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IMS Health Study identifies roadmap to address healthcare access barriers in India

Our Bureau, Mumbai
Monday, July 22, 2013, 16:10 Hrs  [IST]

A new IMS Institute for Healthcare Informatics study reveals that while progress has been made in India over the past decade from both public and private sector initiatives, significant challenges persist in providing quality healthcare on an equitable, accessible and affordable basis across all regions and communities.

It pointed out that a 40 to 45 per cent reduction in out-of-pocket expenditures for both outpatient and inpatient treatments can be attained through a holistic approach addressing four critical, interrelated dimensions of healthcare access. Those components are physical accessibility and the location of healthcare facilities; availability and capacity of needed resources; quality and functionality of service required for patient treatment; and affordability of treatment relative to a patient’s income.

The study – Understanding Healthcare Access in India: What is the Current State? – is the most comprehensive assessment of healthcare access undertaken since 2004 and is based on an extensive survey of nearly 15,000 households covering all socio-economic groups in rural and urban areas across 12 states. Information was gathered on more than 30,000 healthcare system interactions, supplemented by interviews with over 1,000 doctors and experts.

According to Murray Aitken, executive director, IMS Institute for Healthcare Informatics, “While expanding healthcare access is a critical priority for both the Indian government and the private sector, the gap between aspiration and today’s reality is all too apparent. Challenges with resourcing and financing the public sector health infrastructure have a significant impact on the availability of healthcare workers and contribute to low-quality perceptions of public health facilities. This leads the rural-poor population to seek costlier treatment options – and adversely impacts overall healthcare access.”

The study reports that the provision of healthcare services in India is skewed toward urban centres and the private sector. Urban residents, who make up 28 per cent of India’s population, have access to 66 per cent of the country’s available hospital beds, while the remaining 72 per cent who live in rural areas have access to just one-third of the beds. Similarly, the distribution of healthcare workers, including doctors, nurses and pharmacists, is highly concentrated in urban areas and the private sector.

The study also finds that the physical reach of any healthcare facility is a challenge in rural areas, particularly for patients with chronic ailments. Patients in rural areas must travel more than five kilometers to access an inpatient facility 63 per cent of the time. Difficulty in accessing transportation options and the loss of earnings as a result of travel time lead to treatment being deferred, or facilities selected that may be closer but are not cost-effective or best suited to patient needs. This is especially true for patients suffering from chronic ailments.

It has been found that the private healthcare facilities are being used by an increasing proportion of patients due to gaps in quality and availability of public facilities. Over the past 25 years, both rural and urban patients have increased their use of private service providers over public options. In 2012, 61 per cent of rural patients and 69 per cent of urban patients chose private in-patient service providers, up from 40 per cent reported in a 1986/87 government survey. Long waiting times and the absence of diagnostic equipment in public facilities were cited as key reasons by more than 40 percent of those surveyed. Better quality of treatment in private, in-patient centres was cited as an additional reason by 38 per cent of survey respondents.

Availability of doctors is a key reason for selecting private facility outpatient treatments. Across both urban and rural sectors, and among the poor and affording populations, at least 60 per cent of those surveyed considered doctor availability as a significant reason for selecting private facilities for outpatient treatment. Absenteeism is typically higher in the less economically developed states of India. Patients using private facilities face greater affordability challenges. The cost of treatment at private healthcare facilities is between two and nine times higher than at public facilities.

IMS Health’s healthcare access study provides an objective map of the whole system, which can be used to show where the leverage points for action are and to engage stakeholders to arrive at agreements of what strategies will improve the system’s performance.


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