Anirudha Barik and Balakrushna Padhi
One prominent goal of the healthcare system is to meet health needs of the society in the most equitable and efficient manner. But access to government-delivered healthcare services has not been reliable for both rural and urban areas.
The United Nations Sustainable Development Goal-3 (SDG-3) aspires to ensure health and well-being for all, promoting good standard of living and health to the population. Meeting SDGs requires addressing issues of health equity in health systems. Better health status coincides with the increase in tendency of individuals to seek treatment. But in India, treatment seeking behaviour remains diverse within and between classes. It shows extensive regional variations, and resource constraints, including the lack of awareness.
A survey conducted by the Ministry of Statistics and Programme Implementation (MOSPI) entitled ‘Household Social Consumption in India: Health NSS 75th round (July 2017 to June 2018)’ gathered basic quantitative information on the health sector, namely morbidity, profile of ailments, role of government and private facilities in providing healthcare, expenditure on medicines, and expenditure on medical consultation and investigation in both rural and urban India. It covered a random sample of 1,13,823 households comprising 5,55,115 individuals spread over rural and urban areas of every district in the country.
The survey results show that healthcare expenditure at private hospitals is much higher compared with government hospitals. The average medical expenditure at government hospitals, according to the survey, was about Rs 4,452, while it was Rs 31,845 in private hospitals during 2017-18. The National Health Account Estimates (2015-16) also reflect that a household’s Out of Pocket Expenditure on health (OOPE) was Rs 3,20,211 crore (60.6 per cent of the total health expenditure, 2.3 per cent of Gross Domestic Product-GDP, Rs 2,494 per capita) Private Health