Not enough beds

By Nidhi Jamwal
Published: Saturday 15 August 2009

Not enough beds

Makeshift arrangement for a bed at a government hospital in Delhi (Credit: MEETA AHLAWAT)Even in private hospitals; central India is worse off

For 829 people in central India, Madhya Pradesh, Chhattisgarh and Jharkhand, there is just one bed in private hospitals. This is the worst hospital bed-to-person ratio in India, revealed a first-time survey of private healthcare facilities in the country. All over India the bed-to-people ratio is 1: 422. Government hospitals' existing record is worse--one bed for 2,239 people. who recommends a minimum of three beds per 1,000 people.

The survey that focused on the number of beds, affordability and hospital accessibility, found the following:

  • 35 per cent patients in private hospitals belonged to lower income groups who earn less than Rs 10,000 a month

  • 85 per cent of these patients do not have any insurance cover

  • 42 per cent patients visit private facilities from nearby rural areas.

"The private sector dominates healthcare services in India," said Utkarsh Shah, senior consultant at Hosmac India Pvt Ltd, the company that surveyed 30 hospitals in 10 states.

The low bed-patient ratio reflects poor healthcare in India, but the survey does not give the full picture, said Padma Deosthali of the Centre for Enquiry into Health and Allied Themes (cehat), a non-profit in Mumbai. "Health is more than just hospitals. It includes primary health services, preventive measures and community health. People are forced to avail of private facilities because public healthcare is in the doldrums," Deosthali said.

Vivek Desai, managing director of Hosmac India, said the public sector should be strengthened so that the poor could be treated there. "For the middle class and the rich, medical insurance should be the norm. The cost of healthcare will only go up," he said.

"Patients in Mumbai come from the suburbs and villages. Public hospitals are not able to handle the patient load. Their condition is terrible. I have seen patients sleeping on the floor of J J Hospital, the largest in Mumbai. Although private hospitals are expensive, patients know they will be taken care of well," said Ansila Triagler of Holy Family Hospital and Medical Research Centre in Mumbai.

But the quality of healthcare in the private sector is also a growing concern. There isn't enough manpower, said Desai. "Seven years ago, a cardiac hospital was inaugurated in Surat. The hospital could not find a person to do angioplasty the first three months," he said.

Think central India
A 2002 study by cehat had found 44 per cent of the households in a municipal ward in Andheri East, Mumbai, were forced to go to private hospitals because there was no government hospital in their area. Most people there said they would shift to a government hospital if it is set up in their ward.

Cities like Mumbai don't need more hospitals and should now act as referral centres, the Hosmac report said. Investment in private healthcare, said Desai, does not depend on need or demand but finances. That explains why Mumbai has so many super speciality hospitals, whereas Nagpur in eastern Maharashtra has none.

The first step to check the bed-patient ratio must be to stop random hospital locations. Before a hospital is set up, factors such as disease profile, demography, patient migration trends and competition from existing healthcare units must be considered, said Jagruti Bhatia of non-profit hopes in Mumbai. Deosthali's solution is a law that ensures a patient is not denied healthcare even if he or she cannot pay. Triagler stressed on preventive and community health: "Basic medical help should be provided at home or near one's home. Clean water supply, hygiene and sanitation are imperative."

A more immediate approach, said the Hosmac survey, would be to think of central India first.

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