Dr Satya Dev Gupta
Starting from the Ramayana period it is Sushane, the physician of King Ravana who treated Lakshmana, but obvious instances of some Hospital like the institution is obscure. (International Journal of Neurooncology November 2021) In the later period of Mahabarata and thereafter instances regarding the practice of medical science could be quoted as a profession. Yagyavlkya, a Hindu sage, along with other contributions “Yogas, Universal self and Atman” has established a seat of medicine which was later followed by Sushruta. (Science.blogspot.com) mentions that In Vedas, particularly Atharva-Veda which is deemed to be an encyclopedia of medicine, Lord Danvantri, the incarnation of Lord Vishnu, the immanent divine consciousness represents the divine healer in the tradition of Ayurveda Healing.
It is also quoted that archaeological evidence of Mohenjo-Daro and Harappa have proved that there were well-planned settlements of Harappa itself and special areas deduced to be hospital or treatment buildings. “Caraka or Charak Samhita” is an early Ayurvedic text of internal medicine and “Sushruta Samhita”1000 to 600 BC known by the title “Father of Surgery”, description of 300 surgical procedures and 120 surgical instruments and classifies human surgery into eight categories. All these could only be performed and possible when there were facilities of the ward or hospital-like culture.
Post- Mahabhrata Era
S.A Tabish January 2000 (Historical Development of Healthcare in India) mentions, ” In India, hospitals have existed from ancient times. Even in the 6th century BC, during the time of Buddha, there were several hospitals to look after the handicapped and the poor. The outstanding hospitals in India at that time were those built by King Ashoka (273-232 BC). Books written by Arabian and European travelers (around AD 600) reveal that the study of medicine in India was in its bloom. The zeal of the native Vaidyas for the investigation of the Indian flora slackened for want of encouragement. The invasion of foreigners in the 10th century AD brought with them their physicians called Hakims. The use of the Allopathic system of medicine commenced in the 16th century with the arrival of European missionaries. It was during British rule that there was progress in the construction of hospitals. Organized medical training was started in the 19th. century.”
Modern Hospitals in India
The introduction of the modern hospital in India was first done by the Portuguese in Goa as Royal Hospital in 1510 to 1515 where general medical training was also provided and later on upgraded to a Medical School for Medicine and Surgery in 1842. Although the Portuguese started the basis of modern medicine school impetus was brought by the French and British. The First Medical School was established in 1846 first in Calcutta and then in Madras; followed by a network of district hospitals and dispensaries culminated in 1250 hospitals and dispensaries by the end of 1885. In British India, although Medicare growth was a slow pace by 1947 there were 7400 hospitals with 1lakh 13 thousand beds, the ratio of hospital beds to country population was 0.24 beds/1000. The total number of available Doctor of Modern Medicine was only 47000, 7000 nurses in 19 medical schools and 28 medical colleges.
After independence primary healthcare was designed to render the services on maternal, childcare, and family welfare in rural and urban areas, where specialized treatment centers were concentrated at the urban level.
* India has a total of 43,486 private hospitals, 1.18 million beds, 59,264 ICUs, and 29,631 ventilators. On the other hand, there are 25,778 public hospitals, 713,986 beds, 35,700 ICUs, and 17,850 ventilators.03-Nov-2020
Other achievements are the control of communicable and dreadful diseases like Malaria, Smallpox, Tuberculosis, Leprosy, Aids, Polio, launching of the Goiter control program, implementation of the program of immunization and vaccination in Maternal and Child Health Systems. For uplifting the Tradition System of Medicine like Ayurveda, Unani, Sidha and Homeopathy lot of endeavor has been done and more is in pipeline. Ayuhman Bharat, Jan Oshdhi played a commendable role in upgrading the healthcare aspects of the downtrodden population in the unorganized sector. In organized sectors Employees’ State Insurance which funds the consumer in both Public and Private hospitals. Many people get healthcare benefits from Health Insurance Companies, as in 2020, about 30 crore people are brought under an insurance plan (en.m.wikipedia. org).
Health-Care Sector
The Healthcare sector has become one of India’s largest sectors, both in terms of revenue and employment. Healthcare comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services and increasing expenditure by public as well private players.
Indian healthcare delivery system is categorized into two major components Public and Private. The Government, i.e., public healthcare system, comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of Primary Health Care Centres (PHCs) in rural areas. The Private Sector provides most secondary, tertiary, and quaternary care institutions with a major concentration in metros and tier I and tier-II cities.
Advantage India
India’s competitive advantage lies in its Large Pool of Well-trained Medical Professionals. India is also cost-competitive compared to its peers in Asia and Western countries. The Cost of Surgery in India is About One Tenth of That in The US or Western Europe . As of November 19, 2021, >115 crore COVID-19 vaccine doses have been administered across the country.
