Indian healthcare sector needs reforms and strict enforcement of existing  regulations. Besides, accreditation and ratings should be encouraged, said Vivek Kulkarni, managing director, Brickwork Ratings.

The healthcare in India covers infrastructure, human resources, regulations and reforms, said Kulkarni at the recently concluded Healthex 2012 while providing a bird’s eye of the regulatory landscape in the country.

According to Kulkarni, regulations should be decentralized and encourage  innovation. It is not the lack of reforms and regulations in the healthcare industry, but what is needed is better enforcement.

For instance, issues in public and private hospitals are different. Even a study by the NGO Transparency International reveals that the health service sector is among the most corrupt in India. The key factors leading to corruption are attributed to doctors followed by hospital staff, he said.

For India, water and sanitation reforms are crucial. At the same time the country has a large share of the global disease burden. These include 23 per cent of under-five deaths, 25 per cent of neonatal deaths, 34 per cent of undernourished children and 45 per cent of non vaccinated children with DTP3, the Brickwork Ratings chief said.

Even the disease burden in India is highest compared to China and US. The communicable diseases account for 50 per cent of the burden, followed by 33 per cent of non communicable and 17 per cent of injuries. On the contrary, in China which accounts for 64 per cent of non communicable diseases and US 81 per cent. The communicable diseases in China is 18 per cent and US reports a mere seven per cent. While China reports 18 per cent of injuries, in the US it is 12 per cent.

Only access to water, sanitation and pollution control can control and reduce the disease burden to a great extent, said Kulkarni.

Moreover, the total expenditure on health as percentage of gross  domestic product in India is the lowest 3.6 in comparison to China and the US which is 4.6 and 15.3 per cent respectively. Even the government expenditure on health is reported to be 25 per cent, compared to China‘s 40.7 and US 45.8 per cent.

The out-of-pocket private expenses on health from India is 91.4 percent. China and US are 83.1 per cent and 23.5 per cent respectively. This is primarily because the insurance plans are a mere 1.1 per cent in India compared to China which is seen to be 6.5 per cent and US at 66.4 per cent respectively.

Besides, the public and private sectors' share in service delivery with regard to immunization is the lowest in the private sector with maximum numbers in the public hospitals. In the case of antenatal care, the private hospital account for 40 per cent and 60 by the public sector. For institutional deliveries, private hospitals account for around 45 per cent with government hospitals attending to the maximum number of cases. In the outpatient care too, the private overrule the public medical centres.