Does India have adequate number of Hospital beds?

Posted on January 27, 2009


In this entry I want to return to the question: in pursuit of an universal healthcare initiative does India have adequate soft and hard infrastructure to deliver universal coverage? In a previous entry I investigated the availability of health workers, doctors and nurses, and was pleasantly surprised to find that India does indeed have an acceptable number of health workers for its population. In this entry I want to write about what I found about another equally important infrastructure resource: hospital beds.

As I had done in the earlier entry, I turned to the excellent database that the World Health Organisation (WHO) maintains on health indicators and infrastructure for a number of countries. I have used average life expectancy at birth for both sexes as the proxy variable for the quality of healthcare services that citizens of a country enjoy. I have then looked at the impact of 2 variables that affect life expectancy – the per capita income (corrected for PPP) and the number (more specifically the density) of hospital beds. I could find data for 180 countries. For most countries the data is for years between 2004 and 2006. It is reasonable to argue that these 3 variables do not/will not see dramatic changes over a short span of 3-4 years and hence the data for various countries, though not strictly comparable, is adequately comparable.

table-1I divided the countries in life expectancy quartiles. The results are in the table on the left and show the median values for the 3 variables.

It is obvious that a country needs a certain threshold hospital bed density – as seen when comparing data for quartiles 1 & 2 – to make any meaningful impact on the quality of healthcare services that it delivers to its citizens. Unsurprisingly, the gains in quality get more difficult to achieve after this threshold – as seen by comparing data for quartiles 3 & 4 but more dramatically when comparing data for quartiles 2 & 3.

Unfortunately the WHO database does not record the hospital bed density for India and I had to turn to anotable-2ther source.  The Federation of Indian Chambers of Commerce and Industry (FICCI) in partnership with Ernest & Young released the Opportunities in Healthcare: Destination India report in January 2007. The report estimates that in 2006 the hospital bed density for India was a little over 10 beds per 10,000 people. How does India score? The table on the right shows the same data for India and some countries to compare with.

 The abysmal hospital bed density is an important reason why India lies in the 2nd quartile of nations arranged according to the quality of health services delivers to its citizens. Inspite of having an acceptable number of healthcare workers, India is not able to deliver adequate quality of healthcare services to its citizens because she severely lacks formal hospital infrastructure.

table-11If India were to set a goal, for 2020, of bettering the quality of healthcare for its citizens to the next level (graduate to the 3rd quartile) through achieving a hospital bed density of 30, the table on the left tells you what she faces:

The aforementioned FICCI-E&Y report estimates that it costs Rs. 2.2M (Rs. 22 lakhs) for every hospital bed added by the private sector. In absence of any better estimate (P.S. If any of you have a better and a more rigorous estimate of this cost, I would greatly appreciate if you can let me know), this translates into a recurring investment of Rs. 460B in creating additional 210,000 hospital beds annually. Even assuming that there are economies of scale to be enjoyed and the per bed cost may be reduced, this reduction is unlikely to be significant and hence the required investment represents a significant sum of money. To put it in perspective, this investment number would be roughly a little under 10% of India’s total tax revenue.

There are a number of policy and fiscal responses that the government can initiate to fund this rather significant investment. What these responses is a matter of a different and lengthy discussion.