The National Health Profile 2015 is another reminder of the grim state of health care in India. For a population of 1.26 billion, India has 20,306 hospitals and 675,000 beds, less than a third of which are in villages, which are home to 70% of the population. State-funded hospitals and beds are being added, but are not keeping pace with the growing population. One government hospital serves 61,000 people, up from 50,000 people in 2012. Across India, there is one government hospital bed for 1,833 people.
The fragility of our public health services stems from our policymakers’ misplaced view that health spending is a dole, a non-productive form of expenditure that takes from the government’s coffers without generating returns. India thus spends less on health as a percentage of its GDP than some of the world’s poorest nations. Of the total health spending of 4.1% of GDP (2012), the government spends a little over 1.16%, compared to 2.9% in China and 4.1% in Brazil. With the Centre accounting for just a third of the total public health spending - states provide 67% - the divide between the under-served and well-performing states is growing: Uttar Pradesh has one government hospital for 250,000 people, while Kerala has a hospital per 27,500 people. This lacuna in care has led to the private sector providing nearly 80% of outpatient and 60% of inpatient care. Incremental human resource requirement in the sector will almost double to 7.4 million by 2022.
Improving access, affordability and quality of care to respond to the growing health need to be made central to the development debate and the government needs to recognise that it cannot do it alone. Instead of adding hospitals and beds, it needs to strengthen regulatory systems to enforce quality and cost standards to ensure people get adequate, appropriate and ethical care wherever they choose to go.