Re-imagining private healthcare in India

Abstract

The present article is written from a very interesting vantage point: Private healthcare in India is still relatively young and therefore malleable. It commenced to scale about two decades ago. While that's a long period of time, it is still early mid-life for this sector given its position of impending inflection, actualisation and then gaining of maturity. Overall, the situation and circumstance are fluid because the government with robust measures on public health increasingly seeks to co-opt private healthcare providers and private healthcare providers seek to co-create the aspirational healthcare ecosystem with the government. At the same time, unforeseen dynamics like the COVID-19 situation, chronic legacy issues, and the disruptive, still evolving interplay of technologies and applications, demographic changes and socioeconomic vectors, all add to the mix. Amidst this ferment of emerging and forming contours, the scope and scale of private healthcare in India must be defined and must be realised with vision, with compassion and with a higher ambition which creates enduring value for all stakeholders. Moreover, this must be seen as within and closely interlinked with the overall healthcare imperatives of this country. According to the National Sample Survey Organisation (NSSO), the private sector accounts for 'most of the health expenditures in the country'. According to NSSO, 79% of people in cities and 71% of people in villages visit private institutions for healthcare.[1] This is due to a multiplicity of factors ranging from missing links in government-owned healthcare facilities to the ubiquitous nature of what passes as private healthcare. At the same time, the plurality of private health sector must be emphasised upon. The private sector is not a homogeneous entity. It has both formal and informal providers as well as for-profit and not-for-profit entities under it. The non-corporate private sector comprises single-doctor dispensaries, 2–10-bed nursing homes and medium-sized facilities. In addition, India has the facilities of the recognised traditional systems of medicine. Meanwhile, the formal sector comprises large corporate hospitals, diagnostics chains and stand-alone superspeciality facilities. There are very less comprehensive data available on the size and composition of the private sector. In 2005, the National Commission on Macroeconomics and Health had done some estimates.[2] There is a PwC report from 2014 on estimates of private sector and public sector in India.[3] What is clear is that private sector is the bedrock of our health infrastructure and will become even more vital. Within the ecosystem of private healthcare providers, disproportionately large healthcare services are delivered by the private sector in India. Therefore, the role of private healthcare providers is key to the health of India and its public health ambitions. Hence, it is essential to see healthcare delivery overall and in a more comprehensive manner because public and private are interlinked, interdependent and melded to a very large extent. At the same time, the present and the future, both demand an approach in unison. Our focus must be to view healthcare as a key national imperative. We must optimise all aspects and all players in it and must create synergies of collaboration, partnership and mutual complements if we are to realise our goal which is also our moral duty. The forces manifesting are tectonic and within these lies negotiation of the best and most appropriate ingenuine ideas for India. Consider the fact that by 2050, India's population is expected to reach 1.7 billion people. Growth of the Indian population and transition of its demography will need leapfrogging in healthcare delivery including transformation of public healthcare system. The demographic and epidemiology profile of India will witness a change. Geriatric population is expected to grow to 14% (from 4% at present) with geriatric specialised services