HEALTH SECTOR

The healthcare industry (also called the medical

industry or health economy) is an aggregation and integration of sectors
within the economic system that provides goods and services to treat
patients with curative, preventive, rehabilitative, and palliative care. It
includes the generation and commercialization of goods and services
lending themselves to maintaining and re-establishing health. The modern
healthcare industry includes three essential branches which are services,
products, and finance and may be divided into many sectors and
categories and depends on the interdisciplinary teams of trained
professionals and paraprofessionals to meet health needs of individuals
and populations

WORLD HEALTH ORGANIZATION

The World Health Organization (WHO) is a specialized

agency of the United Nations responsible for international public health.
[1] The WHO Constitution, which establishes the agency's governing
structure and principles, states its main objective as "the attainment by all
peoples of the highest possible level of health."[2] It is headquartered
in Geneva, Switzerland, with six semi-autonomous regional offices and 150
field offices worldwide.
The WHO was established by constitution on 7 April 1948,[3] which is
commemorated as World Health Day.[4] The first meeting of the World
Health Assembly (WHA), the agency's governing body, took place on 24
July 1948. The WHO incorporated the assets, personnel, and duties of
the League of Nations' Health Organisation and the Office International
d'Hygiène Publique, including the International Classification of Diseases.
[5] Its work began in earnest in 1951 following a significant infusion of
financial and technical resources.[6]
The WHO's broad mandate includes advocating for universal healthcare,
monitoring public health risks, coordinating responses to health
emergencies, and promoting human health and well being.[7] It provides
technical assistance to countries, sets international health standards and
guidelines, and collects data on global health issues through the World
Health Survey. Its flagship publication, the World Health Report, provides
expert assessments of global health topics and health statistics on all
nations.[8] The WHO also serves as a forum for summits and discussions
on health issues.[1]

PRIMARY CARE
Primary care refers to the work of health professionals who act
as a first point of consultation for all patients within the health care system.
[7][9] Such a professional would usually be a primary care physician, such
as a general practitioner or family physician. Another professional would be
a licensed independent practitioner such as a physiotherapist, or a non-
physician primary care provider such as a physician assistant or nurse
practitioner. Depending on the locality, health system organization the
patient may see another health care professional first, such as
a pharmacist or nurse. Depending on the nature of the health
condition, patients may be referred for secondary or tertiary care.
Primary care is often used as the term for the health care services that play
a role in the local community. It can be provided in different settings, such
as Urgent care centers which provide same day appointments or services
on a walk-in basis.
Primary care involves the widest scope of health care, including all ages of
patients, patients of all socioeconomic and geographic origins, patients
seeking to maintain optimal health, and patients with all types of acute and
chronic physical, mental and social health issues, including multiple
chronic diseases. Consequently, a primary care practitioner must possess
a wide breadth of knowledge in many areas. Continuity is a key
characteristic of primary care, as patients usually prefer to consult the
same practitioner for routine check-ups and preventive care, health
education, and every time they require an initial consultation about a new
health problem. The International Classification of Primary Care (ICPC) is
a standardized tool for understanding and analyzing information on
interventions in primary care based on the reason for the patient's visit.
SECONDARY CARE
Secondary care includes acute care: necessary treatment for
a short period of time for a brief but serious illness, injury, or other health
condition. This care is often found in a hospital emergency department.
Secondary care also includes skilled attendance during childbirth, intensive
care, and medical imaging services.
The term "secondary care" is sometimes used synonymously with "hospital
care". However, many secondary care providers, such
as psychiatrists, clinical psychologists, occupational therapists, most dental
specialties or physiotherapists, do not necessarily work in hospitals. Some
primary care services are delivered within hospitals. Depending on the
organization and policies of the national health system, patients may be
required to see a primary care provider for a referral before they can
access secondary care.
In countries which operate under a mixed market health care system,
some physicians limit their practice to secondary care by requiring patients
to see a primary care provider first. This restriction may be imposed under
the terms of the payment agreements in private or group health
insurance plans. In other cases, medical specialists may see patients
without a referral, and patients may decide whether self-referral is
preferred.
In other countries patient self-referral to a medical specialist for secondary
care is rare as prior referral from another physician (either a primary care
physician or another specialist) is considered necessary, regardless of
whether the funding is from private insurance schemes or national health
insurance.

