INTRODUCTION

The concept of health as a balance between a person and the environment, the unity of soul and

body, and the natural origin of disease, was the backbone of the perception of health in ancient

Greece. Similar concepts existed in ancient Indian and Chinese medicine. In the 5th century BC,

Pindar defined health as “harmonious functioning of the organs”, emphasizing the physical

dimension of health, the physical body and the overall functionality, accompanied by the feeling

of comfort and absence of pain. Even today, his definition bears importance as a prerequisite for

the overall health and wellness. Plato (429-347 BC) in his “Dialogues” pointed out that a perfect

human society could be achieved by harmonizing the interests of the individual and the

community, and that the ideal of ancient Greek philosophy “a healthy mind in a healthy body”

could be achieved if people established internal harmony and harmony with the physical and the

social environment. According to Aristotle’s teaching, man is a social being by his very nature;

he tends to live in communities with the duty to respect the moral standards and ethical rules.

Aristotle emphasized the necessity for regulating the relations in the society to achieve

harmonious functioning and preservation of health of its members. Democritus connected health

with behavior, wandering why people prayed to God for health, which was essentially under

their own control. Hippocrates explained health in connection with the environmental factors and

lifestyle. Hippocrates was the creator of the concept of “positive health”, which depended on the

primary human constitution (we consider it today as genetics), diet, and exercise. He thought that

proper diet and exercise were essential for health, and that seasons’ changes had a profound

effect on the mind and body, resulting in different types of predominant diseases during the

winter (respiratory tract diseases) and summer (digestive tract diseases) ( A lot might be said

about the long standing philosophical discussion about body and soul, and in present society

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between body and mind, as an active dichotomy (Plato and Hellenism) or as an integrated unity

(usually reference to Aristotle), which is important to know about in the current online

environment.

In the Middle Ages, health perception was strongly influenced by religion and the church. After

Roman Empire fell apart, the church was left as an only important infrastructure providing care

for the people and collecting the knowledge on remedies, e.g, herbs grown in monastery gardens.

The “forgotten” knowledge of antiquity was re-discovered during the Renaissance and re-framed

up to the present. During the period of Industrial Revolution, health became an economic

category, which was to allow good condition and working ability and reduce lost work days due

to illness. Accordingly, the value of health was such as enabling economic profit. The health was

intertwined with Darwinian understandings of strength and being the fittest, where meaning of

life was tied to physical survival. Another health aspect considered the ability of the individual to

adapt to the influences from the environment to the extent that the individual could tolerate and

resist. When the adjustment is over, the disease occurs as a natural consequence. This approach

first reflected only biological mechanisms of adaptation, later adding on influences from the

environment, which needed to be governed and modified.

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 MODERN CONCEPT OF HEALTH

All modern concepts of health recognize health as more than the absence of disease, implying a

maximum capacity of the individual for self-realization and self-fulfillment. This should

equilibrate the human inner forces and possibilities with the feeling of pleasure or dissatisfaction

in their relations with the environment. Social medicine and public health approach to health

advocate that we should not only observe the health of the individuals, but also the health of the

groups and the community, as a result of the interaction of the individuals with the social

environment.

The holistic concept of health is contained in the expression of wholeness. Health is a relative

state in which one is able to function well physically, mentally, socially, and spiritually to

express the full range of one’s unique potentialities within the environment in which one lives.

Both health and illness are dynamic processes and each person is located on a graduated scale or

continuous spectrum (continuum) ranging from wellness and optimal functioning in every aspect

of one’s life, at one end, to illness culminating in death, at the other.

The modern theories take a different view of what creates health and what factors support health,

as opposed to the conventional approach of pathogenesis to study the factors that cause disease.

To find the “origins of health”, one needs to search for factors that support the human health and

welfare.

