In the Health Care segment, stagnant public spending on health (less than 1 percent of GDP) places India among the bottom 20 percent of countries.  Most low-income countries spend more than India, where current levels are far below what is needed to provide basic health care to the population. The bulk of public spending on primary health care has been spread too thinly to be fully effective, while the referral linkages to secondary care have been suffered.  As in other countries, preventive health services take a back seat to curative care.

Over the last five decades, India has built up a vast health infrastructure and manpower at primary, secondary and tertiary care in government, voluntary and private sectors.  These institutions are manned by professionals and para-professionals trained in the medical colleges. Currently, private sector health services range from those provided by large corporate hospitals, smaller hospitals / b\nursing homes to clinics / dispensaries run by qualified personnel.

As on June 2001, there were 181 medical colleges out of which 155 (46 of them private) were recognized and 26 (19 of then private) were permitted under the section 10A of the Indian Medical Council Act.  A total 5,39,00 MBBS doctors were registered with the Medical council number of Physicians and specialists available is more than the estimated requirements.  The current doctor population ratio is 1:1800.

Tertiary hospitals in major cities are in many cases, run by business houses and use corporate business strategies and hi-tech specialization to create demand and attract those with effective demand or the critically vulnerable at increasing costs. Standards in some of them are truly world class and some who work there are outstanding leaders in their areas.

 Public health spending accounts for 25% of aggregate expenditure, the balance being out of pocket expenditure incurred by patients to private practitioners of various hues.                                                                                                                

Public spending on health in India has itself declined after liberalization from 1.3% of GDP in 1990 to 0.9% in 1999. Consider the contrast with the Bhore Committee recommendation of 15% committed to health from the revenue expenditure budget, against the WHO, which recommended 55% of GDP for health.  The current annual per capita public health expenditure is no more than Rs. 160and a recent World Bank review showed that over all primary health services account for 58% f public expenditure mostly but on salaries, and the secondary/tertiary sector for about 38%, perhaps the greater part going to tertiary sector, including government funded medical education.