The provision of healthcare services in India is skewed toward urban centres and the private sector. Urban residents, who make up 28 per cent of Indias population, have access to 66 per cent of the countrys available hospital beds, while the remaining 72 per cent who live in rural areas have access to just one-third of the beds. Similarly, the distribution of healthcare workers, including doctors, nurses and pharmacists, is highly concentrated in urban areas and the private sector.

According to a latest report released by the IMS Institute for Healthcare Informatics, physical reach of any healthcare facility is a also a challenge in rural areas, particularly for patients with chronic ailments. Patients in rural areas travel more than five kilometres to access an in-patient facility 63 percent of the time. Difficulty in accessing transportation options and the loss of earnings as a result of travel time lead to treatment being deferred, or facilities selected that maybe closer but are not cost-effective or best suited to patient needs.

Gap apparent

The study Understanding Healthcare Access in India: What is the Current State? is the most comprehensive assessment of healthcare access undertaken since 2004 and is based on an extensive survey of nearly 15,000 households covering all socio-economic groups in rural and urban areas across 12 States. Information was gathered on more than 30,000 healthcare system interactions, supplemented by interviews with over 1,000 doctors and experts.

While expanding healthcare access is a critical priority for both the Indian Government and the private sector, the gap between aspiration and reality is all too apparent, said Murray Aitken, utive director, IMS Institute for Healthcare Informatics.

In 2012, 61 per cent of rural patients and 69 per cent of urban patients chose private in-patient service providers, up from 40 per cent reported in a 1986/87 government survey. Long waiting times and the absence of diagnostic equipment in public facilities were cited as key reasons by more than 40 per cent of those surveyed. Better quality of treatment in private, in-patient centres was cited as an additional reason by 38 per cent of survey respondents.

Availability of doctors is another key reason for selecting private facility out-patient treatments. Across both urban and rural sectors, and among the poor and affording populations, at least 60 per cent of those surveyed considered doctor availability as a significant reason for selecting private facilities for out-patient treatment. Absenteeism is typically higher in the less economically developed states of India.

Cost of treatment

At the same time, the cost of treatment at private healthcare facilities is between two and nine times higher than at public facilities. For example, poor patients receiving out-patient care for chronic conditions at a private facility spent, on average, 44 per cent of their monthly household expenditure per treatment, compared to 23 per cent for those using a public facility.

On average, across public and private facilities, and for chronic and acute diseases, medicines account for more than 60 per cent of patients total out-of-pocket expenses for out-patient treatments, and 43 per cent for in-patient treatments. This share of expenditures for medicines has not increased since 2004 for in-patient treatments, and has decreased for out-patient treatments. Low insurance penetration and current insurance plans that do not cover drug costs make the total cost of medicines a continuing, significant burden for a majority of the population.

The report assessed the relative impact of improvements across each of the four components that contribute to healthcare access. Enhancing the quality and availability of public healthcare facilities would curb the diversion of patients to private channels enabling more patients to utilize lower-cost facilities and reduce their out-of-pocket costs.

Effective financing mechanisms are a critical requirement to making healthcare more affordable for patients. Increased insurance penetration, while relevant across all segments of the Indian population, is particularly critical for those below the poverty line to ensure adequate coverage for out-patient care and prescription medicines. For the middle-income population, increased use of generic medicines, innovative delivery models and other cost-effective treatment options will yield more affordable care.

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