TERTIARY CARE
Tertiary care is specialized consultative health care, usually
for inpatients and on referral from a primary or secondary health
professional, in a facility that has personnel and facilities for
advanced medical investigation and treatment, such as a tertiary referral
hospital.[14]
Examples of tertiary care services
are cancer management, neurosurgery, cardiac surgery, plastic surgery,
treatment for severe burns, advanced neonatology services, palliative, and
other complex medical and surgical interventions.

HEALTH SECTOR IN INDIA

The Indian Constitution makes the provision of healthcare

in India the responsibility of the state governments, rather than the central
federal government. It makes every state responsible for "raising the level
of nutrition and the standard of living of its people and the improvement
of public health as among its primary duties".[1][2]
The National Health Policy was endorsed by the Parliament of India in
1983 and updated in 2002, and then again updated in 2017. The
recent four main updates in 2017 mentions the need to focus on the
growing burden of non-communicable diseases, on the emergence of
the robust healthcare industry, on growing incidences of unsustainable
expenditure due to health care costs and on rising economic growth
enabling enhanced fiscal capacity.[3] In practice however, the private
healthcare sector is responsible for the majority of healthcare in India, and
most healthcare expenses are paid directly out of pocket by patients and
their families, rather than through health insurance.[4] Government health
policy has thus far largely encouraged private-sector expansion in
conjunction with well designed but limited public health programmes.[5]
A government-funded health insurance project was launched in 2018 by
the Government of India, called Ayushman Bharat.

PUBLIC HEALTH CARE

Public healthcare is free and subsidized for those who are below the
poverty line.[9] The Indian public health sector encompasses 18% of
total outpatient care and 44% of total inpatient care.[10] Middle and upper
class individuals living in India tend to use public healthcare less than
those with a lower standard of living.[11] Additionally, women and the
elderly are more likely to use public services.[11] The public health care
System was originally developed in order to provide a means to healthcare
access regardless of socioeconomic status or caste.[12] However, reliance
on public and private healthcare sectors varies significantly between
states. Several reasons are cited for relying on the private rather than
public sector; the main reason at the national level is poor quality of care in
the public sector, with more than 57% of households pointing to this as the
reason for a preference for private health care.[13] Much of the public
healthcare sector caters to the rural areas, and the poor quality arises from
the reluctance of experienced healthcare providers to visit the rural areas.
Consequently, the majority of the public healthcare system catering to the
rural and remote areas relies on inexperienced and unmotivated interns
who are mandated to spend time in public healthcare clinics as part of
their curricular requirement. Other major reasons are long distances
between public hospitals and residential areas, long wait times, and
inconvenient hours of operation.[13]

PRIVATE HEALTH CARE

Since 2005, most of the healthcare capacity added has been in

the private sector, or in partnership with the private sector. The private
sector consists of 58% of the hospitals in the country, 29% of beds in
hospitals, and 81% of doctors.[10]

Max Health hospital facility in Delhi, India

According to National Family Health Survey-3, the private medical sector
remains the primary source of health care for 70% of households in urban
areas and 63% of households in rural areas.[13] The study conducted by
IMS Institute for Healthcare Informatics in 2013, across 12 states in over
14,000 households indicated a steady increase in the usage of private
healthcare facilities over the last 25 years for both Out Patient and In
Patient services, across rural and urban areas.[17] In terms of healthcare
quality in the private sector, a 2012 study by Sanjay Basu et al., published
in PLOS Medicine, indicated that health care providers in the private sector
were more likely to spend a longer duration with their patients and conduct
physical exams as a part of the visit compared to those working in public
healthcare.[18] However, the high out of pocket cost from the private
healthcare sector has led many households to incur Catastrophic Health
Expenditure, which can be defined as health expenditure that threatens a
household's capacity to maintain a basic standard of living.[3] Costs of the
private sector are only increasing.[19] One study found that over 35% of
poor Indian households incur such expenditure and this reflects the
detrimental state in which Indian health care system is at the moment.
[3] With government expenditure on health as a percentage of GDP falling
over the years and the rise of private health care sector, the poor are left
with fewer options than before to access health care services.[3] Private
insurance is available in India, as are various through government-
sponsored health insurance schemes.