Caring for the critically ill in developing countries: a perspective from India

Health care facilities in India are either privately run institutions or publicly funded. Most intensive care unit (ICU) beds in India are in private hospitals. The relatively few ICU beds in public hospitals, which offer free treatment, constitute approximately 10% of the critical care facilities in India. Health insurance and social security are almost nonexistent, and 57.6% of the total health care bill is paid out of pocket by the patient or their family.(2) The daily cost of ICU care may be approximately 100 times the per capita income.(3) Therefore, a single episode of ICU admission can impoverish families. However, innovative funding schemes by various state governments and contributions from social organizations have enabled increasing numbers of patients to access advanced healthcare facilities. There is a definite role for intensive care because of the relatively young population and the significant burden of severe tropical infectious diseases, trauma, poisonings and envenomations and the rising incidence of non-communicable diseases, such as diabetes, coronary artery disease and cancer. Indeed, intensive care in India may be no more expensive than the costs of treating non-Hodgkin’s lymphoma.(3) It is essential to increase the number of ICU beds and upgrade the facilities and staffing in public hospitals.(4) Investment in intensive care, including that in equipment, organization, staffing and education, may increase the initial costs, but these efforts will prove to be costeffective in the longer term.