‘Fit basic healthcare cuts hospital spend’
Expenses Fall By 77-92%, Finds IIT Study
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.
The IIT-Madras study suggested that the focus should be on strengthening the very bottom of the public healthcare system