Indian Healthcare: Will Hindsight Provide Foresight for Proper Care in 2020 and Beyond?

It is well-known India is one of two countries with more than one billion residents. The 1.5 billion people living in India makes the South Asian nation the world’s second largest, behind China. What happens when one of the billions of Indians fall ill? What system is in place to help take care of her folks? Does India have a system in place to ensure proper healthcare is delivered to the masses – especially when you factor in many within the country can’t afford the proper medical care, in the first place? These questions are at the forefront of policymaking India. The world is closely watching while India’s citizenry eagerly awaits answers. Can the United States, just the same, learn a lesson or two (or more) from the paths India takes (or doesn’t take) in solving its own healthcare crisis?

Healthcare in India, like the United States, is a flawed system. Both countries face similar issues – unaffordable medical care, heavy influence of pharmaceuticals in doctor-patient interactions and a lack of delivery of certain services. What India does to address these large cracks in the healthcare system could very well influence how other countries address their own shortcomings in everyday medical care. Indian policymakers, whatever they develop, ultimately have to create a system where high-quality healthcare is delivered in the most trustworthy way. Hints of greed, underqualified caregivers and inefficiency must be dispelled.

 Indian Prime Minister Narendra Modi, who was recently re-elected to a second five-year term as the country’s head of state, helped launch a government funded healthcare initiative in 2018 called Ayushman Bharat (long life for India). The initiative would help deliver healthcare to 500 million of the poorest Indian citizens. Those covered under this new policy would receive family healthcare coverage, up to Rs 500,000 (US$7,000), regardless of preexisting conditions. The initiative also establishes a framework for creating “Health and Wellness Centers,” which would be responsible for comprehensive primary care.

Insurance policies and primary caregivers have historically neglected components within the Indian healthcare sector. The Indian government, conversly, firmly believes these measures can widen healthcare coverage beyond large, metropolitan Indian cities. A vast majority of India’s citizens still live in large villages or rural areas.

Does Ayushman Bharat adequately address some of the countries maladies when it comes healthcare delivery? India, for many decades, has been hindered by several long-standing obstacles when it comes to the question of healthcare. At the forefront of such obstacles: healthcare expenditure leading to financial ruin, having the supply of caregivers to handle the growing population demands and providing quality, evidence-based healthcare to create a system of trust between caregivers and patients.

Most of Indian healthcare is funded privately, by out of pocket pay. The economic upper class can afford to pay out of pocket for healthcare, but the economic middle and lower classes are often left in debt from catastrophic financial bills, hence leading to economic disaster. Medical debts, sadly, are passed down and inherited by the children, leaving them to pay for care their parents received.

One might think there is a correlation between financial ruin from catastrophic medical bills (expenditures of 10-25 percent of annual family income) and insurance policy holders, but only 20 percent of the population has coverage, with 17 percent having catastrophic healthcare expenditures.   Insurance policies, however, are not sufficient to cover medical conditions of middle- or lower-class policyholders, meaning a major medical procedure or event, such as surgery, cancer and other similar scenarios, would eventually lead to financial ruin.

It is anyone’s guess, based upon these numbers, whether Ayushman Bharat would be able to help decrease the financial ruin for Indian citizens. A cap of US$7,000 per household, while noble, is low, and probably isn’t enough money to make a dent in the financial ruin percentage. A system of a co-pay (between the insured and government) might be helpful in the outset, where the government picks up more of the cost after a cap has been reached, but even the prospect of a co-pay may be unfeasible in more rural areas where there is less wealth distribution.

Healthcare delivery by way of Health and Wellness Centers is, potentially, a mixed bag. The center model, in theory, does propose an infrastructure for having physical locations in remote areas (but off-limits to normal visitations), but there still needs to be a supply of caregivers providing actual care. There is a shortage of doctors and nurses in India, as there are in many parts of the world.

Help could be on the way, what with India pushing for more of its youth to engage in healthcare. Amore short-term solution, however, could be found in technology. Tele-medicine (where doctors can provide care remotely by use of information technology) is being used increasingly throughout the world. One such application for tele-medicine would be to provide care in remote and rural areas where access has been challenging. Investment in such technology in the rural setting may help provide the healthcare support India needs.

The quality of care provided, lastly, is variable at best.  Indian patients, all too often, are misdiagnosed and subjected to a plethora of testing and therapeutics, which, ultimately, do not benefit their health situation. Doctors, even worse, often benefit financially from prescribing testing and therapeutics. This is also a product of medical management by poorly qualified caregivers. Patient care, either way, is compromised.

The Indian government can help to create a public policy and an agency to collect healthcare quality information and provide it to its citizens to not only help expose unqualified or greedy caregivers, but to also help build trust and reputation for those caregivers who offer exemplary care.

This is an exciting time for Indian healthcare. It is even more exciting to see where the nation goes in the next few decades, particularly in terms of what role the Indian government will play in helping its citizens lead healthier, happier lives.

Who knows – maybe the United States can learn a thing or two of how to manage its national healthcare system.