Key barriers in the growth of rural health care: an ISM-MICMAC approach

Purpose The health care industry has experienced vibrant growth since the last few decades. Total health care business has reached more than US$160bn in the country and is still growing, but sustainable growth of industry is a major area of concern. An unsustainable and uneven growth might contribute in growth presently, but will not help in the long run due to extinction in future. The paper aims to discuss this issue. Design/methodology/approach The research has been divided into two phases to analyze the barriers to achieve sustainable growth, i.e., identification of barriers and their analysis. The study has used three different research phases: identification of barriers from the literature, interviews with experts of industry and designing an ISM model. The identification phase led to the selection of 19 barriers from literature and by suggestions from industrial experts. The interpretive structural modeling (ISM) analysis was used to understand the impact and linkage of identified barriers. The barriers are further classified into four major categories on the basis of drive power and dependence power using Matrices d'Impacts Croises Multiplication. Applique a un Classement analysis. Findings The present research identifies 19 barriers in the field of growth of health care mainly in rural area with 11 levels in ISM-designed model. Barriers such as lack of awareness, medical mistrust, cost/benefit, transportation, high out of pocket expenditure, lack of health insurance, medical unawareness and the cultural dimension (traditional beliefs) have very high dependency power. These variables are highly influenced by other barriers. Barriers such as low outreach (geographical reach), information and communication, insufficient capacity planning, and highest growth in population have very high driving and dependence power. They have a very high impact on the system as any change in them will have a direct impact on others. Remaining seven selected barriers have a very high driving power and they are generally independent in nature and have less impact on the system as whole. Social implications This study seeks to identify which barrier is acting as the most dominant one and this result is helpful for policy-makers to achieve goals of National Health Mission (NHM) by removing the dominant barrier. Originality/value Total health care business reaches more than US$160bn in the country and is still growing, but sustainable growth of industry is a major area of concern. This paper is one of the preliminary attempts to identify which barrier is acting as the most dominant one and this result is helpful for policy-makers to achieve the goals of NHM by removing the dominant barrier.