Cashflow in the Indian health system



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Critical Analysis of India’s Health System

 (The subtitle defining the theme of the assignment – please use the assignment title here!)



Module HI-B-22: Current Aspects of Health Economy

Responsible: Prof. Dr. med. Georgi Chaltikyan




Deggendorf Institute of Technology

European Campus Rottal-Inn

Bachelor of Health Informatics, 4th Semester


Your Name

Your Address


Pfarrkirchen, DD.MM.2020


(The Indian healthcare system is still struggling due to the few resources availed to it, the government of India gives less than 3.5% of its GDP to support health. Research in areas of medicine is not well-financed; hence the residence faces the challenge of accessing good healthcare. India has universal healthcare with a multi-payer system. Most of the health services are offered by the private sector because the public facilities are insufficient. Most of the private facilities are also located in urban centers. More than 60% of India’s population live in rural areas hence miss out on this crucial service. In the rural areas, 189 people out of 1000 report  various sickness as compared to 89 in every 1000 for the urban population. Elderly people in India report higher incidences of the different ailments than the younger population. Out of every 1000 individuals, 234 of the elderly population report ailments while only 67 of the youth report sickness. The mortality rate among the vulnerable population is very high, like children and expectant mothers. Essential services, including mental health have not been well invested in. The per capita spending in India has been on a steady rise and currently is at $ 73.  The government should reduce deaths caused by chronic diseases by involving the community in mobilizing resources and collecting data. Useful data may be obtained by financing the countries research and development and giving them human capital)





1 Background information

General Information about India

India is located in the Southern part of Asia; it has the second-largest population in the world. It borders Pakistan to the west and China to the north; to the east are countries like Bangladesh and Myanmar.  British rule in India began in the year 1858. The British Empire in India was partitioned in 1947 into the dominion of India and the dominion of Pakistan that was mainly Muslim (Reitman et al., 2017). The government of India is democratic and has a parliamentary system of governance. The federal republic has been there since the year 1950. In India, people speak diverse languages coming from many ethnic communities (Santosh Kumar et al., 2019). The population of India has been growing very fast in the last decade, rising from 361 million people in 1951 to 1.2 billion people now (McDonald, 2020). India’s per capita income has also been steadily rising. In 2010, it was at Rs 64835, and by 2019 it was at 82229 (National Statistics System India, 2019)









India’s gross per capita in USA dollars from 2011 to 2019


Fig 1.1 Source world bank, 2019

Most of India’s population is comprised of literate people, approximately 74 percent of the people. The economy of India is rated as one of the fasted growing economies globally, with most of the citizens being middle class. Although some residents are still absolutely poverty, the nation’s poverty has been reduced, and child malnutrition is rampant. India has a lot of economic inequality. Most of India’s population is rural.






Comparing India’s GDP growth to China, UK, and Brazil

Source: National Statistics System India, 2019

Fig 1.2: GDP growth of India compared to other countries like China

Historical Information about India

Civilization in India dates back to 2600-2000 BCE (Parikh & Petrie, 2019). The population of India has developed intellectually in fields like mathematics, astronomy, and medicine through time. Islam Arabs disturbed Indians in the 8th century CE by introducing Muslims to the region. By the 13th century, Muslims ruled most of the Indian continent. Vasco da Gama arrived in India in 1498 and opened India to outside influence. Vasco da Gama came to India to establish a trade route with Europe for spices (Mearns et al., 2016).  He was then followed by the Dutch, who set up their base in Ceylon. They, however, did not proceed into India as they were defeated in war. Other European powers to establish trading posts were France and Denmark-Norway in the 17th century. The Europeans established maritime supremacy in the region afterwards, which reduced Muslim influence in the area. India was absorbed by the British Empire. The British began directly administering India in the year 1858. This rule came to an end in 1947. It is only Great Britain and France that struggled for dominance in these territories in the 18th Century (Morris, 2015). They did so by local leaders or even through military interventions. French influence was reduced in 1799, which led to the increment of British power into the interior territories of India.

