India has only 0.79 beds per 1,000 population in government hospitals; Short by 2.4 million hospital beds

The availability of adequate hospital beds directly influences health outcomes, and plays a decisive role in the healthcare system’s capacity to respond to public health crises.

The state of public healthcare infrastructure is a good way to assess a country’s healthcare system. One critical component of such provisioning is hospital beds, meant for providing acute care, managing medical emergencies, and offering access to specialised treatment.

The availability of adequate hospital beds directly influences health outcomes, and plays a decisive role in the healthcare system’s capacity to respond to public health crises.

Data on the availability of hospital beds in India can be revealing.

India’s public healthcare system is grappling with a severe shortage of hospital beds. This deficit is exacerbated by significant regional disparities, particularly in states with larger populations or fewer resources.

The country currently has just 0.79 government hospital beds per 1,000 population — far below the two beds per 1,000 population recommended by the National Health Policy 2017 and the global average of 2.7 beds per 1,000 population.

The Indian Public Health Standards (IPHS) 2022 recommend one bed per 1,000 population as a baseline — a target India has yet to achieve.

Union Minister of Health and Family Welfare Jagat Prakash Nadda recently reported to Parliament that India had a total of 8,18,661 hospital beds at primary health centers (PHCs), community health centers (CHCs), sub-district hospitals, district hospitals, and medical colleges as of 31 March 2021.

Meanwhile, according to UIDAI, India’s estimated population as of 31 March 2023 was approximately 1.38 billion, underscoring the pressing need for expanded healthcare infrastructure to meet demand.

Hospital bed shortfall in India

Even when considering the total number of hospital beds per 1,000 population, including private healthcare, India lags significantly behind global standards.

According to a report by Knight Frank and Berkadia, India’s current hospital bed-to-population ratio stands at 1.3 beds per 1,000 people.

The report highlights that India is short by approximately 2.4 million hospital beds, reflecting the scale of underinvestment in the healthcare sector.

“India needs 2.4 million more hospital beds, which presents a significant investment opportunity in healthcare infrastructure,” the report notes.

The primary drivers for the increasing demand for healthcare include a gradually aging population, the rising incidence of cardiovascular and other lifestyle diseases, growing per capita income, greater health awareness, and wider penetration of health insurance.

Additionally, despite the shortage of medical infrastructure, India is positioning itself as one of the most affordable destinations for medical tourism.

For comparison, OECD countries typically have 3-8 beds per 1,000 people, further underscoring the gap in hospital bed availability in India, with its ratio of 1.3 beds per 1,000.

The challenges are particularly stark in the context of India’s status as a low-middle-income country (LMIC), where the demand for healthcare is compounded by high population density, vulnerability to infectious diseases, and frequent public health emergencies.

The COVID-19 pandemic exposed and exacerbated these gaps, but it also led to some improvements, such as the doubling of hospital beds equipped with oxygen and ICU facilities.

“India faced a pressing need for hospital beds to accommodate its population of 43 crore in 2021, highlighting the critical shortfall in healthcare infrastructure. During non-Covid times, the demand for hospital beds would have been lower, approximately 24 crore people, as the strain on the healthcare system would have been less intense,” secretary general, Telangana Teaching Government Doctors Association, Dr Kiran Madhala, told South First.

He added that currently, the available 13 lakh hospital beds can only serve around 4.8 crore people annually, leaving a vast majority of the population without adequate access to inpatient care.

“This stark disparity underscores that India requires 7 beds per 1,000 population per year to meet its healthcare needs effectively. However, the current bed capacity serves only 20% of the required population, reflecting a severe gap in infrastructure,” said Madhala.

“Expanding hospital bed capacity is crucial to address this inequity and build a resilient healthcare system capable of handling routine demands and unexpected public health emergencies,” said Dr Madhala.

Where are the beds in government institutions?

In terms of government hospital bed density, some states and territories in India have managed to provide relatively higher numbers per capita. This success is largely attributed to focused healthcare investment and smaller population.

Among the states, Kerala leads the way with 1.19 beds per 1,000 population, reflecting its emphasis on public healthcare and community health initiatives. Combined with a high literacy rate, Kerala has achieved better healthcare outcomes and infrastructure.

Tamil Nadu ranks second with 1.07 beds per 1,000 population, benefiting from a robust network of medical colleges and district hospitals.

Similarly, Rajasthan, with 0.82 beds per 1,000 population, has made commendable progress in recent years.

Among the union territories, Lakshadweep stands out with 3.62 beds per 1,000 population, surpassing global averages.

Puducherry follows closely with 3.6 beds per 1,000 population, benefiting from similar advantages, including a strong healthcare infrastructure supported by medical colleges and specialised services.