To establish social welfare and to facilitate, encourage, and secure individual autonomy and

dignity are key challenges in the present time and society. The modern understanding of health

became official when the World Health Organization (WHO), at the time of its establishment in

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1948, included the definition of health in its Constitution. This generally accepted definition

states that “health is a state of complete physical, mental, and social well-being and not merely

the absence of disease or infirmity”. This definition promoted for the first time that, in addition

to physical and mental health, social welfare is an integral component of the overall health,

because health is closely linked to the social environment and living and working conditions.

Within the last few decades, the WHO definition of health has been increasingly amended and

supplemented by the fourth dimension – spiritual health. Generally speaking, spiritual health

involves a sense of fulfillment and satisfaction with our own lives, system of values, self-

confidence and self-esteem, self-awareness and presence, peacefulness and tranquility with

dynamic emotional balance, both internal and toward the environment, morality and truthfulness,

selflessness, positive emotions, compassion and willingness to help and support others,

responsibility and contribution to the common good, and successful management of everyday

life problems and demands as well as social stress.

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 RIGHT TO HEALTH AND HUMAN RIGHTS

With both the UDHR and WHO coming into existence, there was great promise that these two

institutions would complement each other, with WHO like all UN specialized agencies serving to

support human rights in its policies and programs. Yet in spite of this promise and early WHO

support for advancing a human rights basis for its work, the WHO Secretariat intentionally

neglected human rights discourse during crucial years in the development and implementation of

health-related rights, projecting itself as a technical organization above ‘legal rights’ and

squandering opportunities for WHO leadership in the evolution of rights-based approaches to

health.

The reach of public health law is as broad as public health itself and both have expanded to meet

the needs of society. The scope of the right to health and its correlation with the right to

healthcare was first outlined in the Universal Declaration of Human Rights in 1948, wherein

while the right to health was conceived as an individual’s civil right, states were bound to

provide minimum conditions to enable individuals to enjoy this right and provide primary health

services in an equal and fair manner. It is important to note that while the right to health is

considered an inherent human right, the right to healthcare is its progressive realization through

declared constitutional and legal rights, in particular, through public health law.

As states worked through the UN Commission on Human Rights to develop human rights treaty

law, WHO was set to play a defining role in translating the aspirational public health language of

the 1948 UDHR into the binding legal obligations of the 1966 International Covenant on

Economic, Social and Cultural Rights (ICESCR). Although WHO served this vital human rights

leadership role in the first five years of its existence, the political constraints of the Cold War led

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WHO to reposition itself in international health as a purely technical organization, focusing on

medical intervention and disease eradication to the detriment of rights advancement.

Where WHO neglected human rights development, it did so to the detriment of public health.

When WHO sought to reclaim the language of human rights in the 1970s in the pursuit of its

‘Health for All’ strategy, its past neglect of human rights norms left it without the legal

obligations necessary to implement primary health care pursuant to the Declaration of

Alma-Ata.

WHO’s early years were marked by the Secretariat’s active role in drafting human rights treaty

law and its cooperative work with other UN agencies to expand human rights frameworks for

public health. Working with state representatives in the early 1950s, WHO Director-General

Brock Chisholm welcomed ‘opportunities to co-operate with the [UN] Commission on Human

Rights in drafting international conventions, recommendations and standards with a view to

ensuring the enjoyment of the right to health,’ recognizing that ‘the whole programme approved

by the World Health Assembly represents a concerted effort on the part of the Member States to

ensure the right to health.’

In pressing the Commission on Human Rights in its development of health obligations, the WHO

Secretariat successfully suggested in 1951 that the right to health reflects state commitments in

the WHO Constitution, emphasizing (1) a positive definition of health promotion, (2) the

importance of social measures as underlying determinants of health, (3) governmental

responsibility for health provision, and (4) the role of health ministries in creating systems for the

public’s health.

While these WHO proposals survived early objections from the Cold War Superpowers, with

vigorous debates among state representatives in both the WHO Executive Board and the UN

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Commission on Human Rights on the expansiveness of such public health commitments, WHO’s

influential contributions to the development of human rights for public health were explicitly

rejected following a 1953 shift in WHO’s Secretariat leadership and reform of WHO’s health

priorities.

