Public health services in India are suffering while the private sector is rapidly expanding

Public health services in India are suffering while the private sector is rapidly expanding to cater for foreigners and richer citizens, says an editorial in the British Medical Journal.

At less than 1% of gross domestic product (GDP), India has one of the lowest levels of public spending on health care in the world. Meanwhile successive Indian governments have subsidised the private sector with tax breaks and releasing prime building land at low rates, argue the authors.

Patients from western nations like the UK and USA are capitalising on the quick and cheap operations - from routine procedures to heart bypass - provided by India's growing private health industry.

But in public health services many drugs and diagnostic tests remain unavailable. Indians waiting to see harassed doctors face grubby surroundings and "hordes of other patients". There are even reports of hospital patients having to pay bribes to get clean bed linen.

Indians are consequently going to great lengths to pay for private care. Two fifths of hospital inpatients have had to borrow money or sell assets to finance treatment. And a quarter of farmers are driven below the poverty line to fund their medical care.

Drug companies and other big businesses have now begun to dominate the private health sector, with five-star hospitals providing services which "only foreigners and the richest Indians can afford". But these are "largely unregulated, with no standardisation of quality or costs", warn the authors.

The current Indian government aims to create an insurance scheme for poor families and increase health spending. Yet the share of GDP spent on health has decreased in the past two years. The government must focus on improving the health of its citizens rather than "enticing foreigners… with offers of low cost operations," conclude the authors.