Morbidity factors in India

Older people aged over 60 years are reported to be vulnerable to various ailments. Out of every 1000, 234 report several ailments. Young people are reported to be healthier, with only 67 out of 1000 people reporting multiple diseases (Indian Ministry of Health, 2019). Higher morbidity is reported in rural areas than in the modern regions that have a sound healthcare system. Out of 1000 people in a population, 189 report ailment cases in rural settings compared to 89 in urban centers. People living in small households are sicklier compared to those living in more prominent families (Indian Ministry of Health, 2019). Different seasons also predispose people to various diseases, with the highest cases occurring between July and December, where 127 per 1000 population get sick. The population is healthier during October and December, where only 96 per 1000 population get sick. Non-communicable disease cases are found in people who are economically well off. People living in an enormous household do not report ailment cases. There is inequality in the provision of healthcare services leading to some areas reporting more disease cases. Physical inaccessibility to the various healthcare services by the poor due to infrastructure puts them at a disadvantage (Indian Ministry of health, 2019). The poor cannot afford to be hospitalized.  Gastrointestinal and respiratory problems are the significant problems identified in infants.

Mortality factors in India

Several factors have been reported to cause death among the Indian population. Some of the include Childbirth that accounts for 8.3% of the death, diseases of the heart causes 11.9%, accidents and poisoning lead to 12%, Tumors and cancer 6.9%, peptic or gastric ulcer 3.3%, unknown fever 2.8%, diseases of the urinary system and the kidney 6.1%, gynaecological problems 5.2%, Tuberculosis 2.4% and The most common mortality factors in India are caused by heart diseases, chronic obstructive pulmonary disease, diarrhoea, stroke, lower respiratory infections, tuberculosis, Neonatal preterm birth, self-harm, road injuries, and other neonatal conditions (Indian Ministry of Health 2019).

Physicians and nurses per 10 000 population in India

The ratio of Physicians to people in India is very low and does not meet the WHO standards. The number of doctors serving 10,000 population is 8.6 (Ved et al., 2019). The healthcare workers who are qualified are skewed to urban areas. 77.4% of the qualified healthcare workers are found in urban places, with the rural areas remaining with only 22% to serve them. Allopathic doctors comprise of 30% of the health workers in India.

India has a shortage of about 1.94 million nurses in the whole state (WHO, 2017). This is because a few are recruited; those who are well trained migrate while others voluntarily leave the job when they face poor working conditions (Singh et al., 2015). As a result, the number of registered nurses and midwives in India is 1.79.

Population trends of urban versus rural distribution

In 2018, nearly 34 percent of the Indian population lived in urban areas, while 65 percent live in rural areas. More people have been migrating from rural areas to urban centers in the last decade, searching for employment (Chandrasekhar & Sharma, 2015). In the urban centers, there are equal opportunities to job and employment opportunities. As a result, the health facilities are many and also well equipped, including the public and private sectors. The migration has, however, led to urban centers like Delhi and Mumbai becoming overpopulated. This comes with unintended adverse consequences like pollution and poor residential areas, increasing infectious diseases like cholera among the population. In addition, poverty in the informal settlements makes people not access good healthcare services.

Vulnerable population in India

Vulnerable people are not able to easily find medical services when they need them due to the disadvantaged position they are placed in society. Women are much vulnerable compared to men in Indian society as they are restricted from making important decisions and using family resources which can hinder their ability to use their knowledge in control of diseases affecting their communities (Bhatia et al., 2020). Women are subjected to early marriages and childbearing, which adversely affects their health, leading to higher maternal death. The caste system in India is also partly responsible for the health inequalities experienced. Members of a particular caste group also face some discrimination when society perceives them to be unclean. The system in India dictates what one eats, the places they go, and whom to marry according to where they are borne.  Few resources are available to them, and they are likely to miss the medical care they deserve. The scheduled castes have been perceived as low, oppressed and deprived of justice by the Indian society. The Dalits are illiterate and dwell in poor housing conditions (Shergill, 2017). Children and older people in India are vulnerable, those coming from low-income families don’t access good food, and some do not attend school. As a result, the children suffer from Malaria, measles, diarrhoea, and other respiratory infections. Infant mortality is higher, especially in rural areas; 32 die out of every 1000 live birth. The disabled people in India are discriminated against for jobs and cannot find resources for better healthcare; they are approximately 21.9 million people (Majumder,2019). People with mental illness are the most affected. The migrant population of about 5.1 million may also be denied accessing some essential facilities, which puts them at risk compared to the native population. The people living with HIV and AIDS are discriminated against by society and cannot access essential resources, including food and clothing (Mitra and Sarkar., 2011).