In addressing determinants of health through ‘primary healthcare,’ the WHO Secretariat would

adopt human rights discourse to advocate for the national and international redistributions that

would allow people to lead socially and economically satisfying lives.

Embedded in the 1978 Declaration of Alma-Ata, this socio-economic approach to health

reasserted the WHO Constitution’s proclamation that health ‘is a fundamental human right,’

creating a rights-based vision for what many at the time considered ‘the onset of the health

revolution.’

However, despite presenting a nominally rights-based framework for advancing public health,

WHO’s previous neglect of human rights law would prove fatal to the goals of the Health for All

Strategy. Without UN treaty frameworks to guide primary health care, the Declaration of Alma-

Ata presented no obligations on states, with scholars noting in its aftermath that ‘inadequate

national commitment to the ‘Health for All’ strategy is at some level a reflection of the

ineffectiveness of WHO’s strategy of securing national dedication to the right to health.

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 PUBLIC HEALTH

Public health is defined as the science of protecting the safety and improving the health of

communities through education, policy making and research for disease and injury prevention.

The new public health is compressive in scope. It relates to or encompasses all community and

individual activities directed towards reducing factors that contribute to the burden of disease

and foster those that relate directly to improved health. Its programs range from Immunization,

health promotion, and childcare to food labeling and food fortification to the assurance of well

managed, accessible health care service. The planning, management, and monitoring functions of

a health system are indispensable in a world of limited resources and high expectations. This

requires a well developed health information system to provide the feedback and control data

needed for good management.

It includes responsibilities and coordination at all levels of government and by non-

governmental organizations (NGO’S) and participation of a well-informed media and strong

professional and consumer organization. No less important are clear designations of

responsibilities of the individual for his/her own health, and of the provider of care for human,

high quality professional care. It is concerned with the health of the whole population and the

prevention of disease from which it suffers. It is also one of the efforts organized by society to

protect, promote, and restore the peoples’ health. It is the combination of sciences, skills and

beliefs that is directed to the maintenance and improvement of the health of all the people

through collective social actions.

The area of health policy and practice is large and rather complex. For ensuring equitable,

efficient and effective health care services, it is essential for a public health professional to have

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a sound knowledge of all the topics pertaining to the area of health economics. One of the

learning objectives of Community Medicine is that a public health professional should acquire

the ability to perform as an effective leader of health team at primary level (1). The landscape of

health problems in India have undergone a rapid transition bringing in its wake a set of

c h a l l e n g e s b r o u g h t a b o u t b y e p i d e m i c s o f n o n - communicable diseases along

with the age old problems brought in by communicable diseases, nutritional

deficiencies and poor maternal health. This calls for a concerted public health response which

would include cost effective strategies for health promotion, disease control and provision of

health care (2). It is a well known fact that investment in the field of health contributes to

the economic growth of a country and prevents economic loss caused by diseases and

premature death. In a developing country like India where the resources are scarce, health

economics could serve as an important tool to bring about an optimum use of resources to

achieve health gains.

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 PUBLIC HEALTHCARE SYSTEM IN INDIA

India’s health care system consists of different types of providers who practice in different

systems of medicine and use various forms of organization in delivering health care services.

The system is so complex that it includes sub systems each contributing their share in providing

health care services in the country. Each subsystem is different from the others in terms of the

resources invested in the health infrastructure, system of payments, technological sophistication

health needs and demand perceptions about quality and utilization reach capabilities innovative

strategies used geographic concentration and the role of the government.

The services provided by each component are different, yet interdependent and overlapping in

nature. This makes it difficult to define precisely the boundaries of a particular segment of the

health care system. However by using the ownership criterion, the health care system can be

divided into four broad categories. First the public sector which includes government run

hospitals, dispensaries clinics primary health care centres and sub centres and paramedics.

