This article is written by Abhay, a student from Kirit P. Mehta School of Law, NMIMS. This is an exhaustive article which deals with various aspects associated with Healthcare in India.

Introduction

Article 21 of the Constitution guarantees every individual the protection of life and personal liberty. The State is required by the laws of this nation to provide adequate healthcare for all people. As per Article 21, the Constitution of India states that every Indian person has the right to free health and care but in fact, the private health industry takes charge of India’s significant portion of healthcare services.

The VII Schedule of India’s Constitution enlists State List Public Health. Therefore, state governments have the power to introduce, pass, and implement legislation relevant to public health. Conversely, the governments of states are not always able to take effective action with respect to the financial situation. A further critical problem is maintaining the necessary supplies during the epidemic. Public hospitals do provide quality health care services for the country’s population at no cost. 

It’s also important to repair transparency in the system where there are gaping holes. In the event of a medical disaster, it is usually the frontline doctor or the health worker, working in a contaminated camp who is left holding the bag and facing suspension or termination, while the blame for such failures rests with the entire district/state government.

Schemes of the government to improve healthcare facilities

In April 2008, when the central government launched the healthcare insurance scheme — Rashtriya Swasthya Bima Yojana (RSBY)  for the poor, several states gradually joined in, as well as adopted state-specific variants in terms of the level of financial coverage, target population, degree of involvement with private providers and option of implementing agency. 

Though the main purpose of RSBY was to provide financial insurance from hospital expenses, it has tremendous collateral benefits from a health system perspective. It includes managing rates through coordinated procurement of services, through treatment including private providers, initiating performance-based financing of public hospitals, and enhancing the standard of healthcare services.

The government’s healthcare programmes revealed in the budget session included the launch of more than three thousand medical supply outlets under the Jan Aushadhi Scheme. It also focused on lowering of the duties on dialysis equipment and the provision of dialysis care in each district hospital. It also emphasized on the implementation of a new health insurance programme that would expand the financial coverage of the low-income category staff and houses. These have been some of the government’s moves towards making healthcare affordable and available in India. The Jan Aushadhi Scheme aims to make quality medicinal products available at affordable prices.

The National Health Protection Scheme is established by subsuming various schemes like Rashtriya Swasthya Bima Yojana, Senior Citizen Health Insurance Scheme, Central Government Health Scheme, State Insurance Scheme for Employees, etc. The 2017 National Health Policy conceived Health and well-being Centers as the cornerstone of India’s healthcare system to be developed by the scheme.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is a flagship programme of the Indian Government’s National Health Plan aimed at providing free secondary and tertiary health coverage to its lowest 40% poorest and most vulnerable population. This programme is the world’s largest and totally government-sponsored health insurance programme covering a population of the cumulative size of the United States, Mexico, and Canada.

Current problems in the healthcare sector

1. The deprivation of rural masses is a significant downside to Indian health service. It is largely an urban hospital-based service. Although there is a significant number of Public health care and rural hospitals, the urban bias is still evident. The doctors are still reluctant to work in rural areas. In India, shortages of medical staff such as doctors, a nurse, etc. are a fundamental issue in the health sector. 
2. Likewise, the number of hospitals and dispensaries are inadequate as compared to our large population. The country’s research needs to be focused on medicines and tropical disease vaccines that are usually ignored by multinational pharmaceutical firms because of their small profitability opportunities. 
3. Workforce is not efficiently allocated, with most choosing to work in areas where the lifestyle and development services and the facilities are higher. Given that the private sector is the key player in the provision of healthcare services, there have been several initiatives aimed at harnessing private resources to provide public healthcare services. 
4. The current is the newly proposed national scheme which regulates private hospitals to provide government-refundable services. It is ironic that when people from other countries use our private healthcare facilities when their residents collapse under devastating spending on healthcare. In Thailand and the UK,  almost 80% of the services rendered come from government hospitals where wages come set for doctors and staff. 
5. In Japan, private doctors, in conjunction with staff holders, provide services based on set rates through the Ministry of Health. Through enforcing strict fines, the government guarantees that there will be no overbilling. The lack of accountability in healthcare facilities and goods is another big problem in India. 
6. The other thing which can be seen is that some doctors usually prescribe tests, medicines, procedures more than what is necessary. This problem is not regulated properly and innocent people usually end up spending more money on treatment than necessary. 
7. The other problem which can be seen is that drugs which are qualified as Schedule H drugs in India as per Drug and Cosmetic Rules, 1945, basically the drugs which cannot be sold without the proper prescription of a qualified doctor. Though the enforcement of the law is questionable. As very few pharmacy shops agree to these rules and regulations.