2 India’s Health System

Health services are provided to the general public through decentralized systems; the private sector plays a vital role in India’s health system. As a result, public expenditure has also been increased towards healthcare.

Fig 1.3 Public expenditure on health since 2011 in India. (Source: Majumder and Jena, 2018).

Non-allopathic forms of treatment are also emphasized, like the use of Unani and Sidha (Rudra et al., 2017). Decision-making is encouraged to be formed at a decentralized state level. India’s government is federal and health systems divided into unions and state governments. Union ministry of health and family welfare implements nationwide programs that include AIDS prevention and control and diseases of importance like tuberculosis. Traditional and indigenous forms of medication are also promoted through this system and the state governments can adopt them (Srinivasan & Sugumar, 2016). The Ministry plays an essential role in helping the state prevent and control diseases that break seasonally. The state oversees public health, sanitation, and hospitals. The union and the state join to govern population control, family welfare, food, and drug quality control. The health care system in India is comprised of the public and private sectors. Most of the private sector is concentrated in urban centres. A three-tier system healthcare system is developed in rural areas. Sub-centres are formed in areas with between 3000 and 50000 people (Indian Ministry of Health 2019). This center should have a midwife and at least one male health worker. The sub-centers are in charge of infectious diseases, maternal health, family welfare child health, diarrhoea, and immunization. The sub-centers receive all the help from family welfare and the Ministry of health.

Primary health centers are placed in plain or hilly areas serving a population of between 20000 to 30000 people linking village communities to medical officers. They emphasize preventive measures to manage diseases but can also treat them. The state government maintains the primary health centres; it consists of a medical officer, 14 paramedical, and other staff, two additional nurses can be contracted. 5-6 sub-centers refer to one primary health center. It contains four to 6 inpatient beds; their role is promoting healthcare and giving curative services. An area with a population ranging from 80000 to 120000 is served by a community health center that the state government services (Indian Ministry of Health 2019). They contain four medical specialists; the centers should include a pediatrician, gynecologist, surgeon, physician, and other 21 paramedical staff. The center has laboratory facilities, an X-ray, a labor room, and an operating theater. It serves as a referral center for primary health centers in the region. First referral units can provide services 24 hours for emergencies.

Financing of India’s Health System

India gets about 2.1% of health funding from external that is very little. The country funds about 58% of its health expenditure from its pocket. The government offers insurance to about 12% of the population, 3 % are insured by their employers (Ahlin et al., 2016). Two percent of the population insure themselves individually. Close to 80 % inpatient care and 60% outpatient care are provided by the private sector. The sources of financing include the private sector, public sector, social insurance, private insurance, and out-of-pocket. The model is multipayer and is financed by both public and private insurances. India’s health sector is mainly funded by tax revenue. The public hospital is free for the residents of India. Ayushman Bharat covers all the people working in unorganized sectors that pay less. The social insurance scheme covers those earning more than 21000 rupees. Indian employees finance themselves for social security and insurance for health through the Employees state insurance. Employers cover the people who make a monthly salary of more than 21,000 rupees (Prinja et al., 2017). In 2019, the government of India spent $ 36 billion on healthcare. Even though all this, most of India’s poor population uses a proportionate amount of their income to pay for the healthcare service in the private sector.

Human capital distribution/ flow in Healthcare

Urban centres have 28% of the Indian population and are served by 74% of all the doctors in the country. Public hospitals located in the urban center have twice the bed capacity than those found in rural areas. Child mortality is higher in rural areas because national programs like immunization are likely to cover people well in urban centers than rural areas (Basu et al., 2017). The people living in unlisted slums depend on the private sector that is understaffed; 58% of the hospitals are private. Nearly 81% of the doctors in India work in the private sector; the private sector owns 29% of all the beds in Indian hospitals.  In 2018-2019, 3.5 % of the total government budget was spent on health.