Second the not for profit sector which includes voluntary health programs, charitable institutions

missions churches and trusts. Third the organised private sector which includes general

practitioners private hospitals and dispensaries registered medical practitioners and other

licentiates. Fourth the private informal sector which consists of practitioners not having any

formal qualification faith healers, tantriks herbalists, priests, hakims and vaids.

This healthcare system will become effective, efficient, optimal, accessible and equitable if the

state fulfils all the core obligations that are imposed upon it by right to health.  The State as a

regulator, protector and promoter of our health assesses our health care needs, ensures access to

health care service, organizes and regulates the medical and allied professions, regulates medical

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institutions, ensures availability, affordability and quality of drugs, maintains efficacy and

effectiveness of healthcare, reviews the causes of ill health, prescribes regulations for protection

of health of the population and reduces the health risks posed by diseases. When these roles are

reviewed through the touchstone of right to health it tries to incorporate into the role of the State

the principles of equality and non-discrimination.

The framers of the Indian Constitution recognized the mandate on the part of the state to improve

the health. But rather than treating health as a fundamental right they treated it as a directive

principle.  The obligation of the State to ensure the creation and the sustaining of conditions

congenial to good health is cast by the constitutional directives contained in Articles 39, 42 and

47. As per these directives the State has to direct its policy towards securing that health and

strength of workers, men and women, and the tender age of children are not abused and that

citizens are not forced by economic necessity to enter avocations unsuited to their age or strength

and that children are given opportunities and facilities to develop in a healthy manner and in

conditions of freedom of dignity and that childhood and youth are protected against exploitation

and against moral and material abandoned.

The State is also required to make provision for just and human conditions of work and for

maternity benefit.  Again it becomes the primary duty of the State to endeavor the raising of the

level of nutrition and standard of living of its people and improvement of public health and to

bring about prohibition of the consumption, except for medicinal purposes of intoxicating drinks

and of drugs which are injurious to health Protection and improvement of environment is also

made one of the cardinal duties of the state.

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The State legislature is also empowered to make laws with respect to public health and

sanitation, hospitals and dispensaries. Both the Centre and the States have power to legislate in

the matters of social security and social insurance, medical professions and prevention of the

extension from one state to another of infections of contagious diseases or pests affecting man,

animals and plants. The Directive Principles of State Policy represent the minimum national

consensus on the basic socio-economic objectives at the time of framing the Constitution.  These

directives are fundamental in the governance of the country. They can be stated as the rock

bottom level of the socio –economic development that the state is obliged to secure and maintain.

However Directive Principles of State Policy are non-justiciable and their status is only that of a

directive to the government. This has caused to undermine the philosophy behind the inclusion

of Directive Principles in the State Policy. So it is often argued that if Directive Principles of

State Policy were absent in the Constitution it would not have made any difference because

economic justice and public welfare could have been realized through fundamental rights read

together with restrictions.

 But at the same time it must be admitted that a close reading of the Directive Principles enjoins

the government to provide comprehensive, creative, preventive, promotional and rehabilitative

health services and proper nutrition to all the people of India. In tune with these a plethora of

welfare legislations have been enacted by the state. These statutes do not come in a single neat

legislative package marked Health Law. It consists of many different types of legislation, which

have little in common except the benign purpose of advancing public health.

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 THE JUDICIAL TREND

It was emphasized in Paramand Katara v. Union of India.[31]  that it is the duty of the doctors

to take all possible measures to preserve life and observed that preservation of human life is of

paramount importance.  The Apex court held that whether the patient be innocent person or

liable to punishment under the law, it is the obligation of those who are in charge of the health of

the community to preserve life,[33]  so that innocent may be protected and guilty may be

punished. It was also held that this obligation is total, absolute and paramount, and laws of

procedure, whether in statutes or otherwise, which would interfere with the discharge of this

obligation cannot be sustained and must therefore give away.

