IAS Foundation. Mains TS. Smash Prelims. Monthly Mags. Index What is the census? When was the first census in India held Why the census is important Key Findings of the Census What is the census? When was the first census in India held?
Why is the census important? Interviews were also conducted with over 1, doctors and a panel of healthcare experts to provide qualitative input.
Even if only one of these components is missing, a patient is unlikely to receive appropriate healthcare service. Understanding Healthcare Access in India. By contrast, in urban areas, accessibility is less of a challenge due to more facilities being available. Long waiting times and absence of diagnostic facilities are among the main reasons private healthcare facilities are chosen over public centres for inpatient treatment.
For outpatient treatment, the availability or doctors and quality of care are cited as reasons for selecting a private healthcare facility. However, patients would readily switch to public healthcare centres if these issues were addressed. However, due to lack of physical reach, availability of quality treatment and other practices, patients are forced to use more expensive private facilities, thus exacerbating affordability challenges.
The majority of out of pocket expenses are due to medicines, though they have not increased their share of the affordability burden. The largest impact possible can come from improvements in the availability and quality of public healthcare services, as demonstrated in the model. Unserstanding Healthcare Access in India. Sustainable policy solutions to healthcare financing, infrastructure, and human resource challenges are critically needed.
Recognizing that not everything can be changed at once and the timescale is long, a roadmap is essential to ensure gaps are prioritized, interconnections and dependencies recognized, resources directed to the right areas, targets defined, progress measured, and the community integrally involved along the way.
Recent progress and commitments by the Government and private sector suggest the willingness exists to invest and operationalize the changes needed to broaden healthcare access across the entire Indian population. The survey reported on multiple parameters related to healthcare, including morbidity in broad age groups, immunization status, episodes of outpatient and inpatient treatment across geography and income segments, and expenditure on treatment.
These measures collectively were taken to indicate the status of healthcare access. Prior to the assessment and subsequently, the Government of India and the private sector have undertaken multiple programs to improve healthcare access. These programs have addressed numerous issues, in varying proportion, that are linked to healthcare access, including lack of infrastructure, high cost of treatment, and the quality and availability of treatment.
Some of these programs have been enormously successful: for example, India is a polio-free country today. Overall, significant progress has been made on some of the basic healthcare indicators. A few states such as Tamil Nadu, Maharashtra, and Kerala have already achieved the Millennium Development Goal MDG of a maternal mortality ratio less than maternal deaths per , live births, with multiple other states close to achieving this target.
Correspondingly, the under-5 child mortality rate U5MR has decreased by similar percentage levels, and was reported at 64 deaths per 1, live births2.
These programs have been introduced to address a myriad of issues, such as the disproportionate investment in urban cities, general lack of healthcare resources and infrastructure in comparison to international standards, lack of quality treatment, and affordability. Some of the key initiatives by the Government of India which have been announced or are underway and their focus areas are described in Table 1. Report by the IMS Institute for Healthcare Informatics 6 Background Some of the national level programs have been executed with high levels of attention, excellent planning and monitoring, and appropriate resourcing.
Exhibit 1 shows, as a case study, the initiatives that the Government undertook to achieve the goal of polio eradication, and which have led to a polio-free status for India. Today, more than , chemists are providing medicines in the top cities of the country. Some of the key PPP programs are highlighted in Table 2.
Whilst the focus areas of government and the private sector may not be currently overlapping, there is a fair intensity in collaboration between the two sectors. As both sectors plan their future areas of investment and growth - as individual companies or ministries and collaboratively - it is imperative for them to gain a fuller understanding of the current healthcare landscape and prioritized areas of intervention. Since the last assessment of healthcare access occurred almost a decade ago, the need for a current understanding of the access landscape is critical.
Such an understanding would not only help review the state of access against a pre-established baseline, but also provide concrete measures against which to plan improvements. Report by the IMS Institute for Healthcare Informatics Objectives and Approach Objectives and Approach This study has been undertaken for the larger benefit of all healthcare stakeholders: the Government; pharmaceutical, payer, and provider companies; civil society organizations; and non-governmental organizations.
The study has the following objectives: 1. Prioritize challenges or gaps in terms of the relative impact on healthcare access 3. Provide a roadmap to guide future improvements in healthcare access.
