Doctors’ agitation highlights India’s need for universal healthcare | Analysis

Nationwide protests sparked by the rape and murder of a doctor in Kolkata highlight systemic issues in India's healthcare sector.

The rape and murder of the doctor at Kolkata’s R.G. Kar Medical College triggered nationwide protests. At present, junior doctors in Kolkata have been on hunger strike for nine days and their peers in other parts of the state have expressed support with symbolic strikes of their own. Three doctors on hunger strike have already had to be hospitalised after their conditions deteriorated. The State government has thus far punished many police and administrative officials.

Even through breaks in their agitation, the health workers have maintained that their underlying issues are far from resolved. Their protest has sought among other things a complete overhaul of the healthcare system. They have reported working 36-hour shifts with meagre allowances, no proper rest rooms or toilets, and being left vulnerable to violence in the workplace.

These working conditions for health workers are not restricted to West Bengal. A report of the Indian Medical Association in 2018 said 75% of doctors in India have at some point been exposed to harassment or physical violence inside health centres or hospitals, largely due to lack of infrastructure, medicines, long working hours, and excessive political interference. Yet successive governments, both at the Centre and in the States, have swept these pressing issues under the rug.

India’s declared expenditure on healthcare is only 2% of its GDP, compared to the 5-10% in China and Brazil. The success story of Cuba’s healthcare system is rooted in its spending 14% of its GP on health. In India, continued state-led apathy towards favourable government policies, plus long-standing low-quality healthcare infrastructure, has allowed the private sectors to flourish at the public sector’s expense. From 8% in 1950, the private sector captured nearly 70% of India’s total healthcare market in 2024.

According to the National Sample Survey, the cost of treatment in private hospitals is seven-times that in government hospitals, yet only 14% of the rural and 19% of the urban populations have health insurance to help cover the resulting costs.

The consequences have been disastrous. Even as India’s public sector per-capita expenditure on healthcare has steadily declined, out-of-pocket expenses for individuals have soared. According to official data, of every 100 rupees an individual spends on healthcare in India, they spend Rs 52 from their savings, while the Central and the relevant State governments together contribute Rs 35. To compare, Brazilian and Cuban citizens spend Rs 22 and Rs 8, respectively, out of their pockets.

A study by IIT Mandi published in December 2023 reported that much-touted government health schemes — including the Centre’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and West Bengal’s ‘Swasthya Sathi’ — mostly cover treatment costs for inpatient admissions but provide almost no coverage for outpatient services, whereas the latter accounts for up to 80% of the total healthcare expenses in India.