Enablers & Barriers to Providing Equitable Healthcare Access

Case Title – Identifying enablers and barriers for healthcare organizations to deliver equitable healthcare in a profitable and self-sustainable manner

Research project initiated by members of EHAC and funded by Ernst and Young

Authors – D.V.R. Seshadri, Clinical Professor, Indian School of Business; R.D. Thulasiraj, Executive Director, LAICO; and Devendra Tayade, Research Associate, Indian School of Business


In the realm of eyecare, India has shown the world that it is possible to deliver world-class care in an equitable manner, cutting across the entire income spectrum, through unique home-grown business models. Examples include Aravind Eye Care Systems that is based in Madurai; L.V. Prasad Eye Institute, Hyderabad; Dr. Shroff Charity Eye Hospital, Delhi; and a few others. Much has been written about them, and these case studies are commonly used in business schools across the world.

For a society to be stable, the population must be assured of three fundamental needs, viz., livelihood, healthcare and education (“Our Common Future” 1987). Woefully, these are a far cry for large percentage of populations across India. The corporate hospitals have business models that do not enable access by the poor and puts enormous pressure on the middle class. Hence these are out of reach for a major portion of the country’s population (Barik and Thorat 2015).

At the other end of the spectrum, the quality of healthcare – affordable by the poor is often so bad that they refrain from accessing them (Kruk et al., 2018). The only way for the poor to get access to decent healthcare is to borrow or sell off their meagre assets to gain access to reasonable quality of healthcare, often putting them into –inescapable debt trap.

Clearly, a person in any economic strata may be affected by a myriad of health issues including cardiac, neuro, oncology, orthopaedic, dental, ENT, obstetrics, etc. and for women obstetrics & gynaecology. To address these healthcare problems, the patient has little choice between the two options, viz., unaffordable corporate hospitals or uncaring hospitals that serve the poor.

Research focus

The focus of this research is to study the reasons why equitable healthcare models have not gone beyond the realm of eyecare. Even within eyecare, why is it that only a handful of exemplars have been able to formulate and implement equitable eyecare models. It is expected that the research will provide clarity on what the country as a whole as well as individual healthcare providers spanning a variety of healthcare conditions need to do to provide equitable healthcare.

Expected contribution of the research project

The research results have potential to solve huge problem of healthcare access in India. With knowledge of barriers and enablers, players would be able to invest smartly in Indian healthcare, be profitable and at the same time achieve goal of universal health coverage (i.e., doing well and doing good at the same time). While the models of AECS, L.V. Prasad and a few other eyecare providers have been lauded across the world, there is no deep, insightful research on how these learnings may be translated outside the eyecare domain.

The output of the research will thus help in multiple ways as under:

a.Motivate innovation in provide equitable healthcare to specialties beyond eyecare

b.Induce policy-level discussions on how to broad-base providing equitable healthcare

c.Open-up opportunities to healthcare providers to access large untapped sections of the populations, that hitherto have had no access to quality healthcare