The Supreme Court, while interpreting Article 21 of the Constitution ruled that the expression

‘life’ does not connote mere animal existence or continued drudgery through life but includes,

inter alia, the opportunities to eliminate sickness and physical disability. In Francis Coralie

Mullin v. Union Territory of Delhi, it was held that, right to life guaranteed in Article 21 of the

Constitution in its true meaning includes the basic right to food, clothing and shelter.

The Apex Court, in Paschim Banga Khet Mazdoor Samity v. State of West Bengal, while

widening the scope of Article 21 and the government’s responsibility to provide medical aid to

every person in the country, held that in a welfare state, the primary duty of the government is to

secure the welfare of the people. Providing adequate medical facilities for the people is an

obligation undertaken by the government in a welfare state. The government discharges this

obligation by providing medical care to the persons seeking to avail of those facilities.

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In Unnikrishnan, J.P. v. State of Andhra Pradesh, it was held that the maintenance and

improvement of public health is the duty of the State to fulfill its constitutional obligations cast

on it under Article 21 of the Constitution.

In Consumer Education and Research Centre v. Union of India, the Supreme Court explicitly

held that the right to health and medical care is a fundamental right under Article 21 of the

Constitution and this right to health and medical care, to protect health and vigor are some of the

integral factors of a meaningful right to life.

In Bandhua Mukti Morcha v. Union of India the Apex Court addressed the types of conditions

necessary for enjoyment of health and said that right to live with human dignity also involves

right to ‘protection of health’. No State, neither the central government nor any state

government, has the right to take any action which will deprive a person the enjoyment of this

basic essential.

In Virender Gaur v. State of Haryana, the Supreme Court held that environmental, ecological, air

and water pollution, etc., should be regarded as amounting to violation of right to health

guaranteed by Article 21 of the Constitution.

In Vincent v. Union of India, it was held that a healthy body is the very foundation for all human

activities. In a welfare state, therefore, it is the obligation of the state to ensure the creation and

the sustaining of conditions congenial to good health.

The Apex Court, in its landmark judgment in Parmanand Katara v. Union of India, ruled that

every doctor whether at a government hospital or otherwise has the professional obligation to

extend his service with due expertise for protecting life, whether the patient be an innocent

person or be a criminal liable to punishment under the law. No law or state action can intervene

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to avoid/delay, the discharge of the paramount obligation cast upon members of the medical

profession.

In CESC Ltd. v. Subash Chandra Bose, the Supreme Court relied on international instruments

and concluded that right to health is a fundamental right. It went further and observed

that health is not merely absence of sickness: “The term health implies more than an absence of

sickness. Medical care and health facilities not only protect of health and medical care generate

devotion and dedication to give the workers’ best, physically as well as mentally, in productivity.

It enables the worker to enjoy the fruit of his labour, to keep him physically fit and mentally alert

for leading a successful economic, social and cultural life. The medical facilities are, therefore,

part of social security and like gilt edged security, it would yield immediate return in the

increased production or at any rate reduce absenteeism on grounds of sickness, etc. Health is thus

a state of complete physical, mental and social well-being and not merely the absence of disease

or infirmity.”

In Mahendra Pratap Singh v. State of Orissa, the Court had held “in a country like ours, it may

not be possible to have sophisticated hospitals but definitely villagers within their limitations can

aspire to have a Primary Health Centre. The government is required to assist people, get

treatment and lead a healthy life. Thereby, there is an implication that the enforcing of the right

to life is a duty of the state and that this duty covers the providing of right to primary health

care.” For Protection of health of workers and humane conditions of work the Supreme Court

in Occupational Health and Safety Association v. Union of India and others, held that when

workers are engaged in hazardous and risky jobs/ occupations, the responsibility and duty on the

state becomes double fold.

