[HEALTHCARE IN
INDIA]
The major diseases and which India is facing along with the changes which
have happened in the last year are discussed in this report. Along with this we
also look into the scenario in 2025 and provide the possible solutions which
India should follow for a positive change.
ANKIT AWASTHI
Ref : http://www.worldlifeexpectancy.com/cause-of-death/coronary-heartdisease/by-country
Country
India
165.8
United States
80.5
United Kingdom
68.8
Australia
60.3
CAUSES
Smoking
High levels of certain fats and cholesterol in the blood
High blood pressure
High levels of sugar in the blood due to insulin resistance or diabetes
Blood vessel inflammation
DIABETES MELLITUS
Country
India
23.8
United States
15.2
United Kingdom
5.0
Australia
9.9
Causes
o Genetic Susceptibility TCF7L2
o Obesity and Physical Inactivity
o Abnormal Glucose Production by the Liver
o Metabolic Syndrome
higher than normal blood glucose levels
high blood pressure
abnormal levels of cholesterol and triglycerides in the blood
increased waist size due to excess abdominal fat
Country
India
68.0
United States
9.7
United Kingdom
23.7
Australia
7.0
STROKE
DIARRHOEAL DISEASE
CANCER
Country
India
75
United States
123.8
United Kingdom
137
Australia
118.8
AKSHAT RAJ
DUAL BURDEN OF INFECTIOUS AND CHRONIC DISEASES
As discussed above, we can see that the biggest challenge for India is
the dual fight of containing a developing countrys health concerns while a
range of developed world disorders are at its doorstep. On one hand India is
combating basic health concerns such as malnutrition, low immunization rates,
hygiene, sanitation, and infectious diseases. On the other hand, environmental
pollution and lifestyle choices such as alcohol consumption, smoking, and high
fat diet are set to increase the incidence rates of hypertension/high blood
pressure, cardiovascular disease, diabetes and cancer to almost epidemic levels.
Over the past decade or so the increase in the expenditure by private companies
in the health care sector has been huge, as can be witnessed from the Figure A.
Also, in the last decade the private sector added about 70% of the total hospital
beds (Figure B).
Indias Public health care expenditure is alarmingly low, and amounts to around
only 1% of its total GDP while in comparison to Russia (~3%), USA (~15%) and
UK (8.5%).
Another thing of concern has been the increasing OOP outlays (70%), i.e. Out-ofpocket spending on health facilities by people, of this 50% is on drugs.
The reasons for Private sector to pick so much have been both the positive
stimulus for private companies and hospitals and the negative stimulus to public
sector. Poor public healthcare facilities i.e. unavailability of attendants, poor
infrastructure, etc. increased the market for private health care and also many
external drivers of private sector growth like Medical Tourism have also come up.
But High Involvement of Private Sector is undesirable because of various
externalities and also because of the problem of informational asymmetry
(Doctors have more information about the disease than the patient, and may
potentially exploit patients).
PHARMACEUTICAL SECTOR
India has emerged as a major supplier of several bulk drugs, producing these at
lower prices compared to formulation producers worldwide. (Exports US $13
Billion/Year) which is 3rd Largest in World, in terms of Volume. And it is growing
at the rate of 15-20%, annually. Indian Pharmaceutical Industry has helped the
world in a very positive way by bringing to people many generic drugs at much
cheaper rates.
The last decade saw the advent of Product Patent Regime (January 2005), which
brought a considerable change in the policies of the Indian Pharma companies.
Now many bigger of the Indian firms, have increased their investments in R&D to
sustain themselves. Also, now many Multinational firms are now targeting high
end patients while some Indian firms have chosen to target semi-urban and rural
populations.
It is important for Indian Pharmaceutical companies to reinvent themselves to
sustain themselves.
OTHERS
Clinical Trials India has become a more attractive market for clinical
trials, because of various policy changes it took, which has made its
policies similar to those around the world.
Telemedicine Providing access to diagnostics and Treatments through
Video Conferencing.
CANCER
Cancer is one of the leading causes of death in India, with about 2.5 million
cancer patients, 1 million new cases added every year and with a chance of the
disease rising five-fold by 2025.
