JANUARY

INDIA
provide after-hour care, reimbursement for which is built into their salaries. A free medical help line is being
operated by certain states in India.
Hospitals: District hospitals function as the secondary tier of public providers for the rural population (MOH,
2011). The average population served per public bed is 1,946. Of a total of 628,708 government beds, 196,182
are in rural areas (CBHI, 2013). Government hospitals operate within a yearly budget allocation.
There has been a major expansion of the private hospital sector recently, and government-sponsored health
schemes rely on private hospitals as a part of public–private partnerships. Between 2002 and 2010, the private
sector created more than 70 percent of new beds, contributing 63 percent of total hospital beds (Gudwani et
al., 2012). The private sector currently provides about 80 percent of outpatient care and 60 percent of inpatient
care (MOH, 2014). In addition, about 80 percent of doctors, 26 percent of nurses, and 49 percent of beds are in
the private sector (Wennerholm et al., 2013).
Private-sector hospitals range from small, family-run general hospitals to facilities providing super-speciality
tertiary care. Until the 1980s, private-sector hospitals were mainly run by charitable trusts and registered as notfor-profit.
With India’s economic liberalization, a growing middle class, and the rise in medical tourism, a number
of corporate hospitals have been established, and for-profit private hospitals are becoming more common.
There also has been a considerable expansion in tertiary care service providers in recent years, mostly in the
private sector. The need for tertiary care is growing, but the costs are growing even faster and have become
prohibitive (MOH, 2014).
Physician payment in the private sector varies from salary to fee-for-service. Hospitals that pay doctors a fixed
salary do have incentives for attracting new patients but provide no incentives for internal referrals within
the hospital.
Mental health care: Mental health is one of the most neglected areas of India’s health system. India has less
than 21 percent of the psychiatrists its population needs and less than 2 percent of clinical psychologists and
social workers required (CBHI, 2013).
Attempts are being made to rectify the situation. For example, the Mental Health Care Bill of 2013 makes
access to mental health care a right for every person. Access at government health facilities must be affordable,
of good quality, and provided without discrimination. Recently, under the National Mental Health Programme
(NMHP), a mass media campaign on creating awareness and reducing stigma was undertaken. To address the
gap in mental health resources and increase training capacity, 10 centers of excellence and 23 postgraduate
departments in mental health specialties have been established across the country (MOH, 2011).
According to the IPHS guidelines under NMHP, primary health centers should ensure early identification
(diagnosis) and treatment of common mental disorders such as psychosis, depression, anxiety disorders, and
epilepsy, as well as referral services. It is also essential that PHCs provide information, education, and
communication on prevention, stigma removal, and early detection of mental disorders. However, given
capacity constraints, it remains to be seen to what extent these steps are implemented.
Long-term care and social supports: Despite the growing elderly population, there has been a lack of longterm
care services. Families have mainly been responsible for providing necessary care. Recently, the central
government launched the National Programme for Health Care of the Elderly to address the health-related
problems of elderly people (MOH, 2015a; DGHS, 2011). This is intended to provide additional human resources
and funding for home care, screening for early diagnosis, vaccinations for high-risk groups, and health
education for caregivers.
Examples of social welfare support provided to the elderly include old-age pensions, subsidized food and
transport, lower income tax, and higher savings interest rates. Benefits under certain schemes for the elderly,
such as the old-age pension scheme and the public distribution system, are available to those below the
poverty level.
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The Commonwealth Fund