The study was designed by keeping the patient at the centre, but ensuring that the views of key stakeholders were incorporated into the research. The sampling strategy was built to achieve statistically reliable quantitative data, which is representative of geography and income segments prevalent in India. To bolster the analysis, the study team interviewed eminent experts from different backgrounds of healthcare and practicing doctors, in order to gain qualitative and rich insights.
These interviews were conducted both prior to engaging with patients to develop key hypotheses, as well as after data collection in order to validate the findings of the study. The quantitative study involved an extensive nationwide survey covering 14, households, and collected data on 30, episodes. The household sample was statistically chosen from 12 states, equally distributed across progressive, middling, and lagging states See Exhibit 2. For each state, one metro and towns from 3 districts were selected.
The households covered were equally distributed across urban and rural areas. The income distribution of the households across socio-economic classifications was segregated by urban and rural areas.
The objective was to gain a detailed view across all of the SEC segments. On the qualitative side, interviews were conducted with 1, doctors see Exhibit 3 as well as with a panel of experts see Exhibit 4 to support the key insights from the quantitative study.
The experts were from varied backgrounds associated with healthcare, i. In the developed economies, it is often equated to the access status of healthcare insurance, whereas in the developing economies, it is viewed primarily across two dimensions: the physical reach of a healthcare facility, and affordability to the patient.
Before undertaking the study, it was important to build a framework that would allow the study to view healthcare access comprehensively. The framework development gave due attention to the parameters currently or traditionally used to define healthcare access in the Indian context, however aided by other parameters that are key in ensuring quality treatment to a patient. Also, the framework would allow the study to understand each component of healthcare access separately, understand their inter-dependencies, and ensure that the data collection was exhaustive.
For the purpose of this study, healthcare access has 4 key dimensions as shown in Exhibit 5. Physical Reach This component defines physical accessibility of a requisite healthcare facility, i. These facilities may either be public or private in nature. Physical reach is defined as the ability to enter a healthcare facility within 5 kilometres 5km from the place of residence or work.
The availability is governed by minimum specifications defined by the Government of India for public healthcare facilities, and international organizations such as WHO. Affordability This component defines the ability of a patient to afford complete treatment for the illness or disease. Findings from Primary and Secondary Research Collectively, this framework aims at covering all components of healthcare access for a patient.
Even if only one of the components is missing, a patient is unlikely to receive healthcare in the most appropriate and efficient manner. It is therefore essential to consider all four dimensions in order to assess the state of healthcare access. In urban areas, this is less of a challenge, as healthcare facilities are more in number, and the time required to reach these facilities is shorter due to available transportation. However, the study also found that people will readily switch to public healthcare facilities if doctors and quality treatment options were available.
However, for various reasons, people are using more expensive private healthcare facilities, thus exacerbating affordability challenges. This is especially the case in rural areas. Gaps in public sector health infrastructure, resourcing and financing impact affordability of healthcare services and reduce access for large sections of the Indian population. The following sections detail the key insights from the study: 1.
While the finding may seem general and overarching in nature, the study highlighted the magnitude of the problem. Moreover, it is relatively easier in the urban areas to travel either less than or greater than 5 km , which suggests that physical reach is not a barrier to access healthcare in the urban areas. Exhibits 6 and 7 also show that distance travelled is independent of income class of the population; both affording and poor segments are inconvenienced to a similar extent for accessing healthcare facilities.
Additionally, lack of reach also often results in deferment of treatment at early stages in the disease progression, thereby further increasing the disease and cost burden over time. Similar differences were observed across urban and rural segments, and also across acute and chronic segments. Those patients in the poor segment were also more likely to travel less than 5 km when accessing private facilities compared to those utilizing government services. See Exhibit 8. Exhibit 8: Comparison of private and public healthcare facilities on distance traveled by patients to physically access an OPD facility Distance travelled to seek OPD treatment No.
Exhibit Distance travelled to access diagnostic facilities and medicine No. There has been a steady increase in the usage of private healthcare facilities over the last 25 years for both OPD and IPD treatment, across urban and rural areas as shown in Exhibit 11 for IPD treatment. These two reasons reflect a lack of availability of resources in public healthcare facilities. All the reasons for choosing a private healthcare facility for an IPD treatment are highlighted in Exhibit The numbers were similar across the urban and rural segment and across affording and poor segments of society.
