hospitals. By any reckoning, it’s a tall order, even Union Health Minister Ghulam Nabi Azad had admitted. Lately, the ministry has sanctioned 132 Auxillary Nurse Midwives and 137 General Nursing Midwifery schools all over the country. These 269 schools will produce an additional 20,000 nurses every year. Six nursing colleges are also being established at the new AIIMS.

Besides, the number of female allopathic doctors (medical graduates with a bachelor’s or postgraduate specialist diploma or degree registered with the Indian Medical Council) has been abysmally low. Only 17 per cent of all allopathic doctors and six per cent of allopathic doctors in rural areas are women. There is less than one female allopathic doctor per 10,000 population in rural areas (0.5), whereas it is 6.5 in urban areas, according to the ministry.

 India is said to be planning to establish some 200 new medical colleges in the next six years to meet the projected huge shortage of 6,00,000 doctors. However, a skewed distribution of medical colleges is another cause of concern. 

The competitive landscape of the country’s hospital market and medical and para-medical education is primarily segmented into public and private. In the absence of a strong and purposeful regulatory mechanism, the healthcare sector is following its own rule to exploit consumers taking full advantage of the demand supply gap. IPA