India’s Healthcare Paradox

Uttan Bandyopadhyay

The Indian health system has undergone significant transformations over the years, influenced by various socio-economic, cultural, and political factors. During the colonial era, India’s health system was largely designed to cater to the needs of the British rulers and urban elites. The Indian Medical Service (IMS) was established in 1764, and primarily focused on providing medical care to British officials and soldiers. The healthcare infrastructure was limited, and medical facilities were concentrated in urban areas, leaving rural India with negligible access to healthcare.

The Indian government acknowledged the need for a robust healthcare system in the era of post-independence. The Bhore Committee Report (1946) and the Chadha Committee Report (1963) laid the foundation for India’s healthcare policy, emphasising the importance of universal access to healthcare, preventive and curative services, and community participation.

In recent decades, India has made significant strides in improving its health system. Some notable achievements include:

   1. Increased access to healthcare: The expansion of healthcare infrastructure, including hospitals, clinics, and community health centres, has improved access to healthcare services, particularly in rural areas.

   2. National Health Mission (NHM): Launched in 2005, NHM aims to provide universal access to equitable, affordable, and quality healthcare services. The mission has contributed significantly to improving health outcomes, particularly in rural areas.

   3. Ayushman Bharat Yojana (ABY). Introduced in 2018, ABY aims to provide health insurance coverage to economically vulnerable families, providing them with financial protection against catastrophic health expenditures.

Despite these advancements, India’s health system continues to face numerous challenges and limitations, including:

   1. Inequitable distribution of healthcare resources: Healthcare facilities and personnel remain concentrated in urban areas, leaving rural India with inadequate access to healthcare services.

   2. Insufficient funding: India’s healthcare expenditure as a percentage of GDP remains low, resulting in inadequate funding for healthcare infrastructure, personnel, and services.

   3. Quality of care: Concerns regarding the quality of healthcare services persist, including issues related to patient safety, infection control, and medication errors.

   4. Patient rights: India’s health system often neglects patient rights, including the right to informed consent, confidentiality, and respect for autonomy.

Patient rights are an essential component of a patient-centred healthcare system. However, India’s health system often falls short of ensuring that patients’ rights are respected and protected. Some of the key patient rights concerns in India include:

   a) Lack of informed consent: Patients are often not provided with adequate information about their, treatment options, and potential diagnosis risks, violating their right to informed consent.

   b) Confidentiality and privacy: Patient confidentiality and privacy are frequently compromised, particularly in public healthcare facilities.

   c) Respect for autonomy: Patients’ autonomy and decision-making capacity are often disregarded, with healthcare providers making decisions on their behalf without their consent.

A very pertinent question is whether the influence of Corporate Pharma and Corporate Hospital lobbies has significantly impacted the healthcare landscape in India, often prioritising profits over patient welfare. Here are some ways these lobbies operate:

   a) Lobbying: Corporate Pharma and Hospital lobbies exert significant influence on policymakers, shaping laws and regulations that favour their interests.

   b) Campaign financing: These lobbies contribute to election campaigns, ensuring that lawmakers remain sympathetic to their causes.

   1. Overemphasis on expensive treatments: Corporate hospitals and pharma companies promote costly treatments, procedures, and medications, often unnecessary or ineffective.

   2. Aggressive marketing: Pharmaceutical companies engage in aggressive marketing tactics, influencing doctors’ prescribing habits and creating demand for their products.

   3. Unnecessary diagnostic tests: Corporate hospitals often recommend unnecessary diagnostic tests, generating additional revenue.

Lack of transparency: Pharmaceutical companies and hospitals often withhold critical information about treatments, medications, and costs, leaving patients vulnerable.

Misleading advertising: Pharmaceutical companies engage in misleading advertising, exaggerating the benefits of their products and downplaying risks.

   a) Privatisation of healthcare: Corporate lobbies advocate for the privatisation of healthcare services, undermining the public healthcare system and limiting access to affordable care.

   b) Discrediting public healthcare: Corporate lobbies often discredit public healthcare services, portraying them as inferior to private sector alternatives.

   c) Catastrophic healthcare expenditures: Patients are often burdened with exorbitant medical bills, leading to financial ruin.

   d) Inadequate care: The emphasis on profits can result in inadequate care, as hospitals and pharmaceutical companies prioritise revenue over patient welfare.

   e) Lack of accountability: The lack of transparency and accountability in the healthcare system makes it difficult for patients to seek redress for grievances.

   1. Promote transparency and accountability: Strengthen regulatory frameworks to ensure transparency in healthcare pricing, treatment protocols, and pharmaceutical marketing.

   2. Support public healthcare: Invest in and strengthen public healthcare systems to provide accessible, affordable, and quality care.

   3. Empower patients: Educate patients about their rights, treatment options, and costs, enabling them to make informed decisions.

   4. Encourage ethical practices: Foster a culture of ethics in healthcare, promoting evidence-based medicine and discouraging unnecessary treatments and medications.

West Bengal’s Healthcare System
West Bengal’s healthcare system has undergone significant transformations over the years. The state’s healthcare infrastructure is divided into three tiers: primary health-care networks, secondary care systems comprising district and sub-divisional hospitals, and tertiary hospitals providing specialty and super specialty care.

In the past, West Bengal’s healthcare system was marred by inadequate infrastructure, insufficient funding, and a shortage of healthcare professionals. However, in recent years, the state government has increased its focus on healthcare, allocating Rs16,368 crore (US$2.0 billion) for public healthcare in 2021.

The state has also implemented various initiatives to improve healthcare services, including the West Bengal Health Scheme, which provides health insurance coverage to families below the poverty line. Additionally, the state has established a network of community health centres and primary health centers to provide accessible healthcare services to rural populations.

Despite these efforts, West Bengal’s healthcare system still faces challenges, particularly in peripheral centres of remote areas.

Inadequate infrastructure: Many healthcare facilities in rural areas lack basic infrastructure, including equipment, medicines, and sanitation facilities.

Shortage of healthcare professionals: There is a significant shortage of doctors, nurses, and other healthcare professionals in rural areas, making it difficult for patients to access quality care.

Limited access to specialized care: Patients in rural areas often have limited access to specialized care, including diagnostic services and treatment for complex medical conditions.

To address these challenges, the state government needs to increase its focus on strengthening healthcare infrastructure, recruiting and retaining healthcare professionals, and improving access to specialized care in rural areas.

In terms of patient care and patient rights, West Bengal has made some progress, but there is still a long way to go.

While private health insurance and public health insurance schemes have their limitations, the Right to Health would provide a constitutional guarantee for healthcare access, empowering patients and communities to demand better healthcare services and holding the government accountable for healthcare delivery.

The struggle for the Right to Health is not just about healthcare; it is about social justice, equality, and human dignity. By prioritizing the Right to Health, people can build a more just and equitable society where everyone has access to quality healthcare, regardless of their socioeconomic status or background.

[Uttan Bandyopadhyay has been a Health Movement activist for several decades.]

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Frontier
Vol 57, No. 44, Apr 27 - May 3, 2025