The analysis in Exhibit 15 highlights that availability and quality of healthcare resources are important levers in improving healthcare access. Introduction Expanding healthcare access is a critical priority for the Government of India and the private sector. Efforts to date have addressed numerous issues and much progress can be reported.
Our objective in this study was to gain a comprehensive view of achievements that have been made to date and the key challenge areas that remain. We also sought to prioritize areas requiring further attention and develop a roadmap for future actions. This report summarizes the most comprehensive assessment of healthcare access since and brings fresh, objective evidence of the current status of key components.
The quantitative study involved an extensive nationwide survey of households and was supplemented by qualitative interviews with doctors and experts.
We are confident this study provides a solid foundation for the necessary discussion and debate that is required to align efforts by all stakeholders to advance healthcare access for all Indians in the years ahead. The funding of this study by the Organisation of Pharmaceutical Producers of India and the Pharmaceutical Research and Manufacturers of America is gratefully acknowledged.
We would also like to express our sincere thanks to Ms. Amiee Adasczik, Mr. Ranga Iyer, Mr. Tapan Ray, Mr. Ranjit Shahani and Mr. Manish Doshi for their contributions to the study. All reproduction rights, quotations, broadcasting, publications reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without express written consent of IMS Health and the IMS Institute for Healthcare Informatics Understanding Healthcare Access in India.
Yet much more remains to be done. Understanding the current state of healthcare access is one important and foundational element for determining priorities, resource allocations and goals for the future. The most recent objective and comprehensive assessment of healthcare access in India was undertaken in , making an updated status survey critical.
At the core of the research is an extensive nationwide survey covering 14, households that are representative of the country in terms of economic and healthcare parameters, and also provide regional representation. Interviews were also conducted with over 1, doctors and a panel of healthcare experts to provide qualitative input.
Even if only one of these components is missing, a patient is unlikely to receive appropriate healthcare service.
Understanding Healthcare Access in India. By contrast, in urban areas, accessibility is less of a challenge due to more facilities being available. Long waiting times and absence of diagnostic facilities are among the main reasons private healthcare facilities are chosen over public centres for inpatient treatment.
For outpatient treatment, the availability or doctors and quality of care are cited as reasons for selecting a private healthcare facility. However, patients would readily switch to public healthcare centres if these issues were addressed. However, due to lack of physical reach, availability of quality treatment and other practices, patients are forced to use more expensive private facilities, thus exacerbating affordability challenges.
The majority of out of pocket expenses are due to medicines, though they have not increased their share of the affordability burden. The largest impact possible can come from improvements in the availability and quality of public healthcare services, as demonstrated in the model. Unserstanding Healthcare Access in India.
Sustainable policy solutions to healthcare financing, infrastructure, and human resource challenges are critically needed. Recognizing that not everything can be changed at once and the timescale is long, a roadmap is essential to ensure gaps are prioritized, interconnections and dependencies recognized, resources directed to the right areas, targets defined, progress measured, and the community integrally involved along the way.
Recent progress and commitments by the Government and private sector suggest the willingness exists to invest and operationalize the changes needed to broaden healthcare access across the entire Indian population. The survey reported on multiple parameters related to healthcare, including morbidity in broad age groups, immunization status, episodes of outpatient and inpatient treatment across geography and income segments, and expenditure on treatment.
These measures collectively were taken to indicate the status of healthcare access. Prior to the assessment and subsequently, the Government of India and the private sector have undertaken multiple programs to improve healthcare access. These programs have addressed numerous issues, in varying proportion, that are linked to healthcare access, including lack of infrastructure, high cost of treatment, and the quality and availability of treatment.
Some of these programs have been enormously successful: for example, India is a polio-free country today. Overall, significant progress has been made on some of the basic healthcare indicators. A few states such as Tamil Nadu, Maharashtra, and Kerala have already achieved the Millennium Development Goal MDG of a maternal mortality ratio less than maternal deaths per , live births, with multiple other states close to achieving this target.