Suggestion

In order to help restore trust with patients, customers, doctors and health care providers, the Indian government must ensure that pharmaceutical and medical firms are accountable to transparency and refrain from regular price hike. Tax-free laws, land-based clinic construction programmes, preferential interest rates, and bank loans should be introduced, which will change the face of India’s health infrastructure. Regarding rules and regulations, public officials should make plans to replace or remove the current health care laws if required to be amended.

Comparison with other nations

As we have already learned, healthcare in the US is being taken even more seriously. In particular, in 2010 the Patient Protection and Affordable Care Act (PPACA), also known as ‘Obamacare,’ was signed into the law with a mandate to overhaul the health insurance system and offer open, affordable and reliable healthcare coverage to more Americans. Protections for customers, rules, incentives, taxation, insurance markets and other such initiatives are all about ensuring the system works. Throughout India too, a central government programme would help to make healthcare available to the large population.

In the US, getting health insurance is compulsory, and one needs to pay a fine if one chooses not to have it for any reason.  Employers in the US are required to offer health care to their staff as per government guidelines. All these do not hold true in India where health care coverage or purchase is entirely at the discretion of employers or individuals.

In the US, the provision of health insurance is usually extensive, which covers anything from appointments to, fever to hospitalisation. Though, clinic visits are not included under insurance in India. Based on the policy conditions, only 30 days prior to/60 days post-hospitalization are covered. The other costs have to be borne by the individual. 

In the US there is diverse and comprehensive support for quality through both public and private facilities. In India, the private industry controls the delivery of quality healthcare which blocks access for several working-class or poor people.

Sri Lanka has a remarkable health care system where you can go straight to the hospital (government or private), family doctors, or personally to a specialist without a third party referral. Sri Lanka’s primary health care model, which is available free via a government health programme of island-wide access, offers a solid foundation for universal health care. Sri Lanka offers universal healthcare at no charge. This is a nation that has minimal funding for the healthcare industry but offers the best health care system. This is one of the world’s most sustainable medical-care programmes.

The healthcare system in Cuba is the strongest model for developing countries in delivering healthcare to the poorest parts of society. A distinct characteristic of this system is the polyclinics that are group-oriented. The most innovative idea is that doctors live in the neighbourhoods so that patients can be treated as soon as possible.

Each person in Switzerland has to buy health insurance. The universal coverage is a constitutionally assured right and no out-of-pocket costs are involved. The healthcare system in the Netherlands, the European Union (EU), is regarded as one of the best health care systems. Patients throughout the country have plenty of flexibility when it comes to selecting the healthcare provider. Patients with long-term health problems don’t need to worry about finance; as the state, insurance schemes take care of their citizens’ needs.

