Health: India trains more doctors than almost any other country, provides the largest number of emigrant doctors, and tertiary health care system. It is evident that more than 70% of the hospitals in India are run by the private sector. In recent times, private sector has been playing a major role in medical education, medical technology and diagnostics, manufacture and sale of pharmaceuticals, hospital construction and provision of medical services. The cost of private health care system is about 4 times greater than the country’s public health care, yet 72% of residents of rural areas and 79% of residents of urban areas are still using private services because of their better quality services. Foreigners in increasing numbers are now coming from the Middle East, Africa, Pakistan, and Bangladesh to India for private health care for liver transplant or complex paediatric cardiac surgery – procedures that are not done in their home countries. They also come from the United Kingdom, Europe, and North America for efficient, quick and cheap orthopaedic procedures or coronary bypasses. A shoulder operation in the UK would cost £10 000 done privately or entail wait for several months under the NHS. In India, the same operation can be done for £1700 and within 10 days. Despite high sophisticated medical education, training and services from the private sector, there are many bottlenecks in rendering heath care to people of India. Large section of population doesn’t have reliable and affordable access to good quality healthcare. Firstly, though profit-motive private sector provides better services, many of them are indulged in malpractices by selling substandard and even counterfeit medicines, prescribing unnecessary drugs and tests, receiving commissions for referrals, requiring unnecessary hospital admissions and manipulating the length of stay. Secondly, it is because of the loopholes in the services of the public sector. Currently, India, one of the fastest growing economies in the world, spends only 1.3% of GDP on public health. This is the lowest among the BRICS nations. The main reason for this is a highly inadequate spending on infrastructure and an acute scarcity of trained manpower.
There is an urgent need to revamp the health system design and make it transparent and accountable to people at reasonable cost. The first design priority must be to increase public expenditure on health with active participation of state governments who bear close to two-third of public expenditure on health sector. An influx of funds to meet the various infrastructural and technological deficiencies is urgently needed. The majority of the population in India lives in the rural areas and there is a dire need to strengthen rural public health care systems immediately. Countries like Japan and China saw a rapid growth since the second decade of the 20th century in light of the higher investment in health and education. The second design principle is ‘pre-payment’. The government can either work on taxation levels to fund health services or by providing health insurance to people at large. Various countries have worked on different health system models. Britain’s National Health service is an example of a largely tax-financed health system while Germany’s sickness fund is largely reliant on mandatory health insurance and Taiwan’s medical smart card are a huge successful models. The third most crucial design principle is that the government should play an active role in designing and supervising the entire health system, instead of focusing only on the management of a health system owned by itself. Government has to provide incentives to insurance for health. Apart from this, private sector also has an equal role in developing health system. Despite the varied motives of private sector from public sector, there is a huge responsibility in making private services genuine to people. A better solution might be to impose greater social accountability on private providers, making a certain proportion of private services available to the poor. This can be made efficient through the PPP model