Health should be viewed as not merely the absence of disease but as a state of complete physical, mental and social well-being. The determinants of good health are: access to various types of health services and an individual’s lifestyle choices, personal, family and social relationships. In following analysis we identify various bottlenecks that need to be addressed in order to ameliorate the healthcare services:
(a) Availability of health care services from the public and private sectors taken together is quantitatively inadequate. This is starkly evident from the data on doctors or nurses per lakh of the population. At the start of the Eleventh Plan, the number of doctors per lakh of population was only 45, whereas, the desirable number is 85 per lakh population. Similarly, the number of Nurses and Auxiliary Nurse and Midwifes (ANMs) available was only 75 per lakh population whereas the desirable number is 255. The overall shortage is exacerbated by a wide geographical variation in availability across the country. Rural areas are especially poorly served.
(b) Quality of healthcare services varies considerably in both the public and private sector. Many practitioners in the private sector are actually not qualified doctors. Regulatory standards for public and private hospitals are not adequately defined and, in any case, are ineffectively enforced. Affordability of health care is a serious problem for the vast majority of the population, especially in tertiary care. The lack of extensive and adequately funded public health services pushes large numbers of people to incur heavy out of pocket expenditures on services purchased from the private sector. Out of pocket expenditures arise even in public sector hospitals, since lack of medicines means that patients have to buy them. This results in a very high financial burden on families in case of severe illness. A large fraction of the out of pocket expenditure arises from outpatient care and purchase of medicines, which are mostly not covered even by the existing insurance schemes. In any case, the percentage of population covered by health insurance is small.
(c) The problems outlined above are likely to worsen in future. Health care costs are expected to rise because, with rising life expectancy, a larger proportion of our population will become vulnerable to chronic Non Communicable Diseases (NCDs), which typically require expensive treatment. The public awareness treatment possibilities is also increasing and which, in turn, increases the demand for medical care. In the years ahead, India will have to cope with health problems reflecting the dual burden of disease, that is, dealing with the rising cost of managing NCDs and
injuries while still battling communicable diseases that still remain a major public health challenge, both in terms of mortality and disability.