Improvements that can be made

• One of the most important parts of the healthcare expenses is the non-hospitalised treatment that is mostly not protected by any insurance policy. The cost of medication for use other than hospitalisation contributes to the bulk of a household’s medical expenses. The government has to lessen these expenses and that can only be achieved by making non – hospitalised treatment cheaper and affordable through government schemes and programmes.
• The APL population which is not currently protected by the schemes need to be included under government health care schemes and programmes. They will also get a satisfactory amount of benefits from the reduced and negotiated rates after the inclusion in these schemes. This portion of the population may be enrolled as part of the programme but may be required to pay for itself. 
• This will benefit by pushing down costs through coordinated healthcare transactions much like medicines. To this inclusion, every state can create its own set of criteria. Currently, APL has the option of purchasing insurance on the private insurance market that is not affiliated with the organised labour system. 
• Such citizens who make up a large part of the population will also benefit from the subsidized, negotiated rates obtained under NHPS if they are registered but pay at the point of treatment for themselves. Like with organised purchasing of drugs, organized purchasing of treatment will bring down prices and also provide the value of quality control. It is best left to individual states to decide whether or not to offer any subsidy to APL. The reduced pricing benefit could be complemented by some financial innovation that encourages savings to meet APL’s health care expenses.
• There isn’t enough spending in the healthcare sector. Despite a huge population, the per capita expenditure is very less. The government’s expenditure on healthcare amounts to only about 2-3% of G.D.P and private spending forms the bulk of India’s healthcare expenditures. Investment in departments of public health needs to be made since most of these institutions have become inadequate to offer services that force people to switch to private institutions. Early disease identification by delivering improved care through all these public health services will help in successful treatment and also save associated expenditures.
• Innovation will help in bringing down the expenses and make changes in the healthcare quality. Some states have also adopted steps such as sourcing, testing, and low-cost delivery of generic pharmaceutical drugs to public hospitals. States such as Gujarat conducted screening services for the public and have also developed screening centres for people for diseases such as diabetes. Many states will also follow their example and implement creative health-care initiatives.
• Foreign health care companies can be persuaded by offering incentives and creating trouble-free business-friendly policies to set up hubs in India. Health insurance plans benefit people by allowing manageable medical costs. Web aggregators help people with detailed knowledge about the best available health insurance policies in India. Web aggregators offer a comprehensive overview and analysis of the different health insurance plans accessible for the public. Web aggregators have enabled evaluating health insurance plans simpler by offering online access to all the relevant data. Individuals should offer information and their needs.
• India needs to give emphasis from the secondary and tertiary to primary care sectors. PHCs should be made desirable to medical professionals by giving incentives and compulsory rural service for medical students. The focus should be moved from curative health care to preventive healthcare. Universal immunisation aims to lessen the prevalence of communicable diseases, thus reducing the curative care costs. A far more complex and constructive method to tackle the dual disease burden is needed. Cooperation between central and state governments should be fostered in policymaking and in exploring options such as UHC to cater for public health and eradicate the corrupt practices that prevail in the sector with the successful execution of policies.
• Currently, healthcare is one of the country’s most significant topics. Offering effective and efficient healthcare for everyone should be the slogan of the government. Only by taking numerous initiatives and formulated measures in one direction, a government can reach its goal of giving affordable and accessible healthcare to all. 
• In urban and rural areas, private institutions are the primary providers of both hospitalized and non-hospitalised treatment. It is always more costly to receive treatment in private institutions. Healthcare expenses are among the main causes of household impoverishment. Non-hospitalised care impoverishes more families than hospitalized care. Additionally, the purchase of non-hospital drugs accounts for the majority share of overall medical expenditure in a household. A health insurance policy offers monetary protection against healthcare expenses for hospitalised care only.
• Indian leaders, at the centre as well as states, have realized that medical insurance is a good policy because insurance entitlements can be provided to a wide segment of the population. However, only a small percentage of the registered population can necessarily assert the entitlement in a particular year, therefore making a modest demand on public offers.
• Many computer and web-based m-health and e-health initiatives such as the mobile application Swastha Bharat, e-RaktKosh, India’s dengue battles, etc., launched by the Ministry of Health and Family Welfare are very helpful. People need to be educated about the policies of the government. Big data analytics can be used to monitor patient information, to treat, to prescribe, etc.

Conclusion

India is one of the fastest-growing economies with raising public awareness of illnesses, facilities and expenditures. But the rising population and the rise in the prevalence of chronic diseases are acting as a barrier for the healthcare sector. India requires a comprehensive approach for addressing healthcare sector challenges. This requires the effective cooperation of all public, private, and individual stakeholders. Changing patterns of the disease from communicable to non-communicable is being observed, and it is set to increase in the future.

There is an urgent need for reform in the healthcare sector. The government has to focus on each and every segment of society. Practices across the world, which can be useful in any way to provide affordable and qualitative healthcare to all, should be incorporated. And the government has to increase its spending on healthcare. In this time of the Pandemic outbreak, one can easily see and observe that there is still a lot of scope for improving healthcare facilities in India.

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