Dr. Girdhar Gyani Calls for Sustainable Healthcare in India Beyond Affordability

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India’s healthcare system is at a critical crossroads, with rising medical inflation and uneven access posing significant challenges. At the recent ETHealthworld Healthcare Leaders Summit, Dr. Girdhar Gyani, Director General of the Association of Healthcare Providers (India), delivered a compelling call for a healthcare strategy that balances affordability with sustainability—arguing that without this, India’s vision for accessible and quality health services by 2047 cannot be realized.

Key Developments in Healthcare Access and Infrastructure

Dr. Gyani emphasized that the Indian healthcare debate has predominantly focused on affordability but highlighted the urgent need for sustainable healthcare solutions in tandem with cost concerns. Currently, India has approximately 21 lakh (2.1 million) hospital beds, distributed unevenly—about 1.5 beds per 1,000 population, while the recommended standard is 3 beds per 1,000 population. For instance, Karnataka has 4.2 beds per 1,000, but Bihar lags far behind with just 0.3 beds, underscoring stark disparities both between and within states.

He urged investments in regions like Bihar where infrastructure is sparse and highlighted the skewed distribution even within states such as Telangana, where most large hospitals are concentrated in Hyderabad, forcing patients from rural districts to travel long distances for care. Such infrastructure gaps adversely affect accessibility and timely care delivery, contributing to health inequities.

Affordability vs. Sustainability: Understanding the Costs

Dr. Gyani pointed out that while approximately 70% of the Indian population is claimed to be covered under schemes like Ayushman Bharat, the reality is that less than 30% have meaningful access to care under these programs. Many states are withdrawing from these schemes due to structural challenges, raising questions about implementation effectiveness.

He stressed that quality healthcare cannot be delivered at minimal cost without sacrificing standards. India’s life expectancy has increased from less than 37 years at independence to about 73 years today, largely due to advancements in healthcare. Dr. Gyani underscored: “Quality healthcare will cost. Absence of quality healthcare will cost lives. That is the difference people need to understand”.

Addressing private insurance inefficiencies, he warned about administrative overheads, noting Indian insurers often spend 35-40% of premiums on administrative costs, compared to 10-15% in the United States and less than 10% in Germany and France. Improving such inefficiencies is vital to sustainable coverage.

Strategic Healthcare Priorities

To build a sustainable system, Dr. Gyani outlined three critical priorities:

Doubling the number of hospital beds to meet the standard norm of at least 3 beds per 1,000 population, particularly incentivizing private hospitals to establish in tier-3 towns, where healthcare infrastructure is weak.
Expanding specialist healthcare human resources by creating accelerated fellowship programs, especially in critical care fields such as stroke management, since simply increasing postgraduate medical seats is insufficient for urgent needs.
Enhancing transparency by urging government hospitals to issue billing statements, even for fully subsidized care, so patients understand the actual cost of healthcare and the value of personalized private care.economictimes.indiatimes

Context and Background: Why Sustainability Matters

India’s healthcare spending as a percentage of GDP is about 3.5%, lagging behind global averages—much lower than the US (16.9%), Germany (11.4%), or UK (10%). Despite rapid market growth (from USD 86 billion in 2016 to an estimated USD 638 billion by 2025), major hurdles remain including insufficient infrastructure, shortage of skilled personnel, and low insurance penetration.

Experts caution that financial sustainability is not merely about cost-cutting but about smart resource allocation, efficiency improvement, and preventive care integration. The massive out-of-pocket expenditures still prevalent in India impede access to essential services for many. Advanced digital tools like telemedicine and electronic medical records offer promising pathways to streamline processes and reduce costs, further supporting sustainable care.

Expert Perspectives

Dr. Gaurav Katyal, COO of Indraprastha Apollo Hospitals, highlights that India must invest in technology to enhance operational efficiency and build resilient health systems. He asserts, “Financial sustainability serves as the cornerstone upon which a robust healthcare system is established,” emphasizing collaborative strategies to overcome barriers.

Implications for Public Health

The call for sustainable healthcare is critical to ensuring that health advances benefit the entire population equally and persist over decades. Without addressing systemic disparities and inefficiencies, India risks a two-tier system where quality care is accessible only to a privileged few.

Recommendations like incentivizing rural hospital development, specialist training acceleration, and transparent costing could dramatically improve equitable access and foster a culture of accountability among providers, insurers, and policymakers.

Potential Limitations and Counterarguments

While the vision for sustainability is widely supported, hurdles remain. Increasing beds and specialists requires long-term investment and policy continuity. Shifting insurer administrative costs demands regulatory changes and market reforms. The feasibility of universal digital health integration faces logistical and technological barriers in remote areas.

Moreover, balancing affordability and quality may mean higher short-term costs for patients or payers, challenging political and social acceptance. Some stakeholders question whether the focus should skew more toward public or private sector roles in India’s mixed healthcare ecosystem.

Conclusion

Dr. Girdhar Gyani’s call to look beyond affordability to sustainability advances a crucial dialogue for India’s healthcare future. By aligning infrastructure expansion, workforce capacity, efficient insurance management, and transparency in care costs, India can build a resilient healthcare system capable of meeting its ambitious 2047 health vision and emerge as a global leader in accessible, quality care.

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.

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