kpmg.com/in
Introduction
Current state of healthcare in India
Life
expectancy
at birth
(years)
1990
2008
Male
Female
Male
Female
57
58
63
66
1994
2008
74
53
1999-01
2004-06
327
254
Number of
Physicians
(Allopathic)
2005
2006
2007
2008
2009
660856
682080
708043
736743
757377
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated with
KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
Developed Economies
Emerging Economies
Indicator
Year
India
US
UK
Japan
Brazil
Russia
China
2008
64
78
80
83
73
68
74
2008
52
18
18
2000-09
254
13
77
24
34
2000-09
31
39
139
24
97
30
2000-09
27
21
21
17
43
14
2000-08
47
99
NA
100
97
100
98
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated with
KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
Developed Economies
Emerging Economies
Indicator
Year
India
US
UK
Japan
Brazil
Russia
China
2008
31
100
100
100
80
87
55
Indicator (2007)
Rural
Urban
8.0
6.0
61.0
37.0
40.0
22.0
20.0
16.0
41.0
24.0
9.0
8.0
The primary reasons for underdeveloped infrastructure in the semiurban and rural areas are the lack of
investment incentives for private sector
investment, inefficiencies in the public
healthcare system and lack of a quality
human resource pool and supply and
distribution infrastructure.
1991
Distribution of households having
safe drinking water facilities in
India (percent)
2001
Rural
Urban
Rural
Urban
55.54
81.38
73.2
90
2001
Distribution of households having
electricity in India 2001 (percent)
Rural
Urban
Total
43.53
87.58
55.85
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated with
KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
States
Life expectancy
(Years)
Infant mortality
rates (per 1000
live births)
2002-06
2008
Maternal mortality
ratio (per 100,000
live births) mortality
2004-06
Male
Female
Male
Female
Punjab
68.4
70.4
39
43
192
Bihar
62.2
60.4
53
58
312
Uttar Pradesh
60.3
59.5
64
70
440
Rajasthan
61.5
62.3
60
65
388
Gujarat
62.9
65.2
49
51
160
Maharashtra
66
68.4
33
33
130
West Bengal
64.1
65.8
34
37
141
Karnataka
63.6
67.1
44
46
213
Madhya Pradesh
58.1
57.9
68
72
335
Orissa
59.5
59.6
68
70
303
Kerala
71.4
76.3
10
13
95
State/UT wise number of government hospitals and beds in rural and urban areas (including CHCs) in India
State/UT
Rural Hospitals
Urban Hospitals
Total Hospitals
Projected
Population
as on
reference
period (In
thousand)
Average
Population
Served Per
Govt.
Hospital
Average
Population
Served Per
Govt.
Hospital
Bed
Reference
Period
Number
Beds
Number
Beds
Number
Beds
Punjab
72
2180
159
8440
231
10620
26391
114247
2485
01.01.2008
Bihar
NA
NA
NA
NA
1717
22494
93633
54533
4163
01.09.2008
Uttar Pradesh
397
11910
528
20550
925
32460
183282
198143
5646
01.01.2007
Rajasthan
347
11850
128
20217
475
32067
63408
133491
1977
01.01.2008
Gujarat
282
9619
91
19339
373
28958
57434
153979
1983
01.01.2010
Maharashtra
376
11280
389
38299
765
49579
109553
143207
2210
01.01.2010
West Bengal
14
2399
280
52360
294
54759
87839
298772
1604
01.01.2010
Karnataka
468
8010
451
55731
919
63741
58181
63309
913
01.01.2010
Kerala
281
13756
105
17529
386
31285
34063
88246
1089
01.01.2010
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated with
KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated with
KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
Indicator
India
US
UK
Japan
Brazil
Russia
China
4.1
15.7
8.4
8.4
5.4
4.3
26.2
45.5
81.7
81.3
41.6
64.2
44.7
73.8
54.5
18.3
18.7
58.4
35.8
55.3
109
7285
2992
2696
837
797
233
11
3317
3161
2237
252
316
49
29
3317
2446
2193
348
512
104
However, the government of India aims to increase healthcare expenditure to 3 percent of GDP by 2012.3
Percenrage
50
40
39.1
30
29.1
20
10
15.1
12.4
0
Health Worker
(Female)/ Auxiliary
Nurse Midwife
Health Worker
(Male)
Health Assistant
(Male)
Doctors at PHC
27.6
Percentahe
25
20
18.8
15
13.4
10
5
6.1
0
Health Worker
(Female)/ Auxiliary
Nurse Midwife
Health Worker
(Male)
Health Assistant
(Male)
Doctors at PHC
Even out of the sanctioned posts, a considerable percentage of posts are vacant across all the levels.
