DEMOGRAPHICS
The constitution of India ensures the "right to health" for every citizen. It is the responsibility of the state governments to provide health care services to citizens. The funding for healthcare in India is 3% of GDP and is continuously decreasing since (3.75% in 2013). Government spending currently accounts for 1% of GDP, and the Indian government aims to increase it to 2.5% by 2025.
The infant mortality rate was reduced from 88/1,000 in 1990 to 32/1,000 in 2020. The maternal mortality rate was reduced from 556/100,000 to 113/100,000 during 2016-18.
DESCRIPTION OF HEALTHCARE SYSTEM
India has a mixed healthcare delivery mechanism. Approximately 70% of outpatient and 58% of inpatient services are provided in the private sector. Government healthcare centers account for 30% of outpatients and 42% of inpatient services.
HEALTH INSURANCE COVERAGE
In the National Family Health Survey (NFHS), the government clearly stated that it was not satisfied with the coverage in India. Nealy 41% of households mentioned that at least one household member was covered with health insurance or financing schemes.
The distribution of the coverage of insured people was
Ayushman Bharat PM-JAY – Key Statements with Important Numbers:
Largest Health Assurance Scheme:PM-JAY is the largest health assurance scheme globally, covering 12 crore families (approximately 55 crore beneficiaries).
Health Cover Amount:Each family receives Rs. 5 lakhs per year for secondary and tertiary care hospitalization.
Population Coverage:The scheme targets the bottom 40% of the Indian population, focusing on poor and vulnerable families.
Hospital Network:Benefits are available nationwide across public and private empanelled hospitals.
Pre- and Post-Hospitalization Expenses:PM-JAY covers up to 3 days of pre-hospitalization and 15 days of post-hospitalization expenses, including diagnostics and medicines.
Number of Procedures Covered:The scheme covers 1,929 procedures, encompassing various medical treatments and services.
Poverty Prevention:PM-JAY aims to reduce catastrophic medical expenses that push nearly 6 crore Indians into poverty each year.
Family Size and Age:There is no restriction on family size, age, or gender under the scheme.
Pre-existing Conditions:All pre-existing conditions are covered from day one.
Reimbursement for Public Hospitals:Public hospitals are reimbursed at the same rate as private hospitals for services provided.
The government launched Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana in 2018, which provides cashless secondary and tertiary care for the low-income population. This scheme aims to cover nearly 40% of the population and provides an insurance amount of Rs.500,000 (~$6250) per year. Further, Ayushman Bharat was aimed at reducing out-of-pocket spending.
The state contributes 40% of the funds for public health insurance, and the federal government contributes 60%.
CGHS cover the costs of current and retired central government employees and their dependents.
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ROLE OF GOVERNMENT AND PRIVATE SECTOR
The Ministry of Health and Family Welfare at the federal level is responsible for the policy decisions but was not involved in delivering the majority of services. It is responsible for providing national health programs.
In 2014, the government launched the federal Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy, to promote alternative medicinal practices in India.
The State departments of health and family welfare are involved in the delivery of services. The responsibilities of the state unit are
managing the workforce
collecting health information
supervising the healthcare facilities and services
There is also a significant variation in the delivery of services between the states.
Public sector
Nearly 50% of patients seek care in the public sector whenever the patient becomes sick, and almost 48% of people seek care in private centers. Patients visit government and municipality hospitals. There is a gradual increase in the population using the public sector for health care services (45% in 2015-16 to 50% in 2019-21). All citizens can avail free inpatient and outpatient services in government facilities. However, because of the lack of adequate facilities, patients often opt private sector.
Private sector
Clinics and physicians are most commonly visited in the private sector. A significant portion of patients typically visits high-cost private hospitals for services, which leads to high out-of-pocket costs (65% of health care spending in 2015-16).
DELIVERY OF SERVICES
Primary care: Under the Health and Wellness Centres program, 150,000 subcenters provide primary healthcare services, including free medicines, diagnostics, and healthcare services. Primary healthcare centers (PHCs) and community healthcare centers offer other healthcare services. All the services are provided for free-of-care and require no registration. Community healthcare centers also provide obstetric care and specialist consultations.
All the physicians working in the primary and specialty physicians within the public sector were provided with fixed salaries. It is planned to provide social security and free insurance to these patients.
Outpatient specialty care: Outpatient care is provided at community healthcare centers. District hospitals cover services that are not covered at community healthcare centers.
Hospital care: District hospital is the terminal referral centers. In addition to services provided in the community health center, emergency care, and maternity services, newborn care was provided at district hospitals.
There is an increase in the number of private hospitals in India because of the perceived poor quality of care in public hospitals and increased medical tourism. Public hospitals account for only 10% of total hospitals in India.
Long-term care: The National Programme for Health Care of the Elderly was launched in 2011 to provide long-term care to senior citizens. Free services are provided at the primary and secondary healthcare facilities for the elderly population. The National Health Protection Scheme was launched.
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