This is owing to the poor availability of prevention, diagnosis and treatment of
the disease. All types of cancers have been reported in Indian population
including the cancers of skin, lungs, breast, rectum, stomach, liver, cervix,
esophagus, bladder, blood, mouth etc. Cancers of lung and mouth in men and
cervix and breast in women are the biggest killers. Ignorance among public,
delayed diagnosis and lack of adequate medical facilities has given cancer the
dubious distinction of being a killer disease . As per a Boston Consulting Group
study, 70-80% of cancer patients are diagnosed late when treatment is less
efficient and 60% of them do not have access to quality cancer treatment. Out of
300+ cancer centres in India, 40% are not adequately equipped with advanced
cancer care equipment.
High treatment costs are one of the main reasons why cancer care is out of reach
for millions of Indians. If detected early, treatment is effective and cheaper.
However, if detected late, it is more expensive (can even lead to bankruptcy)
and also reduces chances of survival. An average cancer patient bears an
economic burden of Rs 36,812 for the entire cancer therapy at an institution like
the All India Institute of Medical Sciences (AIIMS) where services are free or
highly subsidized. Chemotherapy and hormonal drug therapy can cost from
Rs10,000 to Rs 4 lakhs depending on the drugs used and duration of treatment.
Some breast cancer patients, for example, need targeted treatment drugs, such
as Herceptin or Herclon, made by global major Roche, which cost around Rs
75,000 for a course; a patient could need up to 17 courses. Similarly, a drug
called Avastin - used to treat colon, kidney, lung and gall bladder cancer - can
add around Rs 8 lakh to a patient's bill at around Rs 1 lakh a cycle . India has a
population of approximately 1,200 million with a requirement of more than 1,200
Radiation Therapy (RT) machines. At present, there are just 400 RT machines
that are available for cancer treatment. Access to cancer detection technologies
-- quality pathology labs, imaging equipment, especially PET/CT or molecular
imaging that can detect cancer at least 5 years earlier than any other technology
-- needs to be improved.
DIABETES
At present, India is considered as the diabetic capital of the world. In India, 63
million people have diabetes as of 2012, and the number is estimated to
increase to 101 million by 2030. Diabetes is a metabolic disease in which
a person has high blood glucose, either because the body does not
produce enough insulin, or their cells do not respond to the insulin
produced. People with diabetes develop further health complications as a
result of inadequate blood sugar control, a condition that can lead to
heart disease and stroke, as well as damage to kidneys, nerves and
retina.
Because of its chronic nature, the severity of its complications and the means
required to control them, diabetes is a costly disease . Diabetes consumes
between 5% and 25% of the income of an average Indian family, which
translates to USD 2.2 billion a year on diabetes care and treatment. Many
patients are unaware of treatment expenses and are not able to plan the
budget. Direct costs to individuals and their families include medical care, drugs,
insulin and other supplies. Since it is a chronic disease it requires prolonged
treatment like regular doses of insulin injection, regular intake of tablets to
maintain metabolism of body.
In India, more than half of patients have poor glycaemic control and have
vascular complications. Therefore, there is an urgent need to develop
novel therapeutic agents of diabetes without the development and
progression of complications or compromising on safety.
TUBERCULOSIS (TB)
Tuberculosis (TB) is one of the major public health problems in India with a
significant impact on the health and economy of the country. India is the highest
tuberculosis (TB) burden country in the world, accounting for nearly one-fifth of
the global incidence. Annually more than 250,000 people die of TB. This is most
unfortunate as TB is a curable disease if treated appropriately and adequately.
Almost 70% of TB patients are aged between 15 and 54 years. The disease is
more common amongst the poorest and the marginalized sections of the
community. Whilst two-thirds of cases are male, TB takes a disproportionately
larger toll among young females, with more than 50% of cases occurring
amongst females less than 34 years of age. The most reliable test for diagnosis
of TB is smear microscopy which is widely used under the RNTCP(revised national
tuberculosis control programme). However, the private sector does not prefer
this simple and reliable test; instead a number of antibody based blood tests
(serological tests) which are nonspecific are being widely used for diagnosing TB.
Patients are therefore often falsely diagnosed based on these unreliable tests
and unnecessarily treated for a disease they are not suffering from while
incurring unwarranted out of pocket expenditure. It is estimated that over 1.5
million of such unreliable serological tests are performed in India annually
primarily by private laboratories.