Structure and distribution of different healthcare.

Primary health care should be near the people, offering affordable services and having high acceptability. Primary healthcare ought to be equally distributed in the state. In India, they are located in urban centers, making rural areas miss out on essential health services. The government needs to provide primary healthcare, which meets the challenge of a language barrier, the government of India is trying hard to seek community help, but the industry relies on low budgets, making it complicated (Gupta, 2018). India’s primary healthcare system has three levels: primary health centers and the sub-centres, secondary levels composed of the community health centers, and tertiary levels that consists of hospitals and the collages. In 2017 India had one million allopath doctors to treat a population of 1.3 billion people. Among the one million, 10% worked with the public sector. A fifth of the doctors serving the rural population is not qualified.

India’s government recommends that a doctor should help 3500 people. A nurse should do 5000 per population, while a health assistant ought to serve 20,000 people. Public hospitals IN India are in a dilapidated state as only 2% of GDP is spent on healthcare (Prakash, 2019). India’s primary healthcare system challenges are low ratio of doctors to the patient, a lack of facilities and infrastructure, and less financial support from the Indian government. The poor rural population is not well insured for their health. People pay for health services from their savings, and the resources are unevenly distributed.

Acute care services

Emergence service in India is primarily due to cardiovascular problems, trauma, and also issues related to tropical diseases. India has no centralized body that deals with responding and training health workers for emergency medical services. Those available are not evenly distributed in the country and are also fragmented (Pilot et al., 2017). During emergencies, most of the Indian population does not know which lines to call to access help. Emergency Medical service education among the students is not standard and varies with the program one chooses to take. Some of the causes include paramedics, pre-hospital trauma technicians, and diploma trauma technicians. There is also a wider variability among the private and the public emergency services like the Centralized Accidents and Trauma Services (CATS). Current emergency Medical services in India include dial 108, a free service (Modi et al., 2018).

The provision of this service is enhanced by a partnership between the private and the public sector. A similar service is offered by Dial 1298, but the users have to pay for them.  Most ambulances in India are well equipped and operated by the private sector but very costly to the consumers of this service. Medical emergencies include fracture, syncope, and fever, which are usually responded to by Basic life support. Advanced life support deals with serious ambulance emergencies like snake bites, seizures, cardiac arrests, unconsciousness, burns, and other emergencies linked to pregnancy (Alsharahni et al., 2017). However, the skilled personnel available do not match the population demand. Natural disasters kill many people because the country is not well prepared to handle them. Information system in many parts of the country is rudimentary.

Chronic care services

Non- communicable chronic diseases account for about 60% of the death that occurs in India (Amin et al., 2018. These diseases include cancer, heart ailment, diabetes, and respiratory infections. The disorders affect the health of people reducing their quality of life and even their productivity. It is estimated that in over 20 percent of India’s population, at least one individual suffers from a chronic illness. India is working towards the formation of a robust primary healthcare system to handle most chronic diseases (Adams et al., 2020). The care services are coordinated, and the disorders are monitored. Local communities participate in programs that aim at mobilizing resources and creating awareness. In addition, the Indian government forms policies on the technological response towards chronic ailments. For example, the National cancer control program’s policies educate people on the dangers of substances like tobacco. Another program that was started in 2008 is the National program for the prevention and control of Diabetes, Cardiovascular disease, and stroke.

Mental care services

India’s health system is not well prepared to handle patients with mental problems. Members of society stigmatize the patients; hence they hide and seek a medical solution when it is too late. India has a national mental health program that has not managed to reach all the patients effectively. About 70 million people in India are mentally ill, but there is a shortage of qualified psychiatrists to handle them. According to World Health Organization, in 2017, there only 40 facilities in the whole country. The Atlas mental health resource shows that the ratio of psychiatrists to the 10000 population is 0.2, way below the global balance of 1.2.  Non-governmental organizations that are not profit-making play an essential role in providing services to people with mental problems.

