Diagnosing India’s Healthcare: Understanding the Gaps in India’s Healthcare System

Introduction: India’s healthcare system faces multifaceted and dynamic challenges, ranging from inadequate infrastructure to financial barriers. Despite some progress, the system still struggles to address the needs of its vast population, especially in rural areas. Dr. Yogesh Jain, founder of the community health program Jan Swasthya Sahyog, highlights the central point of the issue: “Our health system is not made for the large majority of people in rural areas. It is so highly privatised that people end up spending money out of pocket and getting indebted.”

Infrastructure and Accessibility Issues

India has an extensive network of public health facilities, including 767 district hospitals, 1,275 sub-district hospitals, 6,064 community health centres, 31,053 primary health centres, and 1,61,829 sub-health centres. However, only 20% of facilities assessed in 2024 meet the Indian Public Health Standards, with 42% scoring below 50% and 38% falling between 50-80%. These numbers highlight the inadequate infrastructure, particularly in poorer regions of Northern and Central India.

Access to healthcare remains a significant challenge. A 2012 study revealed that only 37% of rural residents had access to inpatient facilities within a 5 km radius, and 68% could access outpatient facilities. Vacancies in healthcare positions exacerbate these issues. For instance, a study found that 27% of doctor posts at public healthcare centres remain unfilled, and 40.7% of posts for male health workers are vacant. (Source: Statista – Public Health Facilities in India)

Financial Burden and Privatization

The healthcare system imposes significant financial burdens on many. Over 63% of healthcare spending comes directly from individuals’ pockets, and more than 55 million people are pushed into poverty annually due to medical expenses. As Dr. Jain emphasises, “India spends just 2.1% of its GDP on healthcare, far below the recommended 3%. With inadequate funding, we cannot address the absence of personnel, medicines, and diagnostic facilities.” (Source: The Times of India)

Thailand’s Universal Health Care System, on the other hand, initiated in 2002, offers an interesting model. Every Thai citizen has access to essential health services, including high-cost treatments like cancer therapy and stem cell transplants. The government’s heavy investment in healthcare has reduced financial barriers and improved patient outcomes. Life expectancy in Thailand increased from 71.8 years in 2002 to 74.2 years a decade later, while infant mortality rates dropped significantly. (Source: BioMed Central)

Health Equity and Outcomes

India grapples with significant health inequities. Only 11.3% of adolescent girls in urban Haryana correctly understand key reproductive health issues. Furthermore, two-thirds of women in India are anaemic, and half of the children are undernourished. Dr. Jain points out that “tuberculosis in India is often a disease determined by hunger, with 55% of cases attributed to malnutrition.”

The lack of focus on outpatient care also deters progress. Government-funded programs such as the Ayushman Bharat cover only inpatient services, leaving a gap in preventive and primary care. Dr. Jain stresses the need for a universal healthcare system in India that is affordable and accessible.

Rising Medication Costs

The cost of medicines in India is another significant barrier. The National Pharmaceutical Pricing Authority (NPPA) regulates drug prices, but recent adjustments have led to increased costs. Between 2022 and 2024, prices of commonly used drugs, such as those for tuberculosis and asthma, rose due to supply chain disruptions and inflation. For instance, paracetamol prices surged by 130%, affecting affordability. The urban population spent 17.64% of their MPCE on prescriptions, while the rural population spent 23.4%, indicating a heavier burden for rural patients.

So how does India control its prices?

India’s pharmaceutical market, the 3rd largest globally by volume, has over 20,000 manufacturers. Yet many lack access to essential medicines in government hospitals due to reliance on private healthcare. The NPPA, established in 1997, regulates drug prices, including 376 drugs under NLEM 2015, to ensure affordability and accessibility, reducing costs for essential medications since its inception.

Lessons from Thailand

Thailand’s well-structured district health systems offer accessible care through local centres and specialised units when needed. This approach has significantly reduced unmet healthcare needs, with only 1.3% of the population reporting access issues, and provided robust financial protection, as 80% of healthcare expenses are government-funded. In contrast, India faces a higher out-of-pocket expenditure (63% of total healthcare spending) and widespread gaps in primary care services. Adopting Thailand’s model could address India’s challenges by strengthening primary healthcare networks and increasing public health spending, currently at just 1.3% of GDP. Effective implementation would enhance access, equity, and affordability in India’s healthcare system. (Source: Millions Saved – Thailand’s Universal Health Coverage Scheme)

India’s healthcare challenges are multifaceted but not unconquerable. Increased funding, improved infrastructure, and a focus on implementing universal health care can help pave the way for a more equitable and efficient system. As Dr. Jain states, “The people who decide on healthcare policies don’t suffer the consequences of their decisions. It’s time for accountability and a commitment to health.” (Source: Press Information Bureau, Government of India)

About Authors:

Mouli Verma and Aarav Sharma are authors with a keen interest in cinema and storytelling. Mouli focuses on movies, sports, and human interest stories, exploring societal issues with depth and nuance. Aarav specialises in narratives about entertainment media, combining his love for films with insightful critiques and analyses.

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