A cause for concern is the potential threat of extensively drug-resistant
tuberculosis in India, with unregulated availability and injudicious use of the
second-line drugs and no system to ensure adherence to standardized regimens
and treatment for multidrug-resistant tuberculosis. Multidrug-Resistant TB (MDRTB) is the resistance to the two most effective first line drugs isoniazid and
rifampicin. When these first-line drugs fail, second-line drugs are used for
treatment. The cost of these drugs is staggering, as much as 1400 times that of
regular treatment, with severe side effects and prolonged duration of treatment
over 2 years.
India needs an enhanced model for the control of tuberculosis. District public
health officers are needed to receive reports about all cases that are diagnosed
in all health-care clinics in the district.
CONCLUSION
Indias health care industry needs managers with knowledge about the reality at
the ground level to help grapple with the above challenges. Most people in India
buy healthcare from the private sector, a compulsion that accounts for a high
proportion of healthcare-related expenditure. To reduce the burden of healthcare
costs, the government must improve availability and affordability of generic and
essential medicines in the market. Government needs to understand the scope of
Indias health care gaps, work to build infrastructure to reach rural pockets, and
to create innovative financing to deliver health care to the underprivileged.
Creating incentives for local companies, roping in support from global players
and putting in place public-private partnerships are the main areas for the
improvement of Indian health care services industry.
RISHI YADAV
MAJOR PROGRAMMES BY MINISTRY OF HEALTH AND FAMILY
WELFARE
Communicable Diseases
Non-Communicable Diseases, Injury & Trauma
Pradhan Mantri Swasthya Suraksha Yojana - PMSSY
Poor Patients-Financial Support
Other National Health Programmes
National Health Mission
COMMUNICABLE DISEASES
Human Immunodeficiency Virus Infection/Acquired
Immunodeficiency Syndrome (HIV/AIDS) - Department of AIDS Control
State AIDS Prevention and Control Societies
Revised National TB Control Programme (RNTCP)
Second largest DOTS (Directly Observed Treatment, Short course)
programme in the world. However, India's DOTS programme is the fastest
expanding programme, and the largest in the world in terms of patients
Department of Ayush
Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was
created in March,1995 and re-named as Department of Ayurveda, Yoga &
Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in November,
2003 with a view to providing focused attention to development of
Education & Research in Ayurveda, Yoga & Naturopathy, Unani, Siddha and
Homoeopathy systems.
Central Government Health Scheme (CGHS)
The Central Government Health Scheme (CGHS) provides
comprehensive health care facilities for the Central Govt. employees and
pensioners and their dependents residing in CGHS covered cities.
ANMOL SARRAF
(http://mospi.nic.in/Mospi_New/upload/mdg_2014_28jan14.pdf)
HIV infections have declined by 56 per cent during the last decade from 2.7 lakh
in 2000 to 1.2 lakh in 2009 in our country, Indian Health and Family Welfare
Minister Ghulam Nabi Azad said in the national capital.
This has been possible due to political support at the highest levels to the
various interventions under National AIDS Control Programme
More than one third of all measles deaths worldwide (around 56 000 in 2011) are
among children in India. With support from WHO, in November 2010, India
launched a massive polio-style measles vaccination project in 14 high-burden
states, in a three-phase campaign.
With two phases of the measles vaccination campaign completed, and the third
phase ongoing, more than 102 million children in 344 districts have been
vaccinated, achieving between 87% and 90% coverage. (Improving measles
control in India, April 2013, WHO)
As per the historical trend, the IMR is likely to reach 40 deaths per 1000 live
births, missing the MDG target of 27 with a considerable margin. However, as
IMR is declining at a sharper rate in the recent years, the gap between the likely
achievement and MDG target 2015 is set to reduce.
Indicator: Proportion of one year old children immunised against measles.
The national level coverage of the proportion of one-year old (12-23 months)
children immunised against measles has registered an increase from 42.2% in
1992-93 to 74.1% in 2009 (UNICEF &GOI-Coverage Evaluation Survey 2009). At
the historical rate of increase, India is expected cover about 89% children in the
age group 12-23 months for immunisation against measles by 2015. Thus India
is likely to fall short of universal immunisation of one-year olds against measles
by about 11 percentage points in 2015.
The problem in estimating MMR is due to the comparative rarity of the event,
necessitating a large sample size. However, even with this constraint, Sample
Registration System (SRS) data indicates India has recorded a deep decline of
45.6%in MMR from 327 in 1999-2001 to 178 in 2010-12 and a fall of about 30%
happened during 2006-12.
