‘Fit ba­sic health­care cuts hospi­tal spend’

Ex­penses Fall By 77-92%, Finds IIT Study

The Times of India (New Delhi edition) - - TIMES NATION - NEWS NET­WORK

STIMES trength­en­ing health sub-cen­tres by en­sur­ing ad­e­quate medicines, ba­sic in­fra­struc­ture and trained per­son­nel dras­ti­cally re­duces out-pa­tient vis­its to pri­vate hos­pi­tals and clin­ics and hence also out-of­pocket ex­penses (OOP) by fam­i­lies, a study by the Cen­tre for Tech­nol­ogy and Pol­icy in IIT Madras has found.

The scale of the re­duc­tion in ex­penses var­ied be­tween 77% and 92% in three blocks in Tamil Nadu in a pi­lot project on en­sur­ing univer­sal health cov­er­age. While the study was re­stricted to the pi­lot project, its find­ings have a larger sig­nif­i­cance for pol­icy at the na­tional level, in­di­cat­ing that the best bang for the buck may be from strength­en­ing the very bot­tom of the pub­lic health­care sys­tem rather than fo­cus­ing on in­sur­ance cov­er­age.

Within eight months of the pi­lot project be­ing rolled out last year, it was found that the share of pri­vate hos­pi­tals for out­pa­tient care dropped from 51% to 21% in Shoola­giri block, from 48% to 24% in Vi­ral­i­malai block and from 41% to 24% in Vep­pur block. Spend­ing by pa­tients ac­cess­ing a pub­lic fa­cil­ity also fell -- from Rs 261 per out­pa­tient visit to Rs 59 in Shoola­giri, from Rs 351 to Rs 26 in Vi­ral­i­malai and from Rs 395 to Rs 67 in Vep­pur.

Pa­tients spent much less than they would have on out­pa­tient vis­its even to pub­lic fa­cil­i­ties like pri­mary health cen­tres (PHC), com­mu­nity health cen­tres (CHC) or gov­ern­ment hos­pi­tals (GH), which would be much fur­ther away. Trans­porta­tion ac­counted for al­most all the ex­penses a pa­tient had to bear for ac­cess­ing these fa­cil­i­ties as di­ag­nos­tic tests, medicines and con­sul­ta­tion fee are al­most free in them. At the sub-cen­tres, pa­tients spent less than Rs 5 per out­pa­tient visit, in- clud­ing cost of trans­port.

More­over, every pa­tient di­verted from PHC/CHC/GH to the sub-cen­tre amounted to an av­er­age sav­ing of Rs 200 for the gov­ern­ment (from Rs 300 to be­low Rs 100) on cost of care. This “enor­mous sav­ing of pub­lic re­sources” could be re­de­ployed to fur­ther strengthen the pub­lic health sys­tem, noted the re­port.

The to­tal value of drugs dis­trib­uted free of cost from these sub-cen­tres at the gov­ern­ment’s bulk pro­cure­ment price was Rs 10.5 lakhs. This would have cost Rs 57 lakh at mar­ket price, go­ing by the price of the drugs in a phar­macy in Shoola­giri town. With medicines ac­count­ing for the big­gest chunk of outof-pocket health ex­pen­di­ture, free medicines also helped boost peo­ple’s uti­liza­tion of the sub-cen­tre.

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The IIT-Madras study sug­gested that the fo­cus should be on strength­en­ing the very bot­tom of the pub­lic health­care sys­tem

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