Understanding How India’s Healthcare System Works
India is home to one of the world’s largest healthcare systems. Despite enormous challenges, the country provides free, albeit basic, healthcare to over one billion people. That’s no small accomplishment! It has also achieved significant triumphs, such as eradicating polio in 2011.
Additionally, communicable diseases in India fell by a remarkable 50% between 1990 and 2016. These are tremendous feats for the world’s second-most populous country. However, behind these achievements are some harrowing statistics.
The country ranks 112 out of 191 countries on the World Health Organization’s ranking of global healthcare systems. Infant mortality remains unacceptably high, approximately seven times that of the United States. India’s healthcare system presents many serious challenges for both residents and visitors.
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Overview of the Indian Healthcare System
In theory, at least, India has a universal healthcare system. In some states, as many as 90% of the public relies on government-run hospitals, which are free of charge.
However, as critics quickly point out, India’s universal healthcare is not exactly universal in nature. There are significant gaps in care based on gender, socioeconomic status, and geographic location.
By law, providing healthcare services is a state responsibility. States are additionally charged with addressing public health, nutrition, and standards of living. The extent to which they succeed in their undertakings varies tremendously. Corruption is widespread, both among government and healthcare officials.
As a result, public facilities are underfunded. Standards of care are basic (at best) and sometimes abhorrent (at worst). Supplies that are supposed to be guaranteed, such as free medications, are often unavailable.
Unsurprisingly, wait times are significant. Patients sometimes resort to bribery in an effort to receive timely care.
However, Indian patients have reason to be hopeful. Approximately 150,000 Health and Wellness Centres (HWCs) have been established to enhance timely access to healthcare. This has been achieved in part by transforming existing Sub-Health Centres to deliver comprehensive primary healthcare.
Who is Eligible For Healthcare Coverage
Unless you are among India’s poorest people, there is no public health program to qualify for. Indian citizens receive free treatment at public hospitals. Expats and tourists can also use these same facilities, but they will have to pay out of pocket. For minor medical concerns, this can cost as little as just a few dollars.
Healthcare Options for Expats and Foreigners in India
The vast majority of expats opt to carry private international health insurance in India and be treated in private facilities.
This isn’t just because public facilities are very basic in nature. It’s also because there are limited resources. An expat who receives care in a public facility is just one more person causing delays and congestion.
For those who opt to use public facilities (or have no other choice due to their location), a registration fee will be added to the treatment cost. Those admitted overnight also pay room charges.
Most public hospitals offer different levels of accommodations (standard classifications include “deluxe,” “deluxe with AC,” or “super deluxe”). Generally, the better the room, the happier the patient. Expats who find themselves in this situation should request the best room classification that they can afford.
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Costs of the Healthcare System
India’s healthcare system is funded through government taxation. In 2019, the government was spending $36 billion on healthcare annually, or roughly 1.23% of its GDP. When out-of-pocket costs that patients pay for private healthcare are taken into account, the country’s total healthcare GDP equals 3.6%.
India has the most extensive private healthcare system in the world. It’s so pervasive that only about 20% of all healthcare services fall under the purview of public funding. Unlike many other countries, it’s not just wealthy citizens using private facilities.
Much of the demand is driven by financially precarious citizens who cannot afford to visit a private clinic. However, they feel they have no other choice but to receive timely care.
In an effort to relieve the financial and healthcare burdens of India’s most vulnerable people, the government introduced a new national health protection plan in 2018. Called Ayushman Bharat, it targets the poorest half of India’s population, some 500 million people.
Patients are allocated $7,200 in annual coverage to put towards the cost of care at private hospitals. The country’s newly developed Health and Wellness Centres are an additional core component of Ayushman Bharat, as their focus is on making comprehensive primary care more accessible.
The Differences Between Private and Public Care
A significant proportion of India’s population utilizes private healthcare facilities, and a substantial minority holds private health insurance. As of 2020, it was estimated that 36% of Indians have a private insurance plan.
The majority of local patients who cannot afford insurance opt to pay for services as they need them. Sadly, in some cases, patients incur significant debt to afford care.
The standard of healthcare in private facilities ranges from adequate to world-class. Those private facilities that mainly target local working-class residents differ significantly from those targeting expats and wealthy locals.
In all cases, patients can expect comfortable facilities with greater personal privacy. Facilities are cleaner, more organized, and more up-to-date than those in the public sector. Wait times are shorter, and a wide variety of specialists are on staff.
And, at the high end of the scale, the swankiest private hospitals can resemble hotels. They offer spacious, comfortable rooms, excellent food, and personalized care.
Perhaps unsurprisingly, India is a global leader in medical tourism, primarily due to the high standard of care offered at the country’s top private hospitals.
Uninsured patients from countries such as the United States can travel to India for procedures such as joint replacement and pay just a fraction of the price they’d face at home.
Rural Healthcare In India
The state of healthcare in rural India is, to say the least, problematic. 74% of India’s doctors serve urban areas. In India’s vast rural areas, doctors are indeed very scarce. This statistic seems unlikely to change significantly.
Doctors are frustrated by the inadequate housing, limited education options, and subpar infrastructure in rural areas. Then there are the hospitals themselves. There are half as many beds compared to urban facilities. Additionally, rural hospitals are perpetually the last to receive new equipment.
This all adds up to devastating results for local healthcare. For instance, children under five in some rural regions have higher mortality rates than those in urban environments.
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Joe Cronin, President of ICI, is a leading expert in international health, life, and travel insurance. An MBA and founder of multiple global businesses, he helps expatriates and travelers access trusted, comprehensive insurance solutions worldwide.
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