Healthcare in India splitting into urban, rural centres

Healthcare in India is splitting into two camps with urban hospitals capable of offering modern care on par with developed nations and most often neglected rural centres that are left behind, medical professionals have warned.

“There is one India where hospitals have cutting-edge tech and then there is another, which has a lack of access to healthcare, a lack of affordability and a lack of quality,” said Dr Srinivasa Pulijala, CEO of Apollo MedSkills, while speaking on the sidelines of a healthcare leadership summit at the Indian Institute of Management in Bengaluru on Sunday.

This stark disparity, according to K Sujatha Rao, former Union health secretary, is a result of India spending just 1% of its Gross Domestic Product (GDP) on healthcare. “This is unacceptable but the reality is we are one of the lowest public health funding countries in the world – in contrast to Europe, which spends between 7% and 9% of their GDP on health,” Rao said.

For some professionals, the answer to this under-funding is international equity. Dr Pulijala suggested, urban hospitals should court foreign investment while leaving the government to “focus on improving healthcare in other parts of India, which is predominately rural”.

It is a recommendation which has its critics. The buying up of India’s iconic hospitals by foreign corporations is a development, which Rao described as “extremely disturbing” because it would place advanced healthcare in India within the hands of the elites and foreign nationals, and drive up prices, further alienating the poor.

Out of pocket

Medical administrators categorised “out of pocket” medical expenses as the single greatest factor determining accessibility of healthcare among Indian citizens.

N T Abroo, executive director of Suvarna Arogya Suraksha Trust, said it was not uncommon to see poor families in rural Karnataka turn up at government hospitals with their belongings, after having sold all their properties and holdings in order to afford treatment.

According to Dr Manish Rai, an estimated 50% of “out of pocket” costs involve the purchase of medicine.

Many patients also take loans to pay for medical care. “Nearly 40% of healthcare costs are borne by loans,” said Dr Pulijala.

Contradicting the assertion that government healthcare is inferior to private medicine, Abroo displayed figures showing the top 10 performing hospitals in the state were all government-run, with the Kidwai Institute at the top.

According to Sujatha Rao, however, it was difficult to rate hospitals on a scale of success as quality is mostly measured by “marketing, granite floors and flowerbeds in the lobbies” due to the absence of outcome data.

The root of the problem is poor allocation of funding for public health, she said. The lack of funding forces governments to prioritise who should be treated: ‘Do we save a child or do we save an old man?’ These are unfair and cruel choices to make because government hospitals do not have the money. A good country should not be making these choices,” said Rao.