Introduction

In India, Over 1.4 billion people live, in one of the most Populated Countries with and least availability of a proper health care system, it is very difficult for a patient to survive in this health system. India Still ranks 145th out of 195 countries in the healthcare access and quality index behind Countries like Sri Lanka and Bangladesh in 2023. According to the Global Health Care Security Index 2021, India ranked 66 out of 195 countries with an overall index score of 42.8 along with a change of -0.8 from 2019. According to the health and health systems ranking of Countries worldwide in 2021, by health index score India was ranked 111 out of 167 countries. In the 2016 Global Burden of Disease Study report, India was ranked 145 out of 197 countries in "Health Care Access Quality”. India was ranked behind war-torn Yemen, Sudan, and North Korea out of 94 countries India holds 45th rank with a score of 65.2 healthcare index mid-year in 2023. According to the Global Burden of Disease Study (GBD) published in the Medical Journal The Lancet, India ranked 154th among 195 countries on the healthcare index in 2017. According to the final assessment of sustainable development goals (SDG), health performance published in the Lancet and launched at a special event at the UN General Assembly in New York said India ranked 143 among 188 countries in health study in 2016. The health care system is organised into primary, secondary, and tertiary levels. At the primary level are subcentres and Primary Health Centres (PHCs). At the secondary level, there are Community Health Centres (CHCs) and Smaller Sub-district hospitals. Finally, the top level of public care provided by the government is the tertiary level, which consists of medical colleges and District/General Hospitals. The number of PHCs, CHCs, subcentres, and District Hospitals has increased in the past six years, although not all of them are upto the standards set by Indian public health standards. There are some of the ranks that India has held in recent years.

Objective of the study:

The objective of the study is to find out the number of factors that put a bad impact on the Indian healthcare system.

Lack of Infrastructure: 

The government hospitals are facing a problem of lack of resources and health care infrastructure, there is an inadequate number of beds, rooms, and medicines. On the part of the government there is lack of monitoring of the funds and resources devoted to improving the healthcare sector. Even today, primary health care centres (PHC) across the country do not have adequate infrastructural facilities like beds, rooms, toilets, drinking water facilities, clean labor rooms to deliver babies, and electricity regularly. Hospitals are also failing to maintain the quality and flexibility that is seriously required. Those issues are financial Issues Government mandates for patient safety and quality care, staffing concerns, patient satisfaction, access to care, Doctor related issues, and population health management. India still remains 80% import-dependent on medical devices. India still remains highly dependent on imports for many types of medical devices, especially higher-end equipment such as Cancer diagnostics, medical imaging, ultrasonic scans, and PCR (polymerase chain reaction) technologies. Imports of medical devices increased by a record 41% to 63,200 crores in 202122 from 44,708 crores in 2020-21, as per the Commerce Ministry data analysed by the Association of Indian Medical Device Industry (AiMeD). India imported 40,649 crore worth of medical devices that came under this category in 2021-22 against imports worth 4,569 crore in 2016-17. The import of surgical instruments rose to 1,260 crore from 243 crore during this period. India also has imported medicinal and Pharmaceutical Products to the value of almost 357 billion Indian rupees as of fiscal year 2022. Up until September 2023, India will Import medical and Pharmaceutical products of more than 318 billion Indian rupees in financial year 2023. These heavy dependencies on imports of various medical equipment due to lack of infrastructure, lack of manufacturing medical equipment, and lack of efficient productivity of medical devices.

Shortage of efficient and trained manpower: 

One of the most pressing problems in India remains a severe shortage of trained manpower in the medical stream, this includes doctors, nurses, paramedics and primary health care workers. The situation remains worrisome in rural areas, where almost 66 percent of India’s population resides. The doctor–to–patient ratio remains abysmally low, which is merely 0-7 doctors per 1000 people. This is compared to the World Health Organisation (WHO) average of 2.5 doctors per 1000 people, improving this situation continues store main long-term process the issue can be suitably addressed by increasing the capacity of existing teaching and training institutes while adding new ones in the long run. According to a study presented in parliament by a minister India is short 600,000 doctors.

Policy making: 

Policymaking is undoubtedly crucial in providing effective and efficient healthcare services in India, the issue is one of supply rather than demand and policymaking can help

Lack of prevention care: 

Preventive care is undervalued in india, despite the fact that it has been shown to be quite beneficial in alleviating a variety of difficulties for patients in terms of unhappiness and financial losses.

