User:Keerthikonda/Healthcare in India

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Access to healthcare
As of 2013, the number of trained medical practitioners in the country was as high as 1.4 million, including 0.7 million graduate allopaths. Yet, India has failed to reach its Millennium Development Goals related to health. Developed countries have been able to adapt to the changing needs of a growing elderly population faster than India and other countries with similar socioeconomic conditions and have developed models for over seventy years to address these needs, through more inclusive care and health insurance. The definition of 'access is the ability to receive services of a certain quality at a specific cost and convenience. The healthcare system of India is lacking in three factors related to access to healthcare: provision, utilization, and attainment. Provision, or the supply of healthcare facilities, can lead to utilization, and finally attainment of good health. However, there currently exists a huge gap between these factors, leading to a collapsed system with insufficient access to healthcare. Differential distributions of services, power, and resources have resulted in inequalities in healthcare access. Access and entry into hospitals depends on gender, socioeconomic status, education, wealth, and location of residence (urban versus rural). Furthermore, inequalities in financing healthcare and distance from healthcare facilities are barriers to access. Additionally, there is a lack of sufficient infrastructure in areas with high concentrations of poor individuals. Large numbers of tribes and ex-untouchables that live in isolated and dispersed areas often have low numbers of professionals. Finally, health services may have long wait times or consider ailments as not serious enough to treat. Those with the greatest need often do not have access to healthcare. Institute of Medical Sciences in Thiruvananthapuram, Kerala.

Electronic health records
The Government of India, while unveiling the National Health Portal, has come out with guidelines for Electronic health record standards in India. The document recommends a set of standards to be followed by different healthcare service providers in India, so that medical data becomes portable and easily transferable.

India is considering to set up a National eHealth Authority (NeHA) for standardisation, storage and exchange of electronic health records of patients as part of the government's Digital India programme. The authority, to be set up by an Act of Parliament will work on the integration of multiple health IT systems in a way that ensures security, confidentiality and privacy of patient data. A centralised electronic health record repository of all citizens which is the ultimate goal of the authority will ensure that the health history and status of all patients would always be available to all health institutions. Union Health Ministry has circulated a concept note for the setting up of NeHa, inviting comments from stakeholders.

Rural areas
Rural areas in India have a shortage of medical professionals. 74% of doctors are in urban areas that serve the other 28% of the population. This is a major issue for rural access to healthcare. The lack of human resources causes citizens to resort to fraudulent or ignorant providers. Doctors tend not to work in rural areas due to insufficient housing, healthcare, education for children, drinking water, electricity, roads and transportation. Additionally, there exists a shortage of infrastructure for health services in rural areas. In fact, urban public hospitals have twice as many beds as rural hospitals, which are lacking in supplies. Studies have indicated that the mortality risks before the age of five are greater for children living in certain rural areas compared to urban communities. '''Due to these geographic barriers, limited healthcare infrastructure, and a shortage of healthcare professions, rural areas face unique challenges. Scholars believe that if healthcare providers are able to understand these cultural nuances, they may be able to provide culturally-sensitive services specifically tailored to the needs and preferences of these communities.''' Full immunization coverage also varies between rural and urban India, with 39% completely immunized in rural communities and 58% in urban areas across India. Inequalities in healthcare can result from factors such as socioeconomic status and caste, with caste serving as a social determinant of healthcare in India.

Financing
India ranks among one of the lowest in the world in terms of public expenditure on healthcare due to significant limitations in its workforce, infrastructure, along with deficiencies in quality and availability of healthcare services . With a shortage of doctors and healthcare providers, who are usually concentrated in urban environments, along with the already low government expenditure on health in India, a large percentage of the population is left underserved by the Indian health system, which relies on out-of-pocket payments from patients to fund care '''. These payments hinder a lot of patients from being able to receive healthcare services, leaving a significant economic impact on the poor and an approximate 50-60 million people forced into poverty annually as a result of drastic medical expenses .'''

Despite being one of the most populous countries, India has the most private healthcare in the world. Out-of-pocket private payments make up 48% of the total expenditure on healthcare in 2018 while government and health insurance funds accounted for 62%. This is in stark contrast to most other countries of the world. According to the World Health Organization in 2007, India ranked 184 out of 191 countries in the amount of public expenditure spent on healthcare out of total GDP. In fact, public spending stagnated from 0.9% to 1.2% of total GDP in 1990 to 2010 and further increased to 3.2% of GDP in 2018.

Medical and non-medical out-of-pocket private payments can affect access to healthcare. Poorer populations are more affected by this than the wealthy. The poor pay a disproportionately higher percent of their income towards out-of-pocket expenses than the rich. The Round National Sample Survey of 1955 through 1956 showed that 40% of all people sell or borrow assets to pay for hospitalization. Half of the bottom two quintiles go into debt or sell their assets, but only a third of the top quintiles do. In fact, about half the households that drop into the lower classes do so because of health expenditures. This data shows that financial ability plays a role in determining healthcare access.

In terms of non-medical costs, distance can also prevents access to healthcare. Costs of transportation prevent people from going to health centers. According to scholars, outreach programs are necessary to reach marginalized and isolated groups.