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 ADVANTAGES OF PUBLIC HEALTH APPROACH

The primary advantage of viewing health care system from a right to health perspective is that   

that it establishes that all human beings have an equal right to health and compels the State to

devise measures to ensure the right. This means it is essential to specify adequate minimum

standards of health care facilities, which should be made available to all people irrespective of

their social, geographic and financial position. Secondly it insists upon the State to safeguard and

implement the core content of right to health. This implies that just as the State/Government are

responsible for the suffering caused by arbitrary detention, they are equally responsible for the

far more pervasive suffering caused by arbitrary cuts on health and welfare spending or framing

discriminatory or negligent policies depriving a wide section of the population access to basic

goods like health.

Thirdly it guarantees a proper health care system. The State will have to guarantee life saving

care to all at a reasonable cost. In the long run this will help to build up a quality health care

system accessible and affordable for all. Fourthly the State will have to ensure essential drugs at

affordable cost. This has two implications. Primarily the State has to ensure availability of all

basic medications free of cost through the public health system. Secondly, that the State should

ensure the products and availability of an entire range of essential drugs at affordable price.

Fifthly it assures that the rights of patients are not violated. That means the entire range of

treatment and diagnosis related information should be made available to every patient in either

public or private facility. Every patient should be entitled to information regarding staff

qualifications, fees and facilitates of any medical center before they decide to take the treatment.

Confidentiality, consent and protection of dignity of a patient should be ensured to every patient.

Patient friendly grievance redressal mechanism needs to be made functional, with technical

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guidance and legal support being made available to all those who approach this system. This

would provide an effective check on various forms of malpractices. The State therefore has to

guarantee right to access to health care at least at basic or emergency levels, right to considerable

care, access to essential drugs, and protection of health information.

Sixthly the approach also implies establishing rights and regulations related to private medical

sector. It signifies that everyone has access to emergency medical care and care based on

minimum standards from private medical service. That means in situations of emergency

medical care no hospital or doctor, including those in the private sector can refuse minimum

essential first aid and medical care, irrespective of the person’s ability to pay for it.

It also implies that State should make provisions to regulate qualifications of doctors, required

infrastructure, investigation and treatment procedures especially in the private medical sector.

Standard guidelines for investigations, therapy and surgical decision-making need to be adopted

and followed combined with legal restrictions on common medical malpractices. Maintaining

complete patient records, notification of specific diseases and observing a ceiling on fees also

need to be observed by the private medical sector. It also necessitates the designing of adequate

criteria for a better distribution of health care human resources and regulation of infrastructure

and medical technology. Approaching health issues through a right to health perspective adds an

important dimension to our health status. This is because it links health status to issues of

dignity, justice, equality, non-discrimination and participation. At the same time it also exposes

the obligations imposed upon the state.

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 CHALLENGES TO HEALTHCARE SECTOR IN INDIA

Demographics

India, today, faces the so-called “dual disease burden” as the share of non-communicable

diseases (NCDs), better known as “lifestyle” disease, increases over the years along with a

continuing rise in communicable diseases (FirstPost, 2018). With the growing middle-class and

working-age population, there is increased incidence of lifestyle diseases like diabetes and

cardiac ailments. The NCDs accounted for more than 50 percent of all deaths in 2015, up from

42 percent in 2001-2003 (Upadhyay, 2012). Another staggering fact about the occurrence of

NCDs in India is that while in most western countries NCDs are likely to occur in old age, the

peak occurrence in India is a decade earlier, majorly affecting the age group of 30-59 years

(Maya, 2017). This nature of the problem has socioeconomic consequences as it directly affects

the working-age population and, hence, calls for stronger secondary and tertiary healthcare

system.

