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Insufferable

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published Published on Aug 15, 2010   modified Modified on Aug 15, 2010


Governments in India — Centre and states — spend around one per cent of the country's GDP on health. Only five countries — Burundi, Myanmar, Pakistan , Sudan and Cambodia — have a lower figure than this. But private spending on the crucial sector is 4.2 per cent of GDP, among the top 20 countries in the world. Within this private spend, employers pay for about 9 per cent and health insurance accounts for 5-10 per cent, leaving 82 per cent to be borne from household funds.

The consequences of these figures in human terms are enormous. Over 40 per cent of patients admitted to hospitals have to borrow or sell assets to meet the expenses. Little wonder, then, that rising healthcare costs are the second biggest reason for rural indebtedness, pushing an estimated 39 million people into poverty every year.

What's worse, this expenditure has more than doubled in the last one-anda-half decades with access to affordable public health facilities shrinking. A comparison of data from various rounds of the National Sample Survey Organisation (NSSO) indicates that the share of public health facilities in hospitalisation in the country, which was around 60 per cent in 1987-88 , had fallen to just 40 per cent by 2004.

Outpatient treatment in the private health sector is 150 per cent more expensive than in state facilities; hospitalisation is double what it costs in a government set up. But despite the private sector being vastly more expensive, public healthcare caters to just 26 per cent of the total episodes of ailments in India. Clearly, people are turning to private doctors and hospitals in desperation.

But not everybody can afford to do so. The percentage of episodes of illness that went untreated in rural areas due to lack of facilities went up from 3 per cent in 1986 to 9 per cent in 1995, and 12 per cent in 2004.
Over two-thirds of India's hospitals and health centers are in urban and peri-urban areas. In a bid to remedy this, the government launched the National Rural Health Mission in 2005, hailed as a serious effort to reverse the trend of increasing privatisation and unaffordable health facilities. But recent CAG reports on accumulated, unspent funds and the lack of trained medical and paramedical personnel raise questions about its success. The report pointed out that the incidence of infant and child disease had increased in nine states and the proportion of institutional deliveries had stagnated since the launch of NRHM.

While NRHM focuses on rural areas, urban public health infrastructure is in shambles without any concerted effort to keep up with exploding urban population , especially the urban poor who comprise a quarter of the total poor. The government has decided to postpone to 2012 the launch of the National Urban Health Mission that promises to provide accessible and affordable primary healthcare facilities to the urban poor.

An urban primary health care facility is supposed to cater to a population of 50,000. With no significant addition to the number of urban family welfare centers or urban health posts for several years now, the population served per health facility in urban areas is over 1.86 lakh. The urban poor are either outside the purview of health services or receive a very poor quality of it, a fact reflected in miserable urban health indices, often worse than even rural indices. Only 24.8 per cent of urban mothers receive complete antenatal care and 74.3 per cent of deliveries among urban poor women are home deliveries. Despite a profusion of hospitals and doctors, most of the urban poor are unable to access these services, often because they cannot afford them.

With the private sector expanding from a mere 5-10 per cent at the time of Independence to the current 80 per cent of all outpatient care and 58 per cent of all inpatient treatment, one of the ways suggested for delivering healthcare to more people is public-private partnership . However, the models of public-private partnerships in the national capital inspire little faith. Very few of the 38-odd hospitals in Delhi that were given land at concessional rates in exchange for setting aside free beds for treatment of the poor have done so. Of the 504 free beds spread over these hospitals, 384 were found vacant in March this year.

Even as usage of government facilities is shrinking, they have started charging for services that were provided free of cost earlier such as diagnostics and drugs, raising the cost of public healthcare closer to that of the private sector and consequently making it even less accessible, especially to the poor.

From the total out-of-pocket expenditure on health, nearly 80 per cent is on drugs. This even as public health facilities are cutting down on the distribution of free drugs. The world over, drug prices are subject to controls and regulations and in most countries patients do not bear the entire cost of drugs as there are several reimbursement mechanisms for such expenses. However, in India, even the small list of 347 drugs which were price-controlled since 1979 was whittled down to just 76 by 1995. In the name of liberalisation, pharmaceutical companies are allowed exorbitant trade margins on drugs even as the poor get bankrupted in the process, with no intervention by the state to remedy the situation.

In a scenario of spiraling healthcare costs, largely led by private sector providers, equitable and affordable public health services seem far from becoming a reality. And lack of resources can hardly be an excuse when even neighbouring countries like Sri Lanka and Bangladesh not only manage to allocate more for public health but show far better health indices.

India spends less than even neighbouring countries like Bangladesh and Sri Lanka on health, where health accounts for 7.4 per cent and 8.3 per cent respectively of total government expenditure compared to just 3.4 per cent here. In the US, the figure is 19.1 per cent and in the UK 16.5 per cent.

The Times of India, 14 August, 2010, http://timesofindia.indiatimes.com/india/Insufferable/articleshow/6310034.cms

Tagged with: Health



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