Hailey Tran
India is home to several top-tier hospitals known for their world-class infrastructure, cutting-edge technology, skilled medical professionals, and advanced treatment options. While easy availability of healthcare facilities is an important factor to consider when choosing a home, there are pros and cons to living near a hospital in India. On the one hand, living near a hospital provides easy access to quality healthcare, fitness specialists, and dieticians, which can be especially beneficial for individuals with chronic health issues. On the other hand, the high influx of people and traffic around hospitals may be a nuisance for those seeking a peaceful and quiet environment, and the constant sound of ambulance sirens can be disruptive. Additionally, there may be a stigma associated with living close to a hospital, which could affect the resale value of properties in the area.
| Characteristics | Values |
|---|---|
| Inadequate medical information | 59% of patients aged 60 or older received inadequate medical information |
| Inadequate medical notes | 66% of patients were sent home with notes lacking the information needed for continuity of care |
| Lack of understanding | Only 25% of patients had a good understanding of their condition and post-discharge care requirements |
| Financial concerns | 3.84% of patients left the hospital against medical advice, with 84% of those reporting financial restrictions as the reason |
| Medical inflation | Medical inflation in India is 14% annually, with routine procedures doubling in price |
| Catastrophic health expenditure | Nearly half of Indian families spend more than they can afford on healthcare, with 16% borrowing or selling assets to afford treatment |
| Lack of health insurance | 75% of Indians have no health insurance |
| Underfunded public healthcare | The Indian government only invests about 1% of GDP in public healthcare |
| Overcrowding | Patients in public hospitals frequently share beds |
| Lack of supplies | Hospitals have low supplies of medical devices, forcing families to buy their own |
| Poor sanitation | Hospital supplies are not properly sanitized, leading to bacterial contamination |
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What You'll Learn
- Poor hospital conditions: outdated, unhygienic, and understaffed
- Catastrophic health expenditure: medical inflation is high
- Lack of health insurance: three out of four Indians are uninsured
- Inadequate medical information: patients lack understanding of their conditions
- Financial constraints: patients leave hospitals against medical advice due to costs
Poor hospital conditions: outdated, unhygienic, and understaffed
India's public healthcare system is overstretched and underfunded, with the government investing only about 1% of its GDP in this sector. Consequently, many government-run hospitals are outdated, unhygienic, and understaffed.
The unhygienic conditions in Indian hospitals are a significant concern. Healthcare-associated infections affect hundreds of millions of patients annually, with 15% of patients estimated to develop one or more infections during their hospital stay. This situation arises from a lack of clean toilets, inadequate sanitation, and poor hygiene practices. For instance, only 19.2% of labour rooms and 3.2% of post-natal care wards have functional toilets across India's health facilities. As a result, women are discouraged from institutional deliveries or delay seeking health advice.
The understaffing in Indian hospitals is another critical issue. Hospitals like AIIMS-Delhi and CMC-Vellore, which are considered top-notch medical institutions, face a severe squeeze of personnel and resources compared to their peers in advanced countries. AIIMS-Delhi, for instance, had 19% less faculty (doctors) than sanctioned in 2017-2018, and it suffered a decline of 15 professor-rank doctors between 2015-2016 and 2017-2018. This understaffing can lead to overworked healthcare professionals, potentially compromising the quality of patient care.
The outdated nature of Indian hospitals further exacerbates the problems of unhygienic conditions and understaffing. The hospitals have limited supplies of medical devices, often forcing patient families to purchase their own. Additionally, the lack of centralised electronic health records makes it challenging for healthcare staff to access patient information, particularly during follow-up visits. This deficiency can hinder continuity of care and impact patient recovery.
To address these issues, India has initiated a program to introduce electronic health records in government hospitals and community centres. While the programme's primary goal is to facilitate health insurance administration, adapting the system to include templates for doctors to share with patients could improve patient information and continuity of care. Additionally, wider awareness and implementation of hygiene practices, such as handwashing with soap and COVID-19 protocols, are crucial to reducing healthcare-associated infections.
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Catastrophic health expenditure: medical inflation is high
Catastrophic health expenditure (CHE) in India has increased over time. CHE is a measure of the performance of a country's health system and is defined as out-of-pocket payments equalling or exceeding 10% of household expenditure.
The increase in CHE in India has been more pronounced among poorer households, with a 3.00-fold increase between the 1993–1994 expenditure survey (12.4%) and the 2011–2012 expenditure survey (18.2%), compared to a 1.74-fold increase for the richest quintile. This has resulted in an estimated 8% of the Indian population being pushed below the poverty line by high out-of-pocket healthcare payments.
The major components of inpatient healthcare expenditure in India are bed charges and medicine costs. Larger households, as well as those without latrine facilities and proper waste disposal plans, are more vulnerable to facing financial burdens from inpatient healthcare.
The Indian government has introduced nationwide health programmes such as the National Rural Health Mission in 2005 and Rashtriya Swasthya Bima Yojana in 2008 to protect vulnerable groups from high healthcare costs. However, these programmes have not been very effective due to low public investment in health, a lack of human resources, and poor health infrastructure.
To address the issue of CHE, India needs to increase public expenditure on health, provide affordable healthcare, and improve geriatric health infrastructure. Financial protection mechanisms such as insurance coverage and risk-pooling are also important to ensure health security for all, especially economically disadvantaged groups.
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Lack of health insurance: three out of four Indians are uninsured
India's healthcare sector faces a significant coverage gap, with over 70% of middle-income earners lacking health insurance. This means that three out of four Indians are uninsured and are at risk of financial ruin in the event of a medical emergency. The high cost of insurance is a major reason for this, with many people unable to afford the coverage. In 2023, 63% of uninsured adults aged 18-64 cited the cost of coverage as the reason for being uninsured. The relatively low health insurance coverage in India drives high out-of-pocket expenditure, which stood at 50% of total health expenditure in India in 2021, compared to a global average of 17%.