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated with
KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
51
NABH Applicants
358
16
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated with
KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
10
Current
Required
Physicians
757377
1200000
Dental surgeons
93332
300000
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated with
KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
11
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated with
KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
12
Conclusion
Public-Private Partnership The all inclusive
way forward
In light of the current status of
healthcare in India, a Public-Private
Partnership (PPP) approach appears as
probably the only all inclusive way
forward that will address all the issues
stated in this background note. A PPP
is a synergistic model to bring together
the social objectives (of the
government) of universal healthcare
access and affordability and the
business objective of running a
profitable healthcare facility (industry).
While the public sector contributes in
terms of infrastructure development,
land acquisition, financing, etc., the
private party brings in its knowledge
and expertise of project management
and operational efficiency.
Public-private partnerships have distinct
advantages and help to achieve desired
health outcomes.
1. Creating competition:
a. Competition between the PPP
initiative facilities with other
healthcare providers would make
even the private facilities available to
the poor through reduction in their
costs
b. Greater choice of services would be
available to the poor
c. Better quality of services can be
achieved by setting up of standard
guidelines for the initiative
participants. Thus a basic minimum
level of quality of healthcare services
would be maintained. The competing
private healthcare providers would
try to improve the quality as well, to
increase/ retain their clientele
In summary, through this initiative,
the private providers may have to
compete with public sector providers
to act as agents for providing public
healthcare to the poor.
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated with
KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
13
Initiative Name
Ayush Graham
Bhawali Project,
Nainital
Telemedicine
initiative by
Narayana
Hrudayalaya in
Karnataka
Emergency
Ambulance
Services scheme in
Tamil Nadu
Community Health
Insurance scheme
in Karnataka
Poor patients are identified by field workers and health workers who
visit door-to-door to make people aware of the scheme
Auxillary Nurse Midwives and health workers visiting a village collect
its insurance premiums and deposit them in the bank
Annual premium is INR 22, less than INR 2 a month
If admitted to any government hospital for treatment, an insured
member gets INR 100 per day during hospitalization INR 50 for bedcharges and medicine and INR 50 as compensation for loss of wages
up to a maximum of INR 2500 within a 25-day limit
Extra payment is possible for surgery.
Source: CII-KPMG Report on 'The Emerging Role of PPP in Indian Healthcare Sector, 2008
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated with
KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
14
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated with
KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
Contacts
Vikram Utamsingh
Executive Director and
Head of Markets
e-Mail: vutamsingh@kpmg.com
Tel: +91 22 3090 2320
Ramesh Srinivas
Executive Director
Business Performance Services
e-Mail: rameshs@kpmg.com
Tel: +91 80 3065 4300
kpmg.com/in
The information contained herein is of a general nature and is not intended to address the circumstances of any particular
individual or entity. Although we endeavor to provide accurate and timely information, there can be no guarantee that
such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one
should act on such information without appropriate professional advice after a thorough examination of the particular
situation.
2010 KPMG, an Indian Partnership and a member firm of the KPMG network of independent member firms affiliated
with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
KPMG and the KPMG logo are registered trademarks of KPMG International Cooperative (KPMG International), a Swiss
entity.