India boasts of a world class healthcare infrastructure with impeccable service, making it one of the top 10 destinations for international medical tourism. Yet, access to healthcare and healthcare delivery continues to remain fragmented and skewed across the country, with rural India facing a large deficit. India accounts for over approximately 20% of the global disease burden, with high incidences of tuberculosis, infant mortality, and maternal deaths during childbirth. These indices highlight the limitations of healthcare services and call for immediate attention that goes beyond healthcare reforms.
The Ministry for Health and Family Welfare (MoHFW) in 2020 had stated that about 12,55,786 allopathic practitioners were registered with the erstwhile Medical Council of India (now National Medical Commission). The WHO has stated that the doctor patient ration in India is 1:1445, against the prescribed 1:1000.
Doctor/Healthcare Practitioner Density Varies across the Country
Although the WHO numbers highlight a shortage of medical practitioners, it is clear that the brunt of this shortage is borne by rural/non-urban areas. The report by the Task Force constituted by the (MoHFW) published early in the last decade states that ‘74% of the graduate doctors live in urban areas, serving only 28% of the national population, while the rural population remains largely unserved. In large parts of the country there is no semblance of a subsisting primary healthcare system’. This highlights that despite the shortage of doctors the real issues that need attention is non-equity in distribution of practitioners. This has set a dangerous precedent that has allowed the proliferation of quacks, with even the Government acknowledging that 57% of those practicing medicine do not have requisite licences.
Many reports have stated that lack of medical and service infrastructure like transport and roads in certain areas disincentivises practitioners from moving to or working in these parts, thereby leaving many public/government health centres underserviced. Compulsory rural service of newly graduated doctors is also fraught with apprehensions of lack of adequate infrastructure, with such mandates often challenged in courts. Moreover, the general perception is that most doctors who have been raised and trained in an urban area are reluctant to work in rural India, especially when most aspire to become tertiary care specialists.
While it is true that practitioners, like any other professionals, are rational human beings that seek personal and professional betterment, the key to addressing non-equity in distribution of healthcare workers across India is addressing the information asymmetry between the work and wages prevalent in the system.
Asymmetric Information in Job and Wages for Healthcare practitioners
Theories around asymmetric information, particularly around imbalances in information between groups of people, results in market failure and inefficient economic systems. Asymmetric information has also been explained in healthcare settings, but its examination or application has been focussed on the vulnerability of patients who have little or no information when compared to practitioners or in the case of health insurance where imbalances between information withheld by the insured versus insurers results in losses for insurance companies.
Information asymmetry among practitioners with respect to wages and the availability of jobs in urban metropolises is something that has consistently been ignored. Many medical graduates and professionals find it difficult to secure a job with transparent wages, thus many of them move to larger cities with the hope of a better paying job and other opportunities.
The demand for healthcare in rural India has seen a spurt in growth of private hospitals in areas largely dependent on primary healthcare provided by the state. This has made these areas potentially lucrative for practitioners, making it important to map vacancies in real-time so that doctors are aware about the job market in far-flung areas and the demand for their services.
Technology can overcome information asymmetry and bridge the gap while efficiently manage the supply chain. A Bangalore-based start-up, MedPiper Technologies, founded in 2020 is helping doctors discover opportunities with transparent wages and is concurrently creating a database of verified healthcare professionals in India. It addresses the need gap with regards to fulfilling vacancies, which in some cases pays the doctors higher wages when compared to remunerations in larger cities, thereby triggering a shift in paradigm. Moreover, it also allows hospitals to hire verified practitioners faster, than through other conventional channels.
Between the months of October and December 2020, MedPiper served over 180 mid-sized hospitals and smaller clinics in non-urban areas across Kerala, Karnataka and Tamil Nadu, enabling them find practitioners to deliver care. This helped hospitals reduced time to hire from months to two weeks for non-urban clinics and hospitals, enabling better response to patient footfalls. Over 6500 duty vacancies booked and serviced through Med-Piper, enabling a reach to over 18000 patients, who would have otherwise been redirected to large cities for medical attention.
While the Government has initiated reforms to bolster the number of practitioners, increasing the number of practitioners will be futile if information asymmetry is not addressed and overcome. While tech platforms have begun addressing this gap it is equally important for the state to incentivize practitioners to move and work in non-urban areas.