The Indian government has introduced various initiatives to address the lack of health insurance, such as Ayushman Bharat Yojana and state extension schemes, which provide comprehensive hospitalisation coverage to around 69% of the low-income population. Additionally, public sector employees are covered under CGHS and ESIS schemes. Despite these efforts, approximately 38% of Indians still lack any form of health insurance.
The high cost of insurance in India is partly due to the 18% GST on health insurance, which is higher than in other countries. Lowering this tax to 5% could make health insurance more accessible and affordable for more people. However, despite repeated appeals to reduce the GST, the government has declined to make any changes.
The lack of health insurance has significant implications for Indians, as uninsured people often face unaffordable medical bills and medical debt. Nearly half (49%) of uninsured adults have difficulty affording healthcare costs, and over eight in ten (84%) worry that healthcare costs will put them in debt. Uninsured adults are also more likely to delay or forgo care because of costs, which can lead to negative health outcomes.
The situation is further exacerbated by the inadequate medical information provided to patients leaving hospitals in India. Surveys have shown that only half of patients with chronic non-communicable diseases (NCDs) receive ongoing advice on how to self-treat and manage their conditions. This lack of information can make it difficult for patients to recover after discharge and may lead to poor self-management at home.
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Inadequate medical information: patients lack understanding of their conditions
In India, a lack of medical information can hinder patients' recovery post-discharge from the hospital. Surveys conducted on hundreds of patients with chronic non-communicable diseases (NCDs) revealed that only half of them received ongoing advice on self-treating and managing their conditions. The study also showed that only 25% of patients had a good understanding of all the important details of their condition and post-discharge care requirements.
The study highlights that a high proportion of patients leave hospitals without adequate information or understanding of how to manage their conditions. This could severely affect the treatment they receive from the next doctor they visit and lead to poor self-management at home. The study also found a link between the poorest levels of documented information and patient mortality. Patients with NCDs, which are long-term and require continuous management, often go long periods without medical help due to a poor understanding of their disease or the costs involved.
The issue of inadequate medical information is further exacerbated in low-income/resourced countries like India, where there is a lack of centralised electronic records. This means that healthcare staff have little information to refer to when patients seek help again. Written medical notes were found to be inadequate in many cases, with more than two-thirds of patients being discharged from the hospital with notes that lacked the necessary information for continuity of care. This includes vital information such as diagnosis, treatment plans, follow-up visits, and lifestyle advice.
To address this issue, India has initiated a program to introduce electronic health records in government hospitals and community centres. While the primary goal is to facilitate health insurance administration, the system could be adapted to improve patient information exchange. For instance, it could include templates for doctors to fill out and share with patients after each appointment. Additionally, there is a need for greater awareness about the importance of high-quality communication, both verbal and written, in the medical field. Patients are willing to carry booklets where key medical details can be recorded, but healthcare professionals need encouragement to utilise these effectively.
To ensure patient safety and understanding, it is essential to have a trusted advocate, such as a friend or family member, during hospital visits and stays. Patients should also be encouraged to ask questions and seek clarification until they feel they fully understand their condition and treatment plan. Keeping a written record of one's medical information, including test results, medications, and providers involved, can also help prevent mistakes and enable better self-management.
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Financial constraints: patients leave hospitals against medical advice due to costs
India's healthcare system is largely financed by out-of-pocket expenses, which means that financial constraints play a significant role in patients' decisions to leave hospitals against medical advice (AMA). In a study conducted at a private hospital in India, 3.84% of patients left AMA, with 84% of those reporting financial restrictions as the reason for their departure. Of those, 71% indicated that the medical bill would represent more than 25% of their annual income. This trend is not unique to India, with studies from other developing countries showing that financial constraints are a common reason for patients refusing emergency care.
The Indian Constitution mandates the delivery of timely medical treatment by all hospitals, regardless of a patient's ability to pay. However, the high cost of care at private hospitals and the limited availability of free care in the public system mean that patients may still face economic barriers to accessing healthcare. This is particularly true for patients with long-term conditions, such as cancer or diabetes, who require repeated visits to doctors and continuous management of their condition.
The financial burden of healthcare varies across disease groups and care levels in India. For example, cancer patients are more likely to resort to hardship financing practices, such as informal borrowing or selling assets, compared to patients with other diseases. Additionally, individuals with chronic diseases, people in rural areas, and unmarried people are all more likely to face hardship financing.
Government intervention has been identified as vital in addressing financial distress at the household level. While the Indian government has launched programs to address specific health issues, such as cancer, the implementation and monitoring of these programs have been lacking. Furthermore, government schemes have primarily focused on reducing household expenditure on inpatient care, while outpatient care constitutes a significant proportion of out-of-pocket expenses.
The inadequate provision of medical information upon discharge from hospitals in India may also contribute to financial constraints. Patients with long-term conditions may not receive ongoing advice on how to self-treat and manage their conditions effectively, leading to poor self-management and potentially exacerbating financial difficulties.
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Frequently asked questions
Some people may find the busy and noisy environment near a hospital uncomfortable. The constant stream of patients and traffic may become a hurdle and a source of frustration. Additionally, there is a stigma associated with living near a hospital, which may result in lower property prices.
Living near a hospital can provide easy access to quality healthcare, which can be life-saving, especially for families with elderly members or those with chronic conditions. It also offers an escape from electricity outages as hospitals are exempted from excessive load shedding practices.
Private hospitals in India tend to offer better quality care and are frequented by wealthy locals and medical tourists. However, public hospitals are more accessible to the majority of the population as they are operated by the government, which has enacted programs to ensure that poorer residents can access care without incurring high costs.
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