The Indian Healthcare services sector faces several challenges, this in spite of having some of the best doctors, nurses and excellent talent in all disciplines of healthcare delivery. While we continue to lag behind on several health parameters laid out by WHO; we are also facing an even more grave challenge from lifestyle related disorders i.e., Cardiac diseases, Cancer, Diabetes, Osteoporosis, Neurological conditions etc. We have the knowledge, technology and the necessary skill sets to deal with these challenges; what we need is an enabling environment to quickly scale up the infrastructure to be able to deal with the situation. Policy makers need to understand the gravity of the situation and focus on making necessary changes in the policies to tackle the situation. This has to be followed through with the allocation of adequate resources and the active participation between the Public and Private stakeholders in healthcare delivery.
The challenges can be categorised broadly into 3 headings – Shortage of Skilled Manpower, Bottlenecks in Infrastructure, and Enabling Access to Quality Care.
1. Shortage of Skilled Manpower – For a country as large as ours we have only 381 medical colleges with a combined capacity of 50,078 MBBS seats and less than half that number of seats for post graduation. The condition in other disciplines is equally alarming in terms of quality and numbers – Nursing, Technicians, Support services & Management professionals. While non-availability of seats is the primary reason for not having enough doctors; the other disciplines does not attract the best talent due to limited growth opportunities and abysmal pay cheques. This combined with the high levels of work stress involved makes the industry unattractive for the prospective workforce.
2. Bottlenecks in Infrastructure – Hospitals have today become technology intensive and the cost of capacity creation has skyrocketed. In the absence of financial and non-financial incentives/ support for – land acquisition, bank interest rates, medical equipment imports, etc., it has become unviable to build hospitals in most parts of the country. The lack of social infrastructure in the smaller towns also makes it difficult to attract doctors and other professionals required to run a hospital. Even the government hospitals are finding it difficult to fill vacancies in the PHCs and district hospitals. Investments in the healthcare sector are constrained by the unattractive ROIs and the need for continuous investments in medical equipment due to high rate of technological obsolescence.
3. Enabling Access to Quality Care – A variety of factors influence the rising cost of care delivery, many of these are not even under the control of hospital managements. This is a global phenomenon and the trend is expected to continue in the foreseeable future. A majority of the population even amongst the affluent class will not be able to meet their healthcare expenses. The absence ‘Financial Enabling Mechanism’ to make it possible for all sections of society to meet the healthcare needs is a major constraint.
What should we expect from the Government –
1. We need to critically examine the MCI, DCI and NCI guidelines for establishing teaching medical institutions. Some of the rules are archaic and even absurd.
2. Government support is required for – Land allocation, attractive interest rates and availability of capital for establishing healthcare infrastructure
3. Awareness and promotions is needed to be attract the best talent to the healthcare industry
4. Investment is required in R&D for evolving sustainable healthcare models, best management practices, project financing, costing etc.
5. Thought needs to go into ways for attracting the private healthcare providers to establish hospitals in the rural areas and smaller towns
6. There is a need to widen the reach of health insurance and government should even explore the option of compulsory health insurance on lines of the motor vehicle insurance.
7. Government policy needs to encourage private sector participation and facilitate – health awareness creation, lifestyle management and preventive health behaviour.