Correspondingly, the under-5 child mortality rate U5MR has decreased by similar percentage levels, and was reported at 64 deaths per 1, live births2. These programs have been introduced to address a myriad of issues, such as the disproportionate investment in urban cities, general lack of healthcare resources and infrastructure in comparison to international standards, lack of quality treatment, and affordability. Some of the key initiatives by the Government of India which have been announced or are underway and their focus areas are described in Table 1.
Report by the IMS Institute for Healthcare Informatics 6 Background Some of the national level programs have been executed with high levels of attention, excellent planning and monitoring, and appropriate resourcing. Exhibit 1 shows, as a case study, the initiatives that the Government undertook to achieve the goal of polio eradication, and which have led to a polio-free status for India. Today, more than , chemists are providing medicines in the top cities of the country.
Some of the key PPP programs are highlighted in Table 2. Whilst the focus areas of government and the private sector may not be currently overlapping, there is a fair intensity in collaboration between the two sectors.
As both sectors plan their future areas of investment and growth - as individual companies or ministries and collaboratively - it is imperative for them to gain a fuller understanding of the current healthcare landscape and prioritized areas of intervention.
Since the last assessment of healthcare access occurred almost a decade ago, the need for a current understanding of the access landscape is critical. Such an understanding would not only help review the state of access against a pre-established baseline, but also provide concrete measures against which to plan improvements. Report by the IMS Institute for Healthcare Informatics Objectives and Approach Objectives and Approach This study has been undertaken for the larger benefit of all healthcare stakeholders: the Government; pharmaceutical, payer, and provider companies; civil society organizations; and non-governmental organizations.
The study has the following objectives: 1. Prioritize challenges or gaps in terms of the relative impact on healthcare access 3. Provide a roadmap to guide future improvements in healthcare access. The study was designed by keeping the patient at the centre, but ensuring that the views of key stakeholders were incorporated into the research.
The sampling strategy was built to achieve statistically reliable quantitative data, which is representative of geography and income segments prevalent in India. To bolster the analysis, the study team interviewed eminent experts from different backgrounds of healthcare and practicing doctors, in order to gain qualitative and rich insights.
These interviews were conducted both prior to engaging with patients to develop key hypotheses, as well as after data collection in order to validate the findings of the study. The quantitative study involved an extensive nationwide survey covering 14, households, and collected data on 30, episodes.
The household sample was statistically chosen from 12 states, equally distributed across progressive, middling, and lagging states See Exhibit 2. For each state, one metro and towns from 3 districts were selected.
The households covered were equally distributed across urban and rural areas. The income distribution of the households across socio-economic classifications was segregated by urban and rural areas. The objective was to gain a detailed view across all of the SEC segments. On the qualitative side, interviews were conducted with 1, doctors see Exhibit 3 as well as with a panel of experts see Exhibit 4 to support the key insights from the quantitative study.
The experts were from varied backgrounds associated with healthcare, i. In the developed economies, it is often equated to the access status of healthcare insurance, whereas in the developing economies, it is viewed primarily across two dimensions: the physical reach of a healthcare facility, and affordability to the patient.
Before undertaking the study, it was important to build a framework that would allow the study to view healthcare access comprehensively. The framework development gave due attention to the parameters currently or traditionally used to define healthcare access in the Indian context, however aided by other parameters that are key in ensuring quality treatment to a patient.
Also, the framework would allow the study to understand each component of healthcare access separately, understand their inter-dependencies, and ensure that the data collection was exhaustive. For the purpose of this study, healthcare access has 4 key dimensions as shown in Exhibit 5. Physical Reach This component defines physical accessibility of a requisite healthcare facility, i.
These facilities may either be public or private in nature. Physical reach is defined as the ability to enter a healthcare facility within 5 kilometres 5km from the place of residence or work. The availability is governed by minimum specifications defined by the Government of India for public healthcare facilities, and international organizations such as WHO.
Affordability This component defines the ability of a patient to afford complete treatment for the illness or disease. Findings from Primary and Secondary Research Collectively, this framework aims at covering all components of healthcare access for a patient. Even if only one of the components is missing, a patient is unlikely to receive healthcare in the most appropriate and efficient manner.
It is therefore essential to consider all four dimensions in order to assess the state of healthcare access.
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