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is the responsibility of constituent states and territories of India. The
Constitution charges every state with "raising of the level of nutrition and the standard of living
of its people and the improvement of public health as among its primary duties". The National
Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002.[1]

The art of Health Care in India can be traced back nearly 3500 years. From the early days of
Indian history the Ayurvedic tradition of medicine has been practiced. During the rule of
Emperor Ashoka Maurya (third century B.C.E.), schools of learning in the healing arts were
created. Many valuable herbs and medicinal combinations were created. Even today many of
these continue to be used. During his rein there is evidence that Emperor Ashoka was the first
leader in world history to attempt to give health care to all of his citizens, thus it was the India of
antiquity which was the first state to give it's citizens national health care.

In recent times India has eradicated mass famines however the country still suffers from high
levels of malnutrition and disease especially in rural areas. Water supply and sanitation in India
is also a major issue in the country and many Indians in rural areas lack access to proper
sanitation facilities and safe drinking water. However, at the same time, India's health care
system also includes entities that meet or exceed international quality standards. The medical
tourism business in India has been growing in recent years and as such India is a popular
destination for medical tourists who receive effective medical treatment at lower costs than in
developed countries.

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The Indian healthcare industry is seen to be growing at a rapid pace and is expected to become a
US$280 billion industry by 2020 [2]. The Indian healthcare market was estimated at US$35
billion in 2007 and is expected to reach over US$70 billion by 2012 and US$145 billion by 2017
[3]
. According to the Investment Commission of India the healthcare sector has experienced
phenomenal growth of 12 percent per annum in the last 4 years [4]. Rising income levels and a
growing elderly population are all factors that are driving this growth. In addition, changing
demographics, disease profiles and the shift from chronic to lifestyle diseases in the country has
led to increased spending on healthcare delivery [5].

Even so, the vast majority of the country suffers from a poor standard of healthcare infrastructure
which has not kept up with the growing economy. Despite having centers of excellence in
healthcare delivery, these facilities are limited and are inadequate in meeting the current
healthcare demands. Nearly one million Indians die every year due to inadequate healthcare
facilities and 700 million people have no access to specialist care and 80% of specialists live in
urban areas. [6]

In order to meet manpower shortages and reach world standards India would require investments
of up to $20 billion over the next 5 years [7]. Forty percent of the primary health centers in India
are understaffed. According to WHO statistics there are over 250 medical colleges in the modern
system of medicine and over 400 in the Indian system of medicine and homeopathy (ISM&H).
India produces over 250,000 doctors annually in the modern system of medicine and a similar
number of ISM&H practitioners, nurses and para professionals [8]. Better policy regulations and
the establishment of public private partnerships are possible solutions to the problem of
manpower shortage.

India faces a huge need gap in terms of availability of number of hospital beds per 1000
population. With a world average of 3.96 hospital beds per 1000 population India stands just a
little over 0.7 hospital beds per 1000 population.[9]. Moreover, India faces a shortage of doctors,
nurses and paramedics that are needed to propel the growing healthcare industry. India is now
looking at establishing academic medical centers (AMCs) for the delivery of higher quality care
with leading examples of The Manipal Group & All India Institute of Medical Sciences (AIIMS)
already in place.

As incomes rise and the number of available financing options in terms of health insurance
policies increase, consumers become more and more engaged in making informed decisions
about their health and are well aware of the costs associated with those decisions. In order to
remain competitive, healthcare providers are now not only looking at improving operational
efficiency but are also looking at ways of enhancing patient experience overal

O
   
Health care facilities and personnel increased substantially between the early 1950s and early
1980s, but because of fast population growth, the number of licensed medical practitioners per
10,000 individuals had fallen by the late 1980s to three per 10,000 from the 1981 level of four
per 10,000. In 1991 there were approximately ten hospital beds per 10,000 individuals. However
for comparison, the in China for comparison there are 1.4 doctors per 1000 people.

Primary health centers are the cornerstone of the rural health care system. By 1991, India had
about 22,400 primary health centers, 11,200 hospitals, and 27,400 clinics. These facilities are
part of a tiered health care system that funnels more difficult cases into urban hospitals while
attempting to provide routine medical care to the vast majority in the countryside. Primary health
centers and subcenters rely on trained paramedics to meet most of their needs. The main
problems affecting the success of primary health centers are the predominance of clinical and
curative concerns over the intended emphasis on preventive work and the reluctance of staff to
work in rural areas. In addition, the integration of health services with family planning programs
often causes the local population to perceive the primary health centers as hostile to their
traditional preference for large families. Therefore, primary health centers often play an
adversarial role in local efforts to implement national health policies.

