A chaotic and non-uniform system, after years of neglect cannot be corrected overnight or by change in piecemeal policies. It needs to be revamped from the roots. To do it from grass root  level especially with financial constraints,  it will need a  sincere will to develop  the system.

                     India’s top think tank said Thursday that the country’s healthcare system resembled a “sinking ship”and desperately needs more private participation in smaller towns to run the government’s ambitious Ayushman Bharat program efficiently.

“We would require all hands on deck, as they say,” Niti Aayog adviser Alok Kumar said at the Healthcare Federation of India’s Sixth Annual Summit, referring to the poor state of healthcare in India. The Ayushman Bharat’s insurance program, Pradhan Mantri Jan Arogya Yojana (PMJAY), has been facing constraints in smaller cities due to a dearth of hospitals.

“We can’t have all the patients being transported to tier-1 and tier-2 cities for treatment because that is not a model which is sustainable,” Kumar said.

The Lancet, the world’s oldest and most prestigious journal, had last year ranked India’s healthcare system at a dismal 145 out of 195 countries, worse than even North Korea and Syria. The ranking was worse than its smaller Asian peer Philippines and neighbour Sri Lanka, a fact also pointed by Kumar.

Kumar said that a number of hospitals in smaller cities, including those run by public sector enterprises, are under-utilized even though there is strong demand for their services in these regions, especially because of the insurance program.

“Singrauli, for instance, the power capital of India, has hospitals of NTPC, Coal India Ltd; all of them underutilized (like) shells standing. Railway hospitals (are like) shells standing but not being utilized efficiently enough,” Kumar said.

He urged large private hospital chains to manage the hospitals run by state enterprises better by widening the scope of their services to beyond their own employees.

The PMJAY was introduced last year, and aims to provide health insurance cover of ₹5 lakhs per family per year for secondary and tertiary care hospitalization to over 10 crore poor and vulnerable families, which would total around 50 crore beneficiaries.

Ayushman Bharat is the umbrella program, with PMJAY for secondary and tertiary hospitalization, and health and wellness centres for primary healthcare facilities. Under the Ayushman Bharat, the government aims to create around 1.5 lakh health and wellness centres.

While the Indian government aims to increase the share of public health spending to 2.5% of GDP by 2025 under the National Health Policy, currently it is still only around 1%.

Another major problem for the poor state of the sector is the lack of health insurance for patients, leading to an out of pocket expenditure making up for 61% of total health expenses for households, as of 2015-16, latest National Health Accounts data showed.

To reduce out of pocket expenses, the government introduced the Ayushman Bharat insurance scheme, but large private hospital chains have shown resistance to participating in it due to ‘low package rates’ for various treatment procedures. Kumar said that the government was willing to listen to hospitals and other private entities and make changes to policy if they were ready to invest in the sector.