Comparative Health Policy Library

INDIA | Summary

OVERVIEW

GDP: 2.875 Trillion USD1
Health Expenditure (% of GDP): 3.53%2
 
  • Population: 1.38 billion
  • Housing: 33% Urban, 67% Rural

history

Western medicine has existed in India since the 1600s starting with early Portuguese influence5 but it wasn’t until 1664 that the French established the first hospital, followed by a British hospital in 1668. British rule over the country expanded healthcare facilities such as dispensaries at the local and sub-division levels. At provincial levels, hospitals were converted into teaching hospitals attached to medical colleges. In 1885, there were 1250 hospitals and dispensaries in British India.  With slow progression, India had 7400 hospitals and dispensaries in the country right before independence.7 India’s Ministry of Health was established after its independence from Britain in 1947.6 Post-independence, the government made efforts to recognize traditional medicine such as Ayurveda, Siffh, and Unani as being on par with scientific medicine. Following independence, India has made it a national priority to address health concerns and the Constitution tasks each state to provide health care for its people.8

Along with freedom from British Rule, according to Apoorva Ranjan9, India was left with a crippling economy, booming population, and a deep healthcare crisis. An extensive probe into the health system was conducted and produced The Bhore Report which discovered many discrepancies such as lack of hospital availability to the population (0.24 per 1000 ratio). The report influenced two five-year plans which did little to improve the health system and by the third, five-year plan, the Indian government decided to conduct another study to understand the healthcare issues in the country. In 1966, the Study Group on Hospitals was established by the Ministry of Health and Family Planning. The group examined the shortcomings of prior reports and acts to strengthen their recommendations for the health system. This eventually led to the development of the new model of healthcare in India which was a structured strategy involving ground workers, primary healthcare centers, tertiary care centers, and urban hospitals. The final report contributed greatly to improving the health system in India.9    

Since 1948, the Indian Government has established multiple social health insurance schemes and initiatives to improve health access to various populations as well as reach universal health coverage.9 

Health & Health system

According to Britannica, in recent decades, India has experienced striking economic growth which has improved health and poverty, which has increased life expectancy, among other health indicators. The country continues to struggle with communicable diseases and lacks access to safe drinking water. Diseases caused by water-borne organisms contribute to mortality, mainly among children. Death from starvation is rare now, however, malnutrition persists throughout the country, affecting children as well. HIV/AIDS infections have increased. Although the overall proportion of the population is smaller compared to other countries, the number of individuals with HIV or AIDS is one of the highest in the world. In addition to multiple programs targeting specific diseases, more union- and state-maintained hospitals and rural health centers have ubiquitously been established.10 

The health system, according to The Commonwealth Fund in India is characterized by two very different sectors: the public, and private systems. Indian citizens have access to free outpatient and inpatient care in public, government facilities. The Constitution of India states that the government is to ensure the right to health for all.  In this sector, health coverage is universal but the system is under-funded and facilities experience shortages of staff and supplies. Due to the lack of resources and services, many Indian citizens turn to the private sector for care. This becomes difficult to access for lower-income individuals because most of the health system is funded by out-of-pocket payments.11 From 1995 to 2014, 65% of India’s healthcare spending came from personal budgets.  The average Indian will still access public health care unless they have coverage to receive private care.12 The Indian government has recently established a National Health Protection Scheme called, Ayushman Bharat, or PM-JAY, which is financed by taxes. This program allows low-income individuals to get cashless secondary and tertiary care at private facilities. Only approximately 37% of the population is covered whether by PM-JAY or by employment-based insurance, regional schemes, and voluntary for-profit insurance, among others. The private health sector offers high-quality health care at a fraction of the price of hospitals in developed countries. Even though it is relatively less costly, it can still be a burden to the average Indian citizen. The private sector attracts many foreign patients, which makes India a hot spot for medical tourism. It provides the majority of secondary, tertiary, and quaternary care institutions with a major concentration in metropolitan areas as well as tier-I and tier-II cities.13

The public health system is governed by India’s 28 states and seven territories independently, which has created stark differences between each one.12 There are variations in delivery models, insurance coverage, availability, and access. Health disparities are prevalent between poorer and richer states with underfunded health systems that in many cases are inefficiently run and underregulated. More rural areas also suffer more from physician shortages and less adequate health care.14 The state government focuses more on providing healthcare services and health education, while the central government provides administrative and technical services.15 The government uses its networks of hospitals and clinics for immunizing children and to promote family planning. Some family planning efforts include the encouragement of voluntary sterilization of both males and females. The government also supports a variety of traditional medical systems such as the ancient Ayurvedic system, which is the most widespread. Although the majority of the population is uninsured or underinsured, the Indian government is determined to expand coverage for citizens and increase public spending on health.10

