Comparing the healthcare systems of two of the world’s largest democracies highlights the changes we can make to improve the infrastructure in our country while bringing to the fore some of our potential strengths. While prima facie, it might appear that the United States has perfected its healthcare spending, access, and infrastructure, recent socio-political movements and the call for universal healthcare by its citizens show cracks in the uthopia.
No doubt, the US holds a significant edge over India when it comes to healthcare services. Perhaps the difference in the availability of doctors per 1000 (0.62 for India and 2.55 for the US) is reflected in the difference between the average life expectancy in the two countries (69 years for India and 78.7 years in US). However, it is important to note how unfair this comparison is. Challenges imposed by a developing economy exert a significant influence over the healthcare system in India. The US, on the other hand, already a “developed nation,” has its own challenges. The following are the differences between Indian healthcare and US healthcare on some key aspects.
1.Public health ecosystem : India lags far behind developed nations in the public health arena. A large proportion of the Indian population still lacks adequate access to proper sanitation, clean drinking water, proper nutrition -- long-standing challenges for the country. While the US has overcome the challenges that obstruct the construction of an effective healthcare infrastructure in a country, it is dealing with its own set of issues, such as limited healthcare access and high expenditure.
2. Privatisation of Healthcare : Both the US and India lack a universal healthcare system for its citizens. While the lack of a public healthcare system and unfettered capitalism has allowed private firms to run amok in the US, leading to the call for “Medicare For All” by its citizens, in a country of the size and population such as India, the healthcare delivery system is itself driven by two players -- public and private. The government controls the public healthcare system and aims it at providing basic primary and secondary healthcare services to a wide coverage area in the country; the private sector concentrates more with facilitating high-end tertiary and quaternary care in major metropolitan cities.
3. Out-of-pocket expenditure : A lack of a comprehensive public healthcare system means citizens in both countries are forced to pay out of their own pocket for medical expenditures -- almost 70% in India and around 10-12% for the US.
4. Differentiation in states : Since the US is a federation of states, each state has its own separate rules and regulations. That makes it tricker to have, in the current scenario where there is no public healthcare system in place, a common health insurance policy valid across all states. India, on the other hand, is a republic, and the same rules apply across all states. Therefore, a health insurance policy will have the same rules and regulations across the country.
5. Healthcare spendings as a % of GDP : In India, the total expenditure on healthcare as a percentage of GDP is just 1.2% of its GDP, while the US spends 18% of its GDP on healthcare. Clearly, from the Indian standpoint, there is considerable scope for improvement. The Indian government’s allocation seems to be lagging on a global level. India needs to first compete with its counterparts before it can aim for the US healthcare spending.
6. Drug prescription : When it comes to buying drugs, the US laws are quite stringent and require proper prescription from a medical authority. In India, on the other hand, several scheduled drugs and medicines are available without a prescription and this facilitates the illegal sale and use of limited or banned drugs.
Despite all the differences stated above, India still holds certain advantages over the US, especially when it comes to the cost of medical procedures and treatments. For example, when it comes to comparing surgery in India vs US, a heart bypass surgery can cost up to US$ 144,000 in America, when the same can be done in US$ 5,200 in India. Similarly, knee replacement surgery can cost anywhere around US$ 50,000 in America. The same procedure can be done in US$ 6,200 in India. Affordable and attractive packages have helped boost medical tourism in India and have attracted patients not just from its neighbours like Bangladesh, Afghanistan, Iraq, Maldives, Oman, Yemen, etc, but also from developed nations such as the US, the UK, Germany, etc. Further, India has an abundance of highly skilled professionals. In fact, we've got so many talented doctors, the new stereotype of "doctor" in Hollywood is that of an Indian. No doubt, the plethora of Indian doctors in the USA has also helped boost their healthcare system as well.
Healthcare in India is one of the country’s largest sectors, both in terms of revenue and employment. While on the revenue side of things, the healthcare market is expected to increase threefold to US$ 133.44 billion by 2022, on the employment side, the number of doctors – not counting nurses and other support staff – has seen an increase from 827,006 in 2010 to 841,104 in 2017. With a rise in investments both from public and private bodies to capture this market, the healthcare industry is expected to grow exponentially. We might not be there yet and there is indeed a considerable scope of improvement, but we are on the way for sure.
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