India has demonstrated an overall reduction in the estimated annual new HIV
infections (in all age-groups) from 2.96 lakhs in 2000 to 1.30 lakhs in 2011. The
estimated annual new HIV infections among adult (15+ years) population has
declined steadily over the past decade by about 57% from 2.74 lakhs in 2000 to
1.16 lakhs in 2011. Males account for approximately 61% of total new annual HV
infections in 2011 whilst women account for an estimated 39% of total new HIV
infections.
Total number of annual AIDS related deaths in India is declining over the past
years. It is estimated that about 1.48 lakh (1.14 lakhs-1.78 lakhs) people died of
AIDS related causes in 2011 in India. In comparison with the 2.06 lakhs (1.67
lakhs-2.45 lakhs) AIDS related deaths estimated in 2007, this marks a near 29%
reduction in estimated number of AIDS related deaths during 200711. Deaths
among HIV infected children account for 7% of all AIDS-related deaths.
It is estimated that the scale up of free ART since 2004 has saved cumulatively
over 1.5 lakh lives in the country till 2011by averting deaths due to AIDS-related
causes. With the current scale up of ART services, it is estimated to avert around
50,00060,000 deaths annually in the next five years.
Wider access to Antiretroviral Therapy (ART) has led to 29% reduction in
estimated annual AIDS-related deaths during NACP-III period (2007-2011).
(http://mospi.nic.in/Mospi_New/upload/mdg_2014_28jan14.pdf)
IMPROVED LIFE-EXPECTANCY
Statistics released by the Union ministry of health and family welfare show that
life expectancy in India has gone up by five years, from 62.3 years for males and
63.9 years for females in 2001-2005 to 67.3 years and 69.6 years respectively in
2011-2015. Experts attribute this jump higher than that in the previous
decade to better immunization and nutrition, coupled with prevention and
treatment of infectious diseases.
The World Health Organization defines life expectancy as "the average number
of years a person is expected to live on the basis of the current mortality rates
and prevalence distribution of health states in a population". In India, average
life expectancy which used to be around 42 in 1960, steadily climbed to around
48 in 1980, 58.5 in 1990 and around 62s in 2000.
MOHIT SONI
Gap in Healthcare workforce: As per the Twelfth Five - Year plan, the
physician and nurse density is expected to reach around 0.7 and 1.7 per
1000 people respectively by 2022. Of these, if current utilization numbers
were to be maintained, the active workforce would only be 0.5 and 0.8 per
1000 people respectively.
current 4%. OOP spend will also need to come down from the current 61% to
23%. This would require 17,00,000 to 21,00,000 crores investment by 2022.
CHINMAY JOSHI
RECOMMENDATIONS
For any country, healthcare facilities play an extremely important role in the development of
the country. In modern Human Development Index, health is considered to be an extremely
important factor. In case of developing countries, the role of government in the provision of
the medical and healthcare facilities is all the more important as the large concentration of
poor may be exploited by the private sector.
A look at Indian healthcare related data tells you about the dismal state that public health
services are in India. We start by looking at the vulnerabilities in the Indian public health
system which need to be targeted for significant improvement.
IMPORTANT TARGETS
Lack of Government Expenditure Historically, Indian governments expenditure in
health sector has been abysmally low. This results in high OOP (Out of Pocket)
expenditure by the people which forces millions of people below poverty line. A stable
public health structure is a necessity of a developing nation and poor medical services can
cripple the nation economically. The government expenditure will have to increase
significantly in the right direction to improve the current affairs of the system.
Lack of Primary Care There are huge number of cases, especially in rural India where
there are large number of deaths due to female foeticide and infanticide as well as
inadequate nutrition for mother and newborn child. The situation is not improving much
and infant & maternal mortality has been huge in India. This has a lot of causes which are
lack of education, resources in the rural areas, improper government expenditure but more
importantly, healthcare facilities for women & children have to improve.
Lack of Sanitation facilities The lack of sanitation facilities is a widely recognized
problem in our country which has several times led to epidemics in some parts. There is
severe scarcity of clear drinking water and many diseases like diarrhea, typhoid, cholera
etc. These are basic amenities which have to be provided and any kind of action that is
supposed to be taken in public health has to focus on this aspect.