Chandigarh also performs well, with 3.14 beds per 1,000 population, thanks to its status as a well-planned city with a high concentration of healthcare resources.

While some states in India have managed to achieve relatively higher hospital bed densities, many others continue to lag behind due to a combination of factors such as underinvestment, rapid population growth, and inefficiencies in healthcare management.

Bihar, for instance, has the lowest hospital bed density in the country, with just 0.22 beds per 1,000 population.

The state faces systemic challenges, including chronic underfunding, a shortage of healthcare professionals, and inadequate access to basic healthcare services, particularly in rural areas.

Uttar Pradesh, the most populous state in India with over 230 million residents, fares slightly better but still has only 0.33 beds per 1,000 population. The state’s healthcare system is severely overstretched, with the majority of its limited hospital beds concentrated in urban centers, leaving rural populations underserved.

Madhya Pradesh, with a bed density of 0.5 beds per 1,000 population, faces similar issues. The state has vast rural areas where access to healthcare facilities is limited, and its public healthcare system remains underdeveloped compared to states like Tamil Nadu and Kerala.

Also Read:?Healthcare spending in South India

Other southern states: Different picture

Southern India, often regarded as a leader in healthcare within the country, presents a mixed picture when it comes to hospital bed availability.

While Kerala and Tamil Nadu have excelled in achieving higher bed densities, others still face notable gaps in infrastructure and accessibility.

Karnataka, with 0.83 beds per 1,000 population, performs better than many northern states but lags behind its southern counterparts like Kerala and Tamil Nadu.

The state struggles with disparities in healthcare access, particularly in rural areas.

Andhra Pradesh, at 0.67 beds per 1,000 population, continues to face challenges in expanding healthcare infrastructure. Post-bifurcation, the state has struggled to allocate sufficient resources to improve hospital bed availability, particularly in rural areas.

Telangana, matching the national average with 0.57 beds per 1,000 population, faces similar challenges. The state must focus on building new infrastructure and expanding existing hospitals, especially in rural and remote areas, to meet the growing demands of its population.

Healthcare spending

The low bed density in India can be attributed to several systemic issues. India spends only about 2.1% of its GDP on healthcare, far lower than the global average of 6%. This limits the ability to build and maintain hospital infrastructure.

Dr Madhala pointed out that despite the progress, much of India’s healthcare investment has been skewed towards curative care, such as increasing the number of medical colleges and specialised treatment centers.

“There is a need for a stronger focus on preventive care to reduce the disease burden. Creating environments that minimise the spread of diseases could significantly lower the need for hospital admissions and, by extension, the demand for beds,” he said.

He also pointed out that the prevention aspect of healthcare is significantly neglected in India, with minimal contributions toward reducing the burden of preventable diseases.

According to the World Health Organization (WHO), 66% of healthcare spending should ideally go toward public health, specifically primary healthcare, rather than secondary or tertiary care.

However, India falls short of this target by approximately 16%, which has significant implications for disease prevention and the overall demand for hospital beds.

Also Read:?Kerala’s fight against antimicrobial resistance

Urban-rural divide

Healthcare infrastructure is concentrated in urban areas, with rural regions suffering from limited access to quality healthcare. Rural areas often rely on primary healthcare centers (PHCs) and community health centers (CHCs), which are typically under-resourced in terms of beds.

“The urban-rural divide is another critical issue. 60-70% of India’s population lives in rural areas, yet most hospital beds are concentrated in urban centers. The government must focus on improving healthcare infrastructure in rural regions, possibly through incentives for private hospitals to operate in underserved areas,” said Dr Madhala.

Private sector dominance

Over 60% of India’s hospital beds are in the private sector, catering mostly to urban, affluent populations. This leaves a gap in rural and economically weaker areas, where private healthcare is either too expensive or unavailable.

“Currently, about 60% of inpatient care is provided by the private sector, while the government sector covers just 40% — a reversal of the global norm, where government-run facilities typically provide the majority of care. High operational costs, including taxes for biomedical waste management and service tax, discourage private hospitals from expanding bed capacity. To address this, the government should consider relaxing these norms and offer targeted concessions to the private sector, at least until the country reaches the WHO-recommended three beds per 1,000 population,” said Dr Madhala.

Also, India’s growing population places immense pressure on the healthcare system. Even with improvements in healthcare infrastructure, the sheer size of the population makes it difficult to meet the demand for hospital beds.

Building and maintaining hospitals, especially in urban areas, is capital-intensive. High land costs and construction delays are significant barriers to expanding hospital capacity.

“To address these challenges, a balanced approach is essential. While investments in hospital infrastructure and medical education must continue, equal attention must be given to preventive healthcare measures,” said Dr Madhala.