Health Indicators & Demographics

The large geographic area as well as the division of healthcare between states results in notable differences in health outcomes and standards of living. In the Indo-Aryan and Dravidian communities, there are about 2000 ethnolinguistic groups, with about 645 district indigenous tribes, and 52 major indigenous tribes. The North mostly speaks in languages related to the Indo-Aryan branch such as Hindi, Bengali, and Gujarati. The South mostly speaks languages from the Dravidian branch such as Tamil, Telugu, and Malayalam. India does not have an official language, however, there are 22 nationally recognized languages but two are the most prevalent. Hindi and English are taught in schools and used by government officials.16
 
  • Fertility Rate: 2.2 live births per woman  
  • Life Expectancy (Female, Male): 72, 69  
  • Infant Mortality Rate: 26.6  deaths per 1,000 live births  
  • Child Mortality Rate: 32.9 per 1,000 live births
  • Maternal Mortality Rate: 113 deaths per 100,000 live births  
  • Prevalence of Obesity: 4% 
  • Indo-Aryan: 72% 
  • Dravidian (South Indian): 25% 
  • Other: 4%
  • 0-14 years:  27%
  • 15-24 years:  17.8%  
  • 25-54 years:  41.2%  
  • 55-64 years:  7.6%  
  • 65 years and over:  6.4% 

References

1 The World Bank. India . Data. https://data.worldbank.org/country/india. 

2 The World Bank. (2017). Current health expenditure (% of GDP). Data. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS. 

3 India Population 2020 (Live). India Population 2020 (Demographics, Maps, Graphs). (2020). https://worldpopulationreview.com/countries/india-population. 

4 Mushtaq, M. (2009). Public health in British India: A brief account of the history of medical services and disease prevention in colonial India. Indian Journal of Community Medicine, 34(1), 6–14. https://doi.org/10.4103/0970-0218.45369 

5 Mushtaq, M. (2009). Public health in British India: A brief account of the history of medical services and disease prevention in colonial India. Indian Journal of Community Medicine, 34(1), 6–14. https://doi.org/10.4103/0970-0218.45369 

6 Healthcare System in India. International Student Insurance. https://www.internationalstudentinsurance.com/india-student-insurance/he.... 

7 Tabish, S. A. Health Planning: Past, Present & Future. In Hospital & Health Services Administration: Principles & Practice. essay. https://www.researchgate.net/publication/290447383_Historical_Developmen.... 

8 OVERVIEW OF INDIAN HEALING TRADITIONS: History and Science of Indian Systems of Knowledge. OVERVIEW OF INDIAN HEALING TRADITIONS | History and Science of Indian Systems of Knowledge. https://www.ncbs.res.in/HistoryScienceSociety/content/overview-indian-he.... 

9 Ranjan, A. (2018, August 17). Healthcare System in Pre and Post Independence India. Medlife Blog: Health and Wellness Tips. https://www.medlife.com/blog/healthcare-system-pre-post-independence-india/. 

10 Alam, M., & Allchin, F. R. India. In Encyclopedia Britannica. essay. https://www.britannica.com/place/India/Health-and-welfare. 

11 Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020, June 5). India. Commonwealth Fund. https://www.commonwealthfund.org/international-health-policy-center/coun.... 

12 Ehrenfeld , T. (2018, September 25). Comparing the Healthcare Systems in India and the United States. Healthline. https://www.healthline.com/health-news/comparing-healthcare-systems-indi.... 

13 Brand India. IBEF. (2020, September 6). https://www.ibef.org/industry/healthcare-india.aspx. 

14 Harvard T.H. Chan School of Public Health. (2018, March 7). Improving Health in India. India Research Center. https://www.hsph.harvard.edu/india-center/improving-health-in-india/. 

15 Healthcare System in India. International Student Insurance. https://www.internationalstudentinsurance.com/india-student-insurance/he.... 

16 Geography Now! India. (2017). YouTube. https://www.youtube.com/watch?v=vEy6tcU6eLU. 

17 India Population (LIVE). Worldometer. (2020). https://www.worldometers.info/world-population/india-population/. 

18 India Age structure. India Age structure - Demographics. (2020). https://www.indexmundi.com/india/age_structure.html. 

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