Lack of medical research

In India research and development and cutting-edge technology-led new projects receive little attention.

• It is observed that 70% of population has no access to specialist care as 80% of specialists live in urban areas. Only 13% of rural population have access to primary health centres, 33% to sub centre and 9.6% to a hospital(NFHS-2).
• Rural communities in India face a severe shortage of access to health care services. There is little public spending on health care, and what money the government does spend is largely distributed to urban settings rather than rural ones. Additionally, the private healthcare industry primarily serves urban settings.
• Evidence suggests that improved living and working conditions, better salaries, use of disruptive technology, cooperative arrangements with other rural health facilities and continued training help the doctors and nurses to provide high-quality care in rural areas.
• India has a shortage of hospitals, particularly in rural areas, and many existing healthcare facilities lack basic equipment and resources. According to the national health profile India has only 0.9 beds per 1000 population out of which only 30% are in rural areas.
• India’s import dependency in the “ electronics and equipment” category of medical devices has been the highest and was worth rs 40,649 crore in fy22 this category includes MRI machines, CT scanners, ultrasound machines, cancer diagnostics, dental drills and minimally invasive surgical devices.
• India also imports diagnostic imaging( eg CT scan, x-ray, MRI, USG, X-RAY- tubes etc), Iv diagnostic ( lab equipment and reagents, etc), and other medical devices ( ECG, optional equipment, heart long machine, etc), calorimeters, orthopedic or fracture appliances blood transfusion apparatus, surgical bone saws, cannulae, dialysis apparatus, endoscopes, malaria diagnostic kits, peacemakers and so on form 70% of total import in India in fy16.
• Unmanageable patient load: even prior to the outbreak of the covid-19 pandemic healthcare facilities had been feeling the strain due to unmanageable patient load. Moreover serving a population of 1.4 billion remains alters co lean task in itself when it comes to suitably managing health care facilities. There is a need to adopt technology wherever possible to streamline the operational and clinical processes for healthcare facilities in order to manage efficient patient flow. In addition, there is the challenge to think beyond the obvious and promote virtual care protocols, and telehealth services, which can be leveraged to reduce the patient load burden to a large extent.
• Public health policy and pro-active health care: the latest national health policy (NHP) 2017 highlights the “health for all” approach to provide assured health care for all at an affordable cost. However, there is scope to do much more under the NHP 2017. Ideally, the public health policy needs to be focused towards proactive health care, not reactive health care. Besides, in the case of the government ayushman bharat scheme, the Pradhan Mantri Jan Arogya Yojana (PMJAY), the universal health insurance scheme, has received considerable attention and resources than the health and wellness centres (HWCS) component this asymmetry needs to be suitably addressed for the growth of health care in the future.
• High out-of-pocket expenditure remains a stress factor: while public hospitals offer free health services, these facilities are understaffed, poorly equipped, and located mainly in urban areas. It is a known fact that accessible and affordable health care in the public sector can considerably reduce the rise in dependence on private institutions. However governmental facilities leave no alternatives but to access private institutions and incurring high out-of-pocket expenses in health care most health services are therefore provided by private facilities and 65 percent of medical expenses in India are paid out of pocket by patients. A possible solution to address the issue could be to increase the adoption of health insurance. In this regard, the government and private institutions both need to work together. Adoption of digital insurance processing solutions integrated with the health care ecosystem for faster turnaround time for insurance processes will also motivate adoption of health insurance what primarily all is the health care system is that there has been a general lack of focus on the vertical from the government. For years now knee-jerk reaction work is being witnessed towards the improvement of quality of service. To sum it up there is an urgency to make health care service and service providers more transparent operationally. This will help ensure peace and processes can be made easily accountable to provide better health care services it is only then that the health care system can breathe a bit easier.

Corruption in medical services:

• Bribes to gain access (towards, entering restricted areas such as labour wards)
• Bribes to jump queues (out-patient department, laboratory sampling)
• Bribes to get free services (for x-rays, medicines, diet supplements)
• Bribes to get admission or discharge from the hospital, or to release bodies from the mortuary
• Bribes to obtain certificates on medical conditions such as fitness certificates, disability certificates, etc., which are required for various purposes such as foreign travel, professional recruitment, etc.

So these are the factors responsible for the lack of proper medical services for needy people.

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