The Healthcare System That Creates Health Neglect

By: Alexandra Welke

India spends a little over one percent of its Gross National Product (GDP) on public health, despite an increase in health expenditure since 2009.[1] India’s low budget allocation for health and family planning, combined with the increasing costs for medical treatment, is leading to an inequality in health care.[2] Unfortunately, this is not a new issue in India. For years, India has apportioned a low percentage of its GDP as public expenditure on health.[3] Between 2018 and 2019, India’s public health budget as a percentage of GDP went up by just 0.16 percentage points from 1.12% to 1.28% of GDP.[4] In both 2015 and 2016, the public expenditure on health as a percentage of GDP was only 1.02%.[5] Because of the low funding, many cannot afford health care.[6] Additionally, about 7% of Indians are pushed into poverty each year because of unaffordable health care, a figure that remained largely constant from 2004 until 2014.[7]

India’s low health budget allocation is causing concern because of growing medical treatment costs, insufficient access to available services, and the poor quality of healthcare services.[8] Compared to BRICS countries, India spends a much lower figure on its healthcare system.[9] Brazil, a member of the BRICS, spends around 8.3% of its GDP on health care, Russia 7.1%, and South Africa around 8.8%.[10] Among SAARC countries, Afghanistan spends 8.2% of its GDP on health services, Maldives 13.7%, and Nepal 5.8%.[11] India’s low funding has been the cause of growing inequities, insufficient access to healthcare, and poor quality of healthcare services.[12] Although India’s government is aiming to increase its public expenditure to 2.5% of the GDP by 2025, the country remains the lowest globally, making meeting the target seem like an uphill task.[13]

As the healthcare funding in India remains stagnant, the population continues to suffer from preventable diseases.[14] Anemia, for example, continues to remain a large health concern in India, as is illustrated by the fact that one in two women between 15-49 years suffers from the disease.[15] It is reported that the problem is more severe in children, which is illustrated by the fact that 60% of children between 6 and 9 tested positive for anemia. Further, India has seen a sharp rise in the number of people testing positive for both diabetes and hypertension.[16] India also ranks below most other neighboring countries in life expectancy, maternal mortality, and infant mortality.[17] Moreover, the number of reported coronavirus cases in India recently surpassed 3.5 million.[18] India recorded 78,761 new cases of coronavirus in one day, serving as the highest single-day spike in the world since the pandemic began.[19] It is apparent that India's rising coronavirus cases have put a further strain on the country's healthcare system.[20] Experts say that the shortage of resources, overworked doctors, and lack of funding are costing lives.[21]

The constitution of India impels the government to ensure the “right to health” for all.[22] However, health care in India has been long underfunded.[23] Historically, government-funded health insurance schemes have been implemented to improve coverage for specific population groups.[24] The National Health Insurance Program, aimed at reducing medical costs and vulnerability for lower-income populations, first launched in India around 2008.[25] As of 2016, approximately 41 million families were enrolled in this program.[26] Unfortunately, evidence reveals that the program has not significantly reduced out-of-pocket spending, and systemic barriers remain prevalent in India’s system of care.[27] Even with the new health care programs, the quality of health care has consistently been reported far from satisfactory.[28]

Structural health system reform in India is imperative. The answer seems clear; India must allocate more funding to its public healthcare system and reduce health care costs. While India may not be able to control diseases that have an impact on its country, it can allocate a larger portion of its funds in order to solve the downfalls of the current system in place. In India, many significant health, social, and income inequities exist, and structural health reform could alleviate these inequities by assisting individuals who cannot currently afford health care. As seen in over 20 other countries that have undertaken structural health reform, out-of-pocket medical expenditure will decrease, and access to health care facilities will improve.[29] India’s current healthcare system is “poor, fragmented, skewed to urban areas, and … low quality.”[30] For years, India has limited its allocation to funding health care and failed to implement standards for the quality of health care provided. If India reevaluates its funding and considers structural health reform, it may have a chance at controlling the spread of coronavirus and properly providing care to those in need.

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[1] Himani Chandna, At 1.28% of GDP, India’s expenditure on health is still low although higher than before, The Print (Oct. 31, 2019), https://theprint.in/health/at-1-28-gdp-india-expenditure-on-health-still-low-although-higher-than-before/313702/.

[2] National Health Profile, Central Bureau of Health Intelligence (2019), http://www.cbhidghs.nic.in/showfile.php?lid=1147.

[3] Id.

[4] Abantika Ghosh, Explained: What National Health Profile says about targeted, actual health spend, Indian Express (Nov. 1, 2019), https://indianexpress.com/article/explained/national-health-profile-nhp-report-2019-healthcare-india-6096911/.

[5] Id.

[6] See Id.

[7] K. Srinath Reddy, Health Care Reforms in India, JAMA, June 26, 2018 at 2478.

[8] See Id.

[9] India spends less than BRICS, SAARC nations on health, The Economic Times (Jan. 29, 2017), https://economictimes.indiatimes.com.

[10] Id.

[11] Id.

[12] See Id.

[13] Rhythma Kaul, India’s public spending on healthcare continues to remain lowest globally, Hindustan Times (Nov. 1, 2019), https://www.hindustantimes.com/india-news/india-s-public-health-spending-lagging-behind/story-6YPZFSfWMVlHGipDXyUEFO.html.

[14] See Id.

[15] Id.

[16] Id.

[17] Reddy, supra note 7.

[18] India records biggest single-day coronavirus infection spike with 78,761 new cases, Fox News (Aug. 30, 2020), https://www.foxnews.com/world/india-biggest-single-day-coronavirus-infection-spike.

[19] Id.

[20] Id.

[21] Id.

[22] Roosa Tikkanen et al., India, The Commonwealth Fund, (June 5, 2020), https://www.commonwealthfund.org/international-health-policy-center/countries/india.

[23] See Id.

[24] See Id.

[25] Id.

[26] Id.

[27] Id.

[28] Id.

[29] Parijat Ghosh, India is poised for deep structural health reforms, Hindustan Times (Apr. 21, 2020), https://www.hindustantimes.com/analysis/india-is-poised-for-deep-structural-health-reforms/story-Jxr42qwyp0jftEFHB4E8TK.html.

[30] Id.