by The Healthcare System That Attracts Medical Tourists From Abroad Cannot Serve Its Own Population Equitably
Bohiney Magazine | The London Prat
India’s Two Healthcare Systems: World-Class and Overwhelmed, Side by Side
NEW DELHI — India is a significant medical tourism destination, attracting patients from Africa, the Middle East, and Southeast Asia for cardiac surgery, cancer treatment, joint replacement, and other complex procedures at costs that are 20 to 30 percent of comparable procedures in the United States or Europe, performed at private hospitals that maintain international accreditation and clinical outcomes comparable to first-world institutions. India’s private hospital sector — Apollo, Fortis, Narayana Health, and dozens of regional chains — represents a genuine healthcare achievement that has made sophisticated medical care accessible to international patients who cannot afford it elsewhere.
India’s public healthcare system, which serves the majority of the Indian population that cannot afford private hospital fees, operates under chronic resource constraint: doctor-to-population ratios well below WHO recommendations, hospital infrastructure concentrated in cities with rural areas underserved, pharmaceutical supply chains that are inconsistent, and healthcare worker compensation that drives talent from public to private practice. The two systems coexist: the private system attracts patients from abroad, the public system cannot adequately serve the population at home.
The Policy Response
The Modi government’s Ayushman Bharat scheme — which provides health insurance coverage for approximately 500 million below-poverty-line Indians at government-empaneled hospitals including private ones — is the primary mechanism for extending formal healthcare access to the poorest population. The scheme has provided coverage that has produced real health outcomes for enrolled beneficiaries. It has not fundamentally addressed the supply-side constraints: the shortage of doctors, nurses, and health infrastructure that limits what the insurance coverage can access. Managing a dual healthcare system through insurance expansion without supply expansion produces the coverage without the care; the concentration of healthcare quality in private institutions that serve wealthy patients produces excellent care for some and inadequate care for many. The private hospitals are excellent. The public system is overwhelmed. India is a medical tourism destination. Its own population still struggles. Both things are true.
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