Costlier medicine

The latest NSSO data shows that peo­ple are be­ing forced to take loans and sell as­sets for treat­ment as the gov­ern­ment healthcare sys­tem de­te­ri­o­rates


Latest NSSO find­ings re­veal that more house­holds are tak­ing loans for their med­i­cal ex­penses as they move to­wards pri­vate healthcare

Ain ev­ery four ru­ral LMOST ONE house­holds in the coun­try takes loans to pay med­i­cal bills, ac­cord­ing to the latest Na­tional Sam­ple Sur­vey Of­fice (nsso) re­port.The sit­u­a­tion in ur­ban In­dia is marginally bet­ter, where one in ev­ery five house­holds bor­rows money to meet their med­i­cal ex­penses. What is even worse is that high debt forces 0.8 per cent of ru­ral and 0.4 per cent of ur­ban house­holds to sell their as­sets to pay med­i­cal bills.

The re­port, Key In­di­ca­tors of So­cial Con­sump­tion in In­dia: Health, shows that the rea­son for the debt is that peo­ple are pay­ing ex­or­bi­tant amounts of money on pri­vate healthcare on the back of a de­cay­ing public healthcare sys­tem. An anal­y­sis of the re­cent and past nsso data shows that over nine per cent peo­ple have turned to pri­vate healthcare in the past two decades be­cause of poor public healthcare in­fra­struc­ture.What is also vis­i­ble is that the ma­jor­ity of this shift took place in the ur­ban clus­ters—an area that is hardly cov­ered un­der any gov­ern­ment scheme. In 2013, the Cen­tre for­mu­lated the Na­tional Ur­ban Health Mis­sion un­der the Na­tional Health Mis­sion (nhm). How­ever, the mis­sion is yet to take off. In con­trast, gov­ern­ment schemes, such as the Na­tional Ru­ral Health Mis­sion (nrhm) that was started in 2005, have at least ar­rested the trend of peo­ple go­ing to pri­vate healthcare. In fact, latest nsso data sug­gests a slight dip in the num­ber of peo­ple in ru­ral ar­eas avail­ing pri­vate healthcare fa­cil­i­ties in the last decade. (see ‘Per­cent­age of hos­pi­talised cases’, p15).

Amit Sengupta of Peo­ple’s Health Move­ment, a global group cam­paign­ing for public health is­sues, says in­ad­e­quate in­fra­struc­ture in public healthcare sys­tem is push­ing peo­ple to pri­vate healthcare sec­tor. “Be­sides nrhm noth­ing has been done to strengthen the public healthcare sys­tem in coun­try. In fact, the gov­ern­ment has been grad­u­ally weak­en­ing ex­ist­ing public healthcare sys­tem,”says Anant Phadke of Jan Swasthya Ab­hiyan,an ex­pert group work­ing for health rights. Phadke’s con­cerns are echoed in a 2014 re­port by pri­vate firm In­fra­struc­ture De­vel­op­ment Fi­nance Com­pany that says de­spite nrhm, the short­fall in the num­ber of sub-cen­tres in­creased by 10 per cent be­tween 2005 and 2012.In pri­mary health cen­tres,the short­fall was nine per cent dur­ing the same pe­riod. Only the num­ber of com­mu­nity health cen­tres (chcs) in­creased by 10 per cent.The 2014 re­port also says that the ex­ist­ing public healthcare set ups lacked ba­sic in­fra­struc­ture. For ex­am­ple, more than90 per cent of chcs

did not have all the spe­cial­ists re­quired by their man­date.

But in­stead of putting in more money in public healthcare, the gov­ern­ment has been re­duc­ing the funds. In­dia spends hardly one per cent of its gdp on health.In com­par­i­son, usa spends 8.3 per cent of its gdp on health. Ex­perts have been de­mand­ing an in­crease in the bud­getary al­lo­ca­tion for health to 2.5 per cent of gdp for decades. But in­stead, the Cen­tre this year slashed the bud­get for the health sec­tor by 6,000 crore. Be­fore this, al­lo­ca­tion to the Union Min­istry for Health and Fam­ily Wel­fare saw an in­crease of 81 per cent in the past six years—from 21,680 crore in 2009-10 to 39,238 in 2014-15.

High cost pushes peo­ple into debt

The gov­ern­ment’s fail­ure to strengthen public healthcare sys­tem is the most ob­vi­ous rea­son peo­ple are be­ing forced to pay through their nose for pri­vate healthcare ser­vices.The sur­vey re­port says a pa­tient hos­pi­talised in a pri­vate nurs­ing home on an av­er­age spends

25,850—which is three times more than the cost in­curred in gov­ern­ment hos­pi­tals. The ac­tual av­er­age for pri­vate hos­pi­tals would be higher be­cause the nsso sur­vey con­sid­ers char­ity hos­pi­tals un­der the pri­vate cat­e­gory (see ‘Av­er­age med­i­cal ex­pen­di­ture (`) per hos­pi­tal­i­sa­tion’). The nsso data also shows that pri­vate hos­pi­tals charge at least eight times more than their gov­ern­ment coun­ter­part for preg­nancy and child­birth.

In­sur­ance for few

The re­port also high­lights that the Cen­tre’s plans of pro­vid­ing health in­sur­ance has failed to reach the poor.The Cen­tre,un­der the 12th Five Year Plan (2012-2017),has promised to pro­vide uni­ver­sal health se­cu­rity through health in­sur­ance us­ing a public-pri­vate part­ner­ship model. But the Cen­tre’s health in­sur­ance schemes, in­clud­ing the flag­ship Ras­triya Swasthya Bima Yo­jana, cover just 12 per cent of ur­ban and 13 per cent of ru­ral pop­u­la­tion, says the re­port. In fact, over 86 per cent of ru­ral and 82 per cent of ur­ban pop­u­la­tion do not have any health in­sur­ance—public or pri­vate (see ‘Per­cent­age dis­tri­bu­tion of per­sons by cov­er­age of health ex­pen­di­ture’).

Sengupta warns that in­creas­ing the in­sur­ance cover will fur­ther weaken the public sec­tor as it in­di­rectly pushes peo­ple to go to pri­vate healthcare fa­cil­i­ties. “The gov­ern­ment needs to make the public healthcare sys­tem ro­bust.This is the only way to achieve uni­ver­sal health cov­er­age,” he adds. Ex­perts sug­gest that the fo­cus should be on im­prov­ing pri­mary healthcare. Even a 2010 re­port by a high-level group un­der the for­mer Plan­ning Com­mis­sion recomm-ended the gov­ern­ment to strengthen its net­work of pri­mary health cen­tres.But the op­po­site is hap­pen­ing on the ground. “The gov­ern­ment is aug­ment­ing ter­tiary care while ne­glect­ing pri­mary health cen­tres,” says Phadke. This flawed fo­cus re­mains the ba­sic prob­lem.

In ru­ral ar­eas, peo­ple visit pri­vate healthcare fa­cil­i­ties for 72 per cent of all ail­ments

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