Lack of accessible healthcare, overburden on private sector due to miniscule public spending, treatment making the poor patients still poorer, and insufficient infrastructure make Indian healthcare scenario very complex in want of innovative solutions, according to a study.

“Accessibility still remains a puzzle for both the public and for-profit sector which are grappling to look for innovative solutions. Till today, patients travel miles of distance to avail medical facilities resulting in huge financial and physical burden. Although varied healthcare delivery formats have come up in the recent years, access has not yet percolated to the rural and semi urban areas,” a white paper on 'Accessible healthcare, joining the dots now' by management consulting firm Technopak and Philips Healthcare India said.

Utilization of healthcare services is also severely affected by the level of access to medical facilities. An analysis of the hospitalization trend in developed and developing countries unveils high hospitalization rates in US, France and Germany owing largely to the better access to medical services found there. In India 45 persons per 1000 get hospitalised against 264 in France and 232 in UK. It is expected that the hospitalization rate in India will more than double in the next decade justifying the need of additional beds, the study said.

Indian states are highly diverse with respect to their economic conditions, infrastructure and social development. Similarly, the dynamics of healthcare also vary widely across the states. For example, Kerala with an exceptionally advanced healthcare system has one hospital bed for every 325 persons which is also an indication of a high proportion of people receiving hospitalized treatment in the state. On the other hand, poor accessibility of healthcare facilities in states like UP, Bihar, Jharkhand limit the utilization of medical services. Geographical access in low income states is further limited by poor healthcare financing, dysfunctional infrastructure and inadequate human capital, it said.

Among the low-density states, while Madhya Pradesh has one medical institution per 220 square kilometers, West Bengal has one per 35 square kilometers. Among the high-density states, Kerala has one medical institution per 8 square kilometers while Maharashtra has one per 23 square kilometers.

“With more than 80 per cent of the healthcare expenditure being financed privately, India distinguishes itself as a country with the highest levels of 'Out of pocket' expenditure on healthcare in the world. Inevitably the high cost of medical care for vast majority of the population remains the root cause of financial inaccessibility,” the white paper said.

“Quantifying the need gap taking into account the year 2020, leaves us with a shortfall of two million doctors, 3.5 million nurses and 8 million paramedics in the country. India currently has about 600,000 doctors and about 1.6 million nurses. Going by WHO norms for developing countries, India has a shortfall of 1.4 million and 2.8 million doctors and nurses respectively for India. Besides doctors and nurses, there is also a shortage of paramedical and administrative staff. The growing need for accessible and affordable healthcare presents a great opportunity to develop viable healthcare models for the country,” it said.

Paramedical education, for instance, in India is apparently the most neglected in terms of quality and quantity, in contrast to Medical education which has produced the best of talents. This situation has in fact worsened due to lack of focused paramedical education and training infrastructure. Due to absence of any defined regulating body, several institutions in the nation are unregulated with a lack of uniformity in the training imparted.

Private institutes witnessed a ten-fold surge during post independence era and rose sharply from 13 in 1980 to 146 in 2010.However, Government medical colleges which are known to produce the best talent in the country failed to uplift their infrastructure both qualitatively and quantitatively. In addition to the uneven growth, there is no uniform distribution of medical colleges nationwide. For instance, more than 50 per cent of medical colleges are clustered in and around five states of Maharashtra, Karnataka, Tamil Nadu, Andhra Pradesh, and Kerala, it said

Currently less than 15 per cent of Indian population has any form of health insurance. Over 70 per cent of the population make out of pocket payments while availing healthcare treatment. Health care Infrastructure shortfall India lags behind developed economies and emerging economies such as Brazil, Russia and China in provision and availability of adequate health care infrastructure. The current bed to population ratio of 0.7 is way below the global average of 2.6 beds per 1000 population, as per the white paper.

“Though a large number of hospitals have been commissioned in the smaller towns in last few years, 46 per cent of patient volume of hospitals comes from patients who travel more than 100 km. On an average a patient spends Rs.9400 for an episode of hospitalisation, which includes hospital bills, spends on drugs and diagnostic tests. Access to quality healthcare is limited by the high cost for the vast majority of India’s population,” the study said.