Health Care Market can increase three-fold to 8.6 trillion Rupee (US$ 133.44 billion) by 2022. In Budget 2021, India’s public expenditure on healthcare stood at 1.2% as a percentage of the GDP.
A growing middle-class, coupled with the rising burden of new diseases, are boosting the demand for health insurance coverage. With the increasing demand for affordable and quality healthcare, penetration of health insurance is poised to expand in the coming years. In Fy (Financial Year) 2021, gross direct premium income underwritten by health insurance companies grew 13.3% YoY(Year over Year )to Rs. 58,572.46 crore (US$ 7.9 billion). The health segment has a 29.5% share in the total gross written premiums earned in the country. Recent developments. Indian medical tourism market was valued at US$ 2.89 billion (Rs.25000 crores). In 2020 and expected to reach US$13.42 by 2026.
Health Tourism in India
According to India Tourism Statistics at a Glance 2020 report, ~697,300 foreign tourists came for medical treatment in India in FY19. India has been ranked 10th in the Medical Tourism Index (MTI), “depending upon these primary dimensions, including DESTINATION ATTRACTIVENESS, SAFETY, and QUALITY of CARE”. for 2020-21 out of 46 destinations by the medical tourism Association.
India is a land full of opportunities for players in the medical devices industry. The country has also become one of the leading destinations for high-end diagnostic services with tremendous capital investment for advanced diagnostic facilities, thus catering to a greater proportion of the population. Besides, Indian medical service consumers have become more conscious of their healthcare upkeep.
The Indian healthcare sector is much diversified and is full of opportunities in every segment, which includes providers, payers, and medical technology. With the increase in the competition, businesses are looking to explore the latest dynamics and trends which will have a positive impact on their business. The hospital industry in India is forecast to increase to Rs. 8.6 trillion (US$ 132.84 billion) by FY22 from Rs. 4 trillion (US$ 61.79 billion) in FY17 at a CAGR (Compound Annual Growth Rate) of 16-17%.
The Government of India is planning to increase public health spending to 2.5% of the country’s GDP by 2025. India’s competitive advantage also lies in the increased success rate of Indian companies in getting Abbreviated New Drug Application (ANDA) approvals. India also offers vast opportunities in R&D (Research and Development) as well as medical tourism. To sum up, there are vast opportunities for investment in healthcare infrastructure in both urban and rural areas
Health Care in Jammu and Kashmir
According to “Greater Kashmir” 17th August 2021(MukeetAkmali) the public health sector is overburdened in Jammu and Kashmir, the J&K’s Healthcare Investment policy aims to boost investments in the private healthcare sector by wooing investors “In J&K, where the private sector is still in infancy and almost 80% of the healthcare facilities are being provided by the public sector, the overcrowding of the government health institutions has led to compromise in the quality of care. In government institutions, out of pocket expenditure is quite substantial as the patients must purchase medicines and other essential items from the market. This entails a huge burden on poor households”, in comparison to the country as published by Statista Research Department May 20, 2021; an estimated 69 thousand public and private hospitals were recorded across India in 2019. Of these, 43 thousand were private sector hospitals, outnumbering the public sector. The state of Uttar Pradesh had the highest number of hospitals, that year. In the recent past, the Union Territory Government of Jammu and Kashmir introduced Ayushman Bharat free healthcare system for all the people.
On December 20, 2020; during the Covid-19 pandemics state of Jammu and Kashmir received an investment proposal of Rs 3325, in Healthcare and Medical Education, even hyped global investors submit was called. After the abrogation of Art 370, an impetus was brought for improvement in this sector. Of these investment proposals, Virinchi Healthcare Pvt Ltd submitted a proposal of establishing a multi-specialty, 500 bedded hospitals with an investment of Rs 200 crore. The HP Kapital Ltd submitted a Rs 2200 crore proposal for High-tech Medical University with 350 bedded Hospital with 700 bedded students’ accommodation, with the generation of 6000 jobs in both divisions of the Union territory of Jammu and Kashmir. Similarly, Apollo Hospital Enterprises Limited submitted a proposal of 200 to 250 bedded Super Specialty Hospital in Jammu with Rs 250 crore and employment opportunities for more than 1200 people. Areesha’s Royal Hospital Private Limited has submitted a plan of Rs 450 crore for setting up 500 bedded referral Hospital with the training of Nurses and Paramedical staff with opportunities for jobs for more than 1000 youths. There are 7 Medical Colleges, prestigious SKIMS along with 2 AIIMS coming up. About 45 private hospitals and nursing homes are executing the healthcare services (per Director Health Services Kashmir, DHSK). These small institutions have been working for decades on the guidelines issued by the concerned authorities of the Government of Jammu and Kashmir. While after the abrogation of 370 there is a boom in the developmental projects of this Union territory, a fervent appeal can be made to the government for upgrading and uplifting these institutions.
(The author is President – Jammu Doctors Forum Ex HOD Anesthesia & ICU GMC Jammu)
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