Lack of Human Resources Again, this is a widely recognized problem in our country
that in rural areas, there is a severe lack of human resources in the medical sector. Despite
being one of the countries with premier medical institutes, India has been unable to cater
to the demand of its humongous population. A large number of doctors, nurses and
medical professionals are added to the workforce but the numbers are highly unevenly
distributed and there is a domino effect of medical professionals moving to urban India.
The above mentioned vulnerabilities can be viewed as problems but importantly, we must
realize that these problems are not the causes of the terrible state of Indias public health but
the results or rather more of indicators and the solutions should be aimed at improving these
indicators.
SUGGESTED SOLUTIONS
While we try to look for solutions and actions to improve the present condition of Indias
healthcare facilities, we must realize that any true solution that provides significant
improvement will take a large amount of time and expenditure. We, therefore, try to look out
for both long-term as well as short-term solutions.
LONG TERM ACTION Concerted & Integrated Public Healthcare and Medical Service Program
If we compare Indian public healthcare system to other developing countries, we realize that
India is doing considerably bad. A closer look at the Indian system reveals that major cause of
such a poor state is the original ideology of the Indian government with which it has tried to
implement health programs. The central government has, generally, mixed up public health
care and medical services and focused heavily on single-issue health programs. Although, this
intermingling of medical and health services was intended to improve coordination between
various different services, it ended up marginalizing public health services. The program that
had intended to eradicate polio was extremely successful and the government of India boasts
of complete eradication of polio as a disease. Unfortunately, the examples of such successful
programs arent many and this focus on single-issue programs has led to concentration of
resources on some important diseases and disallowed the development of an integrated public
health care system that proactively delivers wide range of services including medical services
as well as implementation of sanitary regulations. Instead, with the single-issue programs
doctors several times end up treating patients who should not have been ill at the first place.
Many countries like Bangladesh and Thailand have such robust and strong health care
programs which continue to deliver medical goods to their public. In India, Tamil Nadu has a
strong public health and medical structure and we analyze that.
In the state health department, there are three separate directorates under the health secretary
namely, the Directorate of Public Health, of Medical services, and of Medical Education. This
is the cornerstone of the structure as the separate directorates enjoy the freedom of planning
and policy making in their respective departments. The directorates have separate and
significant budgets which enable them to all the activities related to the implementation of
their policies. Also, the separate budget helps them in maintaining a trained, experienced and
dedicated taskforce which includes not only managerial and grassroots level workers but also,
a range of technical staff. This healthcare structure is legalized by the legislative assembly in
the state. This gives considerable power to the health officers in the state so that they can act
to any kind of complaint regarding to any activity that threatens to jeopardize the
environment.
In our country, we badly need such a structure of health system that proactively caters to the
demand of the public. Such a system will not only provide stable medical services, but also
provide healthcare services such as vaccinations, regular check-up camps, health awareness
campaigns etc. This kind of a system will require dedicated funding and sincere efforts, and
no doubt this will take time to build but only such a system can truly provide to improve the
level of health of a nation.
Public-Private Partnership
Public-Private Partnerships (PPP) are contract-based joint ventures where the private party
provides for the services and the cost is borne out by the government. In health sector, PPPs
can be used extremely efficiently as short term measures. While the private sector should be
able to provide excellent quality and best modern practices for patients, the government can
also use it as an opportunity to monitor and regulate the practices in the medical services
provided by the private sector. This would not only provide efficient service to the patient but
also, widen the reach of such facilities. It should be noted that the key objective again is to
reduce the out of pocket expense and provide good quality medical facilities.
The above mentioned short term solutions have been in place for some time now and are
developing on the way. They have their own importance because of the time frame. But we
need to realize that the long-term solution is of primary importance and if we keep taking the
shorter route, there will not be significant improvement in the health status of the nation.
REFERENCES
Public Private Partnerships for Healthcare in India, B. Birla, U. Taneja, The
Internet Journal of World Health and Societal Politics, 2008 Volume 7
Public-Private Partnership in Health Care: Contexts, Models and Lessons, A.