Public vs. Private Sector

The contributions of public and private sectors in the Indian healthcare system also show a

worrisome picture. As per the National Sample Survey Office (NSSO), between January and

June 2014, 243 people out of 1,000 sought medical treatment within the public healthcare

system, whereas 756 people out of 1,000 opted to visit a private doctor or private hospital

(Lakshman, 2016). Astonishingly, the public sector accounts for only about 20 percent of the

total healthcare expenditure with 80 percent contribution coming from the private sector which

is one of the highest in the world. Equally astonishing is the fact that between 1995 and 2014

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India’s public expenditure on healthcare rose only from 1.1 percent of GDP to 1.4 percent. This,

when compared to other BRICS countries (Brazil: 3.8 percent, China: 3.1 percent, Russia: 3.7

percent, South Africa: 4.2 percent), shows how under-funded and small in size the public

healthcare system in India is to meet the health needs of the country.

Health Infrastructure

Infrastructure is another pain point in the Indian healthcare sector. The country faces severe

resource shortage on both capital invested and manpower. India faces an acute shortage of

hospital beds with a ratio 0.5 per 1000 population for India as compared to 2.3 for China, 2.6 for

Brazil and 3.2 for the US (Sinha, 2011). Huge regional variations exist with some of the more

prosperous states with excess capacity while others with a huge shortage. This ratio is much

lower than the requirement of 1 bed per 1000 population as defined for the low-income countries

by WHO. Providing for quality healthcare services is highly capital intensive where the cost of

building a secondary care and a tertiary care hospital could be as high as 25 lakhs and 40 lakhs

per installed bed, respectively. This means that in order to meet the WHO standards of 1 bed per

1000 population would require an investment of INR 1,62,500 crores.

Human Capital Crunch

Healthcare sector requires highly skilled human resources from doctors to other medical support

staff like nurses, lab technicians, pharmacists, etc. The physicians ratio in India stands at 0.7 per

1000 population while this ratio for countries like China and OECD is at 1.9 and 3.2,

respectively. Moreover, majority of the healthcare professionals happen to be concentrated in

urban areas where consumers have higher paying power, leaving rural areas underserved.

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According to a KPMG report, although India meets the global average in terms of the number of

physicians, 74 percent of its doctors cater to a third of urban population, or no more than 442

million people. As a consequence, India is 81 percent short of specialists at rural community

health centres. The 25,308 primary health centres (PHCs) spread across India’s rural areas are

short of more than 3,000 doctors, with shortage up by 200 percent over the last 10 years (Salve,

2016).

Health Insurance

India’s health insurance model excludes a large part of the population with over three quarters of

the population having no health insurance. 24 percent of the population that has some kind of

medical insurance includes both private and public sector insurance and the central scheme for

weaker sections, the Rashtriya Swasthya Bima Yojana. Government contribution to insurance

stands at roughly 32 percent, as opposed to 83.5 percent in the UK. India primarily relies on

commercial health insurance now. Even as a copy of the U.S. model, commercial health

insurance in India is seriously deficient. It almost entirely covers only catastrophic expenditure,

such as the cost of highly restricted hospital treatments, which are offered without cost and

quality regulation and external audits. Outpatient treatment and prescription medicines are not

covered.

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 CONCLUSION

The healthcare sector in India is poised at a crossroads where the right policy action is extremely

critical in determining the future course of the sector. The industry faces major challenges owing

to the changing demographics of the country, the poor state of the public infrastructure, lack of

financial resources, paucity of human capital and poor governance. The staggeringly low

contribution of the public sector in the healthcare industry sits at the centre of all these problems.

While the National Health Policy tries to address the majority of these challenges, it lacks

significantly in terms of the feasibility of implementation and also inadequate finances.

Although the government realises the need to increase public spending in healthcare, it would be

important to ensure that the spending is done in the right manner. Countries like Sri Lanka and

Bangladesh which have much lower spending on healthcare when compared to India actually

perform much better on several health indicators. This shows the importance of not just

increasing the spending but also spending it more effectively. All said and done, it may not be

very accurate to directly compare the Indian situation with any of the other countries in the world

given its huge population, unique demographics and democratic governance. We need our own

solutions to our own problems which are best suited to our population and our systems.

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 BIBLIOGRAPHY

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