Social care services

Good homes for the elderly are located in urban centers. Most elderly populations residing in the rural part do not have access to elderly services. The elderly depended solely on their families, but employment and urbanization are tearing this fabric. Social isolation is being created by the individualistic society that is being established. India has a social security system where employees contribute 12 percent of their basic wage while employer contributes 12.5% of the basic salary. The government then adds 1.17% of the basic salary (Dreze and Khera, 2017). The employee’s pension scheme may be life after retirement or if one is disabled during employment. Some social security schemes take care of the widows and vulnerable children after the person’s demise.

3 Healthcare system performance and challenges.

India’s large population cannot be served well by the existing healthcare system; hence is ranked one of the lowest globally. The system is also served by poor infrastructure. Most of the Indian population in India live in rural areas, which are served by only 30% of the health facilities. This makes the facility not accessible to a large proportion of the population. Indian government contributes only 3.5% of its GDP to the health system as of 2018, which is way below the WHO requirement of 5%. Over 70% of the Indian population is not insured for health. Moreover, the system is still fighting some malpractices, like selling substandard and counterfeit medicines (Pandey & Litoriya, 2020). Such factors make the system inefficient, which leads to most citizens prefer the private sector.  Little financing makes the public facilities offer low-quality services. Thus, the system becomes weaker. India’s per capita expenditure on health has been steadily rising at 73 $ from 56 $ in 2013. Most of the population seek medical services when needed. The average annual growth rate is estimated to be 8.1%.

Year Per-capita spending on health Percentage change
2018 73 5.07
2017 69 14.38
2016 61 2.86
2015 59 3.23
2014 57 1.7
2013 56 14.65
2012 49 0.7
2011 49 7.7

Source: India’s Ministry of Health 2019

Table 1.1: Per capita annual spending on health by Indian government

Despite all these challenges, the government of India has tried to improve the health services they give to their citizens, which has seen a reduction in some diseases. The number of cases of Malaria and death in cities like Mumbai has reduced by 47% from 2012 to 2017. Death due to Malaria was 238 in 2012 in Mumbai, while only 127 in 2018. Reported cases were 18296 in 2012-2013 but only 9679 in 2016-2017 (Das et al., 2021). On the other hand, tuberculosis cases have increased by 37%. Diarrhea causes have remained the same, but cholera increased.

4 A way to improve India’s healthcare system using health technology

India’s healthcare system should move away from focusing on curative measures to manage both acute and chronic disease and dwell on all the prevention measures so that the number of cases is reduced significantly (Golechha, 2015). This will be well achieved if the government invests well in its primary healthcare compared to the secondary and the tertiary levels.



treatment will reduce, and for some chronic diseases, their occurrences will have been predicted and planned for avoiding the confusion they bring in the health systems. Available data is essential in planning and predicting future events which will guide government when allocating the resources in the health department. Involving community to build an efficient health infrastructure will reduce on the burden of government fully financing the health sector.


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Source: World development Indicators, 2017

Appendices1.1: Comparison of India’s spending on research and development with other nations

Appendices 1.2: Comparison of India’s gross national income with developed nations in 2014 and 2015

Cashflow in the Indian health system

Source: Indian Ministry of Health, 2019

Appendices 1.3: Government spending in the health system.

Source: Indian Ministry of health 2019


1.4: Mortality factors in India

India’s death per 1000 people since 2004

Source: World Development Indicators 2020
































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  • When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
  • We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.

In the event that you don’t like your paper:

  • The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
  • We will have a different writer write the paper from scratch.
  • Last resort, if the above does not work, we will refund your money.

Will the professor find out I didn’t write the paper myself?

Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.

What if the paper is plagiarized?

We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.

When will I get my paper?

You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.

Will anyone find out that I used your services?

We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.

How our Assignment Help Service Works

1. Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2. Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3. Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4. Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.

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550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
The price is based on these factors:
Academic level
Number of pages
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

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Zero-plagiarism guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

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Free-revision policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

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Privacy policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

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Fair-cooperation guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

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