Private healthcare and economic commodification of health are creating equity and inclusivity issues for healthcare systems in India
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MMBSHS Trust, Dehradun, India
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A983
Background and Objectives: COVID-19 exposed the equity and inclusivity issues of healthcare systems globally. This study aimed to understand the commodification of healthcare and equity, inclusivity issues, and privatization of healthcare in a diverse country of 1.3 billion people, India. Methods: We analyzed the increase in population between 2011 and 2020, data provided by government agencies, NGO reports, and media regarding expenditure on healthcare by the government, healthcare resources, health services utilization, and gaps in rural and urban healthcare. Results: While the population of India increased by 13.25% from 2011 to 2020, health expenditure only grew by 0.39%. Three-fourths of the population relies on private healthcare and out-of-pocket spending, so the finance commission recommended increasing healthcare spending to 2.5% of GDP by 2025, which appeared difficult with current budgetary trends and political conditions. 80% of doctors work in urban areas where only 30% of the population lives, resulting in the vacant posts of doctors in rural and semi-urban areas. Unnecessary tests, procedures, unwarranted surgeries, and over-medicalization of healthcare are due to over-commercialization. The system forces doctors to decide on their employers’ business interests, neglecting ethics. Market-driven healthcare inflation increases the vulnerabilities of vulnerable sections of society multiple times, pushing 50-55 million Indians below the poverty line every year. Conclusions: The nudging of strong market-driven forces on healthcare policy frameworks of India is apparent in the PPP model implementation and insurance. Big hospitals, diagnostic facilities, and pharmacies have business interests in urban middle and upper-middle-income households. They are least interested in Primary Health Care and less lucrative National Health Mission (NHM) activities, which are necessary for universal health coverage (UHC), equity, and inclusivity in healthcare. Privatization is increasing commercialization, creating a vicious cycle of commodification and over-medicalization of health, widening the service gaps, and losing confidence in public healthcare.
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