The Covid-19 pandemic has served as a timely wake−up call for countries around the worldand has forced them to re−evaluate the importance of public healthcare infrastructure development and spending. Countries have also learnt that the lack of access to affordable, quality healthcare services for their citizens, in times of a pandemic, can have a devastating impact on the economy. While the pandemic has brought to the fore some immediate tactical challenges, their solutions indelibly lie in fixing the long term systemic issues of our healthcare system.
India’s Healthcare Sector: Pre− & Post− Covid-19 Challenges
Short Term Challenges
Covid-19 has brought several private hospitals to the brink of financial turmoil and bankruptcy due to low occupancy and losses to the tune of Rs 13,400 crores. There is an urgent need to address this but the government’s stimulus package offered little relief to the healthcare sector. Doctors, paramedical staff, and emergency responders like the police, have been complaining about the lack of adequate protective gear (PPEs). In several cases where it was provided, it was reportedly of inferior quality.
There is the persisting possibility of shortage of ICU and ventilator beds. Based on government figures which show that 3−4 percent of active cases need ICU care in hospitals, 30,000−40,000 Covid-19 patients would require ICUs in a time like the present (October 2020).
Long Term Challenges
Despite accounting for a lower share of the total hospitals in the country, public hospitals handle 42 percent of in−patient cases. This shows that public healthcare infrastructure is limited and is highly overburdened. This has been worsened by Covid-19.
TAlso, since several large public hospitals have been marked as dedicated Covid-19 treatment centers, their availability for the poor, for non−Covid-19 related cases have been severely restricted and hampered.
India has a massive shortage of doctors and para medical staff. Visuals of stressed, overburdened doctors, from across the country has made this fact even more than apparent now.
We import consumables, disposables, and capital equipment, including orthopaedic implants, gloves, syringes, bandages, computed tomography and magnetic resonance imaging devices from China. Due to the current crisis in China, the medical device manufacturers across India are finding it difficult to source important raw materials and are having to do so at inflated costs, which is further affecting margins and profitability.
High out−of−pocket on healthcare suggests that Indians don’t trust public hospitals when it comes to critical procedures. There is an urgent need to upgrade public health infrastructure and increase the number of specialty hospitals in rural areas.
More than half of the country, that is, 56 percent, has no medical insurance cover and, as a result, faces the risk of plunging into bankruptcy and crushing debt (2017−18 National Family Health Survey puts the number of uninsured at 85 percent.).
The Government’s Failure
Private hospitals have mostly not been taken into confidence by the government. Most hospitals have not been allowed to test or treat Covid-19 cases, neither have doctors who are practicing in private hospitals been enrolled as temporary consultants to alleviate some of the burden borne by doctors in government hospitals.
As a result, the private healthcare sector is under immense financial strain and the economic package did little to relieve the very sector that is at the heart of India’s andemic response.
The harsh, ill−planned lockdown was not able to flatten the curve and India became the only country that unlocked when its cases were rising at a high rate. It is very likely that when cases peak, India may run out of ICU & ventilator beds. This is already happening in cities like Mumbai and Delhi.
We failed to use the lockdown to test in millions and isolate and contain the spread. Low testing and failure of contact tracing in several states continue to be a challenge. Inadequate supply and inferior quality protective gear to front−line workers has resulted in several doctors, paramedical staff, and policemen succumbing to the Covid-19 virus.
We suffer from a lack of uniform policy directive to states to cap Covid-19 treatment cost in private hospitals and decentralize Covid-19 treatment by roping in private hospitals. Only when cases have spiralled out of control have the state governments reluctantly got private hospitals on board.
Suggestions and Recommendations
We need to rope in private hospitals and decentralize Covid-19 testing and treatment. The government should, by means of a policy directive, ask the states to standardize Covid-19 treatment rates across the country and subsidize treatment for the common man. This should be done in consultation with private hospitals and insurance companies.
We urgently need to further increase our testing capacity and we need to test ten− fold. Another strong need is for us to get a majority of the population under some kind of universal health coverage.
This pandemic has also shown us that we need a timed plan to build and increase our medical capacity in terms of number of medical professionals being added each year by setting up more public medical colleges.