Addressing Disparities: Reforming Doctor Availability across Indian States

Context:

• This article is based on an Editorial “Curing the states’ doctor deficiency” which was published in the Indian Express. India’s reported doctor-population ratio is estimated closer to 0.6 to 0.7 per 1,000, which is stating the challenge is the production and distribution of doctors affecting overall Doctor Availability. 

Concerns Over Disparity: Assessing India’s Varied Doctor Availability Across States

• Decrease in Ratio: India’s reported doctor-population ratio was 0.9 per 1,000 in 2019, before the above mentioned adjusted data.
• Inter-state Variance: The pace of expansion across states has been uneven over the last 40 years. Example: 2.53 per 1,000 in Goa while 0.06 per 1,000 in Nagaland. 
• Recent Trends: In the last decade, some states such as Andhra Pradesh, Delhi, Uttarakhand, Arunachal Pradesh, Haryana, Himachal Pradesh, Chhattisgarh have seen rates of expansion above 8%, while others like Punjab, Maharashtra, West Bengal, Assam, Bihar have below 2%

Understanding the Challenges Impacting Doctor Availability Across Indian States

• Production and Distribution: Doctors availability across states is very variable, depending upon the state’s economic status, public health expenditure and expenditure on medical education. 
• Particularity: Some states (particularly the hilly ones) have a low density of doctors despite high per capita income. 
• Inter-State migration of Doctors: It is linked with seat structure (public versus private seats), policy incentives or disincentives and structural factors. 
• Insufficient Current Policy: The current policy focus on addressing equity (through increasing public medical seats in underserved areas is necessary) may not be sufficient in improving the local availability of doctors.

Examining Doctor Availability: A Categorization of States Based on Supply and Demand Dynamics

• Based on the availability of doctors and net import or export status, state can be classified into four categories.
  • High availability and net exporters: Andhra Pradesh, Karnataka, Jammu & Kashmir
  • High availability and net importers: Delhi, Maharashtra and Tamil Nadu
  • Low availability and net importers: Rajasthan, Jharkhand, Haryana and Odisha
  • Low availability and net exporters: Uttar Pradesh, Bihar and West Bengal

Evaluating State Dynamics: Factors Influencing the Categorization of Doctor Availability

• State policies and incentives for retaining doctors
• Availability of general and medical infrastructure
• Ratio of availability of public and private medical colleges

Factors influencing Decision of Doctors to study and practice in a particular State:

• Policies such as state-specific bond conditions, penalty in case of breach of bond, state retention policies, the potential return on investment, and living and practising infrastructure. 

Conclusion:

To get desired results, the role of state incentives and disincentive mix and structural constraints, with influencing the equity in availability of doctors would be required.