When it comes to health infrastructure, Pune is the most equipped city in India, shows a recent report by leading online real estate portal, Housing.com. Pune offers 3.5 hospital beds per 1,000 people. This is much higher than India’s national average, where there is only half a bed available per 1,000 people in the public healthcare system, shows the report, titled ‘State of Healthcare in India’, by the Elara Technologies-owned online realty firm.
According to the report that ranks health infrastructure in the country’s most urbanised eight cities of Ahmedabad, Bengaluru, Chennai, Delhi-NCR, Hyderabad, Kolkata, Mumbai (MMR) and Pune, through its Housing City Health Card, Pune also scored significantly high on parameters such as ease of living, water quality, as well as performance and sustainable initiatives taken by its local government.
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Housing.com City Heath Card Ranking
Source: Housing Research
These rankings are benchmarked against parameters such as number of hospital beds, air quality, water quality, sanitation, liveability index, etc. However, Pune still struggles with public healthcare delivery, as is highlighted by the fact that it is one of the cities with high COVID-19 caseloads, the report added.
“India, which is the third-largest economy in Asia, needs to significantly increase its spending on healthcare. This has been made eminently clear, as the country is currently struggling to keep its people safe from the ongoing second wave of the Coronavirus pandemic. As the second-most populous country in the world, with over 1.3 billion people, India also has to focus on building quality healthcare infrastructure and economically develop itself in such a way that its overall infrastructure is preventive against health risks. Here, one is also forced to acknowledge how crucial quality housing is, in reducing health risks,” said Mani Rangarajan, Group COO, Housing.com, Makaan.com and PropTiger.com.
With nearly 3.2 hospital beds per 1,000 people, Ahmedabad is ranked second in the list, while India’s Silicon Valley, Bengaluru, is ranked third in spite of a high number of hospital beds per 1,000 people and its top ranking in the ease of living index.
The Delhi-National Capital Region, which covers the national capital, Gurugram, Faridabad, Noida, Greater Noida and Ghaziabad, was ranked the lowest in the list, primarily because of the region’s poor scores on air and water quality, sanitation and performance of municipal bodies.
“The density of hospitals is lower in Ghaziabad and Greater Noida regions, compared to Gurugram, Noida and Faridabad which also have higher levels of service sectors, warehousing and manufacturing activity,” says the report.
India’s financial capital Mumbai and its metropolitan region (which is also the largest residential real estate market in the country with a transactional value of $2.5 billion in the first quarter of 2021) were ranked fourth on the Housing.com City Health Card, with parameters such as the number of beds, air quality, and liveability pulling its overall score down.
Hyderabad, Chennai and Kolkata occupied the fifth, sixth and seventh positions, respectively.
“As quality housing remains integral to health, states should come up with more reformative measures to ensure that a larger number of its citizens are able to afford housing, which acts as a preventive measure against health risks. Although developing better healthcare infrastructure will require a well thought-out medium-term plan and would take some time to build, states could immediately launch measures in the form of stamp duty reductions, to provide their citizens better protection against health hazards in the form of affordable housing and better community living which has easy access to all amenities,” Rangarajan added.
Where does India stand in its healthcare spending?
Source: World Bank, OECD Health statistics 2019, Housing Research
*The total health expenditure includes public healthcare expenditure and out-of-pocket expenditure.
**The number of beds per 1,000 population includes public hospital beds.
The report that provides a perspective of nations’ preparedness in terms of providing health services to its people, which has become highly significant in the aftermath of the Coronavirus pandemic, also states that India is among the countries with the least public health spending and high out-of-pocket expenditure.
According to the report, India spent only 3.5% of its GDP on healthcare in 2018, as compared to developed countries like the US, the UK, Japan, Germany and Canada which extend nearly 10%-18% of their GDP on healthcare. “It is a matter of great concern that despite an impressive economic growth trajectory and healthcare initiatives, India continues to under-perform compared to other countries,” the report said.
Not only does India sit at the bottom of the chart on healthcare spending among 10 countries covered in the analysis, it also has the lowest number of beds available at its public hospitals. India also has the lowest number of doctors (0.86) per 1,000 people, while other major economies have between two and four doctors per 1,000 people.
Other key takeaways from the health report
Hospital bed per person: After the inclusion of private hospitals, the estimated total number of hospital beds (1.4) per 1,000 people in India still does not meet the benchmarks of the major economies.
None of the larger states have reached the global average of 3.2 beds per 1,000 population or the two beds per 1,000 population standard in public healthcare delivery, as mentioned in the National Health Policy, 2017, falling short of nearly 1.9 million beds. The shortfall reduces to 0.8 million, with the inclusion of private beds, highlighting the overarching presence of private healthcare services in India. Also, 69% of all hospital beds are concentrated in urban areas.
Better performing states: Karnataka, Telangana and Kerala have the highest number of beds per 1,000 people (of public and private hospitals). In terms of quality, delivery of services and health outcomes, Kerala, Andhra Pradesh and Maharashtra top the NITI Aayog’s National Health Index (2019).
Personal expenses on healthcare: The gaps in the delivery of healthcare through public sources manifest themselves in the high out-of-pocket expenses. Such expenses range between 45%-70% in countries such as Brazil, China and India, compared to 15%-30% spent in other major developed economies from the total expenditure on health. Data available with the WHO show nearly 67% of total expenditure on health in India was paid out of pocket, while the global average is just 18.2%.
Mortality rate: Despite being on the lower end in terms of important indicators, India has the lowest mortality rate, along with the fact that it has the lowest percentage of ageing population (above 65 years) among the top economies.
“The second wave of COVID-19 pandemic has highlighted the significant work to be done in India’s healthcare infrastructure. The city health card also observes that residential development in our top eight cities is skewed, with the healthcare services not adequately complementing the scale and direction of residential development,” said Ankita Sood, head of research, Housing.com, Makaan.com and PropTiger.com.