According to data provided in 1989 by the Ministry of Health and Family Welfare, the total
number of civilian hospitals for all states and union territories combined was 10,157. In 1991
there was a total of 811,000 hospital and health care facilities beds. The geographical distribution
of hospitals varied according to local socio-economic conditions. In India's most populous state,
Uttar Pradesh, with a 1991 population of more than 139 million, there were 735 hospitals as of
1990. In Kerala, with a 1991 population of 29 million occupying an area only one-seventh the
size of Uttar Pradesh, there were 2,053 hospitals.
Although central government has set a goal of health care for all by 2000, hospitals are
distributed unevenly. Private studies of India's total number of hospitals in the early 1990s were
more conservative than official Indian data, estimating that in 1992 there were 7,300 hospitals.
Of this total, nearly 4,000 were owned and managed by central, state, or local governments.
Another 2,000, owned and managed by charitable trusts, received partial support from the
government, and the remaining 1,300 hospitals, many of which were relatively small facilities,
were owned and managed by the private sector. The use of state-of-the-art medical equipment
was primarily limited to urban centers in the early 1990s. A network of regional cancer
diagnostic and treatment facilities was being established in the early 1990s in major hospitals
that were part of government medical colleges. By 1992 twenty-two such centers were in
operation. Most of the 1,300 private hospitals lacked sophisticated medical facilities, although in
1992 approximately 12% possessed state-of-the-art equipment for diagnosis and treatment of all
major diseases, including cancer. The fast pace of development of the private medical sector and
the burgeoning middle class in the 1990s have led to the emergence of the new concept in India
of establishing hospitals and health care facilities on a for-profit basis.

By the late 1980s, there were approximately 128 medical colleges - roughly three times more
than in 1950. These medical colleges in 1987 accepted a combined annual class of 14,166
students. Data for 1987 show that there were 320,000 registered medical practitioners and
219,300 registered nurses. Various studies have shown that in both urban and rural areas people
preferred to pay and seek the more sophisticated services provided by private physicians rather
than use free treatment at public health centers.

Indigenous or traditional medical practitioners continue to practice throughout the country. The
two main forms of traditional medicine practised are the ayurvedic system, which deals with
mental and spiritual as well as physical well-being, and the unani (or Galenic) herbal medical
practice. A R
 is a practitioner of the ayurvedic tradition, and a  
 is a practitioner of the
unani or Greek tradition. These professions are frequently hereditary. A variety of institutions
offer training in indigenous medical practice. Only in the late 1970s did official health policy
refer to any form of integration between European-trained medical personnel and indigenous
medical practitioners. In the early 1990s, there were ninety-eight ayurvedic colleges and
seventeen unani colleges operating in both the governmental and non-governmental sectors.

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India has a universal health care system run by the local (state or territorial), governments. The
government hospitals, some of which are among the best hospitals in India, provide treatment at
taxpayer expense. Most essential drugs are offered free of charge in these hospitals.

Government hospitals provide treatment either free or at minimal charges. For example, an
outpatient card at AIIMS (one of the best hospitals in India) costs a one time fee of rupees 10
(Around 20 cents US) and thereafter outpatient medical advice is free. In-hospital treatment costs
depend on financial condition of the patient and facilities utilized by him but are usually much
less than the private sector. For instance, a patient is waived treatment costs if he is below
poverty line. Another patient may seek for an air-conditioned room if he is willing to pay extra
for it. The charges for basic in-hospital treatment and investigations are much less compared to
the private sector. The cost for these subsidies comes from annual allocations from the central
and state governments.

Primary health care is provided by city and district hospitals and rural primary health centres
(PHCs). These hospitals provide treatment free of cost. Primary care is focused on immunization,
prevention of malnutrition, pregnancy, child birth, postnatal care, and treatment of common
illnesses.[Y
 

] Patients who receive specialized care or have complicated illnesses are
referred to secondary (often located in district and taluk headquarters) and tertiary care hospitals
(located in district and state headquarters or those that are teaching hospitals).[Y
 

]
However, the fact that the government sector is understaffed and underfinanced and poor
services at state run hospitals forces many people to visit private medical practitioners.

Now organizations like Hindustan Latex Family Planning Promotional Trust and other private
organizations have started creating hospitals and clinics in India, which also provide free or
subsidized health care and subsidized insurance plans.[Y
 

]

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