India's Fragile Healthcare System May Lead To Longer Lockdowns

The COVID-19 pandemic is putting huge pressure on the already-fragile Indian healthcare system.

As Shruti Rajagopalan and Abishek Choutagunta write in a Mercatus working paper titled Assessing Healthcare Capacity in India, the country’s healthcare capacity and health infrastructure funding and personnel are in such poor state that overall, India’s healthcare system is “fragile” in the face of COVID-19.

Public-Sector vs. Private-Sector Healthcare in India

Despite the fact that India is comparable to China in population, India’s healthcare spending per capita is closer to that of Sierra Leone and Nigeria.

Indians spend 3.66 percent of GDP on healthcare as of 2016 (World Bank 2020b) and the government spends 1.17 percent of GDP on healthcare, the lowest amount among emerging economies (Central Bureau of Health Intelligence 2019).

Treatment of Ailments by Type of Healthcare Service Provider

Patients receive treatment for ailments through (1) the public healthcare system (this includes primary health centres, community health centres, district hospitals, subdivisional hospitals, and sub-district hospitals); (2) the private sector hospitals and private doctors and clinics); and (3) charitable providers, nongovernmental organizations, and informal providers, the paper said.

Even though private healthcare providers tend to be clustered in urban areas, Indians in rural areas prefer to travel to urban areas to receive quality treatment. Overall, patients only receive 30.1 percent of treatments at government hospitals and facilities and receive 65.8 percent of treatments from private hospitals and doctors, with the remaining 4.1 percent through charitable hospitals and informal providers.

Across all socioeconomic groups, Indians spend six to eight times more on private-sector treatment than the amount they spend at government hospitals in cases of hospitalization.

Across every quintile of household expenditure, 4 Indians spend more on private healthcare than on government healthcare.

The government-reported figure for the total number of government hospital beds (in all states and union territories) is 739,024 (Government of India 2018). This includes all primary health centres, community health centres, district hospitals, sub-divisional hospitals, and subdistrict hospitals,state the authors.

The total number of hospital beds in India is 1,759,580, with the actual total beds in the government hospitals at 739,024, the estimated total beds in private hospitals across all states at 973,048, and the estimated total beds in charitable hospitals at 47,508. Across all sectors, we estimate that India has about 131 beds per 100,000 persons.