In terms of medical costs, out-of-pocket hospitalization fees prevent access to healthcare. 40% of people that are hospitalized are pushed either into lifelong debt or below the poverty line. Furthermore, over 23% of patients don't have enough money to afford treatment and 63% lack regular access to necessary medications. Healthcare and treatment costs have inflated 10–12% a year and with more advancements in medicine, costs of treatment will continue to rise. Finally, the price of medications rise as they are not controlled. However, out-of-pocket expenditure has declined substantially in recent years with the government and health insurance funds accounting for 62% of the total expenditure.

There was a major gap between outreach, finance and access in India. However, with a growing economy, the state developed an enhanced fiscal capacity to cover most citizens and residents of the country with basic health insurance cover.

The Twelfth Plan[edit]
The government of India has a Twelfth Plan to expand the National Rural Health Mission to the entire country, known as the National Health Mission. Community based health insurance can assist in providing services to areas with disadvantaged populations. Additionally, it can help to emphasize the responsibility of the local government in making resources available. Furthermore, according to the Indian Journal of Community Medicine (IJOCM) the government should reform health insurance as well as its reach in India. The journal states that universal healthcare should slowly yet steadily be expanded to the entire population. Healthcare should be mandatory and no money should be exchanged at appointments. Finally, both private and public sectors should be involved to ensure all marginalized areas are reached. According to the IJOCM, this will increase access for the poor.

See Twelfth Five Year Plan (India).

National Rural Health Mission
To counteract the issue of a lack of professionals in rural areas, the government of India wants to create a 'cadre' of rural doctors through governmental organizations. The National Rural Health Mission (NRHM) was launched in April 2005 by the Government of India. The NRHM has outreach strategies for disadvantaged societies in isolated areas. The goal of the NRHM is to provide effective healthcare to rural people with a focus on 18 states with poor public health indicators and/or weak infrastructure. NRHM has 18,000 ambulances and a workforce of 900,000 community health volunteers and 178,000 paid staff. The mission proposes creating a course for medical students that is centered around rural healthcare. Furthermore, NRHM wants to create a compulsory rural service for younger doctors in the hopes that they will remain in rural areas. However, the NRHM has failings. For example, even with the mission, most construction of health related infrastructure occurs in urban cities. Many scholars call for a new approach that is local and specialized to each state's rural areas. Other regional programs such as the Rajiv Aarogyasri Community Health Insurance Scheme in Andhra Pradesh, India have also been implemented by state governments to assist rural populations in healthcare accessibility, but the success of these programs (without other supplemental interventions at the health system level) has been limited.

National Urban Health Mission
The National Urban Health Mission as a sub-mission of National Health Mission was approved by the cabinet on 1 May 2013. The National Urban Health Mission (NUHM) works in 779 cities and towns with populations of 50,000 each. As urban health professionals are often specialized, current urban healthcare consists of secondary and tertiary, but not primary care. Thus, the mission focuses on expanding primary health services to the urban poor. The initiative recognizes that urban healthcare is lacking due to overpopulation, exclusion of populations, lack of information on health and economic ability, and unorganized health services. Thus, NUHM has appointed three tiers that need improvement: Community level (including outreach programs), Urban Health Center level (including infrastructure and improving existing health systems), and Secondary/Tertiary level (Public-Private Partnerships). Furthermore, the initiative aims to have one Urban Public Health Center for each population of 50,000 and aims to fix current facilities and create new ones. It plans for small municipal governments to take responsibility for planning healthcare facilities that are prioritized towards the urban poor, including unregistered slums and other groups. Additionally, NUHM aims to improve sanitation and drinking water, improve community outreach programs to further access, reduce out-of-pocket expenses for treatment, and initiate monthly health and nutrition days to improve community health.

Pradhan Mantri Jan Arogya Yojana (PM-JAY)
Pradhan Mantri Jan Arogya Yojana (PM-JAY) is an initiative to ensure health coverage for the poor and weaker population in India. This initiative is part of the government's view to ensure that its citizens – particularly poor and weaker groups, have access to healthcare and good quality hospital services without facing financial difficulty.

PM-JAY provides insurance cover up to Rs 5 lakh per annum to the 100 million families in India for secondary and tertiary hospitalization. For transparency, the government made an online portal (Mera PmJay) to check eligibility for PMJAY. Health care service includes follow-up care, daycare surgeries, pre and post hospitalization, hospitalization expenses, expense benefits and newborn child/children services. The comprehensive list of services is available on the website. While a program just recently passed by the government in 2018, PM-JAY offers an opportunity to reform the Indian health system to equitably work for the many relying on it.

National Policy of Older Persons of 1999

'''The National Policy on Older Persons was established by the Indian government in 1999 to ensure the well-being of the elderly and give them a position in society, through such things as financial assistance, healthcare, and shelter. This policy marked the beginning of government intervention in the needs of the elderly . It involved state support to guarantee financial and food security, health care, and protection against abuse for the elderly through schemes such as establishing geriatric wards in district hospitals, including geriatric care in the medical school curriculum, training geriatric caregivers, and strengthening community health centers and mobile clinics . The policy additionally advises for old age pensions, development of health insurance to cater to the needs of individuals within varying income brackets, shelter and welfare measures for elderly who are poor and chronically sick, nongovernmental organization support to make up for the care the state cannot provide alone . The Indira Gandhi National Old Age Pension Scheme of 2007 was eventually launched as part of the National Policy of Older Persons and provided an increase in monthly pension for individuals living below the poverty lines, specifically Rs. 200/- per month for people over the age of 60 and Rs. 500/- per month for people over the age of 80 .'''