Venkat Raman, Faculty of Management Studies, University of Delhi,
http://www.who.int/global_health_histories/seminars/Raman_presentation.
pdf
The Early Success of Indias Health Insurance for the poor, RSBY, Victoria
Fan, 6/10/13, Center for Global Development
The state of healthcare in India is dismal: Amartya Sen, Nirmalya Dutta,
The Health Site, http://health.india.com/healthcare/the-state-of-healthcarein-india-is-dismal-amartya-sen/
Five Ways to Improve Indian Healthcare, Tripti Lahiri, 19/12/2011, The Wall
Street Journal
How to Improve Public Health Systems Lessons from Tamil Nadu, Monica
Das Gupta, B. R. Desikachari, T.V. Somnathan, P. Padmanaban, The World
Bank, Development Research Group
HealthCare Financing Reforms in India, M. Govinda Rao, Mita Choudhury,
March 2012, National Institute of Public Finance and Policy
[1]:http://en.wikipedia.org/wiki/Department_of_Ayurveda,_Yoga_and_Naturopa
thy,_Unani,_Siddha_and_Homoeopathy
[2] : http://en.wikipedia.org/wiki/Janani_Suraksha_Yojana_(India)
http://nrhm.gov.in/nrhm-components/rmnch-a/maternal-health/jananisuraksha-yojana/background.html
[3 : http://en.wikipedia.org/wiki/Rashtriya_Swasthya_Bima_Yojana
[4]: http://en.wikipedia.org/wiki/Infant_mortality
[5]: http://en.wikipedia.org/wiki/Maternal_death
unveils-first-indigenous-rotavirus-vaccine/article4714757.ece
http://timesofindia.indiatimes.com/india/Now-a-desi-rotavirusvaccine/articleshow/20058187.cms
www.dnaindia.com/world/report-indian-scientists-develop-japaneseencephalitis-vaccine-1898431
http://www.thehindu.com/news/national/india-launches-vaccine-to-preventjapanese-encephalitis/article5201813.ece
http://world.time.com/2013/01/13/how-india-fought-polio-and-won/
http://pib.nic.in/newsite/erelease.aspx?relid=99873
http://www.un.org/millenniumgoals/
http://www.healthissuesindia.com/infectious-diseases/
https://www.icicilombard.com/health_insurance_info/Knowing-top-10-killerdeath-diseases-in-India.html
http://indiatoday.intoday.in/story/India%27s+no.1+killer:
+Heart+disease/1/92422.html
http://www.worldlifeexpectancy.com/news/india-vs-china-top-10-causes-ofdeath
http://timesofindia.indiatimes.com/india/Life-expectancy-in-India-goes-upby-5-years-in-a-decade/articleshow/29513964.cms
http://www.jhsph.edu/research/centers-andinstitutes/ivac/IVACBlog/keyword/polio
http://www.jhsph.edu/research/centers-andinstitutes/ivac/IVACBlog/The_Road_to_Conquering_Polio_A_Major_Milestone
http://www.indexmundi.com/facts/india/mortality-rate
Jennifer G. ,Taylo D., Health and Health Care in India, UCL school of
Pharmacy
Jacob J. T., Dandona L.,Sharma P. V., Kakkar M.,India: Towards Universal
Health Coverage: Continuing challenge of infectious diseases in India,
Lancet 2011,
Gudwani A.,Mitra P.,Puri A. Vaidya M., India Healthcare: Inspiring
Possibilities, Challenging Journey ,McKinsey & Company ,December 2012
Tuberculosis Challenges for India, Policy brief series: No.12: 2011
February-March, http://www.clraindia.org/include/TBbriefnew.pdf
Innovating Around Indias Health Care Challenges, Health Economics, 29 July
2010, http://knowledge.wharton.upenn.edu/article/innovating-around-indiashealth-care-challenges/
Kapur A., Economic analysis of diabetes care, March 2007,
http://icmr.nic.in/ijmr/2007/march/0319.pdf
India and the fight against cancer,
http://www.moneycontrol.com/gestepahead/article.php?id=965373
Price Water House Coopers (PWC), Health care in India Emerging Market
Report, 2007.
Jennifer G. ,Taylor D., Health and Health Care in India, UCL school of
Pharmacy.
Balarajan Y, Selvaraj S & Subramanian SV (2011) Healthcare and equity in
India. The Lancet 377, 505-15.
McKinsey & Company, India Healthcare: Inspiring Possibilities, Challenging
Journey, Healthcare Systems and Services, December 2012.
Kannan, R. (2013, July 30). More People opting for Private Healthcare. The
Hindu.