India 2nd last in global health system transparency index

India has been placed second from bottom in a health system transparency index, released by KPMG today, which also highlighted that the country is still "woefully" short in terms of healthcare infrastructure.
Noting that key information were largely not available to the public, the report called for "mandating" public reporting of health outcomes, tariffs and pricing, and patient satisfaction if the country needed to progress further.
"India achieved an overall transparency score of 36 per cent, placing it in the bottom fifth tier among countries on the transparency index," according to a study from KPMG International, "Through the looking glass; A practical path to improving healthcare through transparency".

Among 32 countries analysed in the report, India was only better than China, which achieved an overall transparency score of 32 per cent and was placed at the bottom.
Countries like Japan, Greece and South Africa comparatively fared better than India on the transparency index with scores of 46 per cent, 43 per cent and 37 per cent respectively.
Health system transparency of 32 countries were compared while the study mapped 27 indicators across six dimensions of transparency to provide an individual score for each country.

"An analysis of the results shows that India achieved its highest transparency scores for 'Governance' (44 per cent), 'Personal Healthcare Data' (43 per cent), and 'Finance' (42 per cent)," the study said.

It found that scores ranged from 29 to 31 per cent across the other three dimensions within the transparency index, signalling opportunities to improve in these areas like Quality of Healthcare', 'Communication of Healthcare Data' and 'Patient Experience').
Less than one-third of Indian population use public sector health services, it said.
In terms of Quality of Healthcare, India achieved 29 per cent in the global health systems transparency index while under patient's experience, it scored 31 per cent.
The six main dimensions of health system transparency which were analysed were Quality of healthcare, Patient experience (patient perceptions of their healthcare experience), Finance (price and payments transparency), Governance (open decision making, rights and responsibilities etc), Personal healthcare data (access, ownership, and safeguarding of patients' individual health data) and Communication of healthcare data.

Four Nordic nations - Denmark, Finland, Sweden and Norway - stood at the top of the transparency rankings, with Australia, Netherlands, New Zealand, the UK, Portugal and Singapore among the second tier, and China and India propping up the index.
"The overall shortage of healthcare infrastructure (buildings and human resources) is aggravated by the inequitable distribution among urban and rural areas.
"Over 70 per cent of the infrastructure (beds and outpatient clinics) and 80 per cent of medical professionals are based in urban areas, which are home to a mere 30-35 per cent of Indian population," the report said.
The report stressed the need for India to consider "mandating" public reporting of health outcomes, tariffs and pricing, and patient satisfaction.

"We need to ensure a few things. Firstly, the government should develop a basic framework to report on select transparency parameters such as surgical complications etc.
"Secondly, the government could work to improve reporting by public hospitals against the set indicators. Thirdly, a centralised repository of health data for the general population needs to be developed.
"Finally, efforts to develop learnings through various initiatives on electronic health/medical records or digitalisation of records should be continued," the report said.
The report said that in terms of patients' experience, due to lack of strong regulations, in most cases, reporting is done for select health outcomes, primarily with the perspective of branding and marketing.

Noting that measuring patient satisfaction is critical, especially for private hospitals to evaluate their performance, the report said that though this information is compiled and analysed on a regular basis by individual hospitals, it is "rarely" made publicly available.
"At present, healthcare providers do not publicly report risk-adjusted mortality/survival rates, hospital re-admission rates, wait times for emergency care, or hospital-acquired infections," it said.
"The government will need to take the lead in making India's health system more transparent. Steps like developing basic framework to report specific parameters, linking performance with incentives and developing a central repository with information publicly available, needs to be taken," said Nilaya Varma, Partner and COO, Infrastructure, Government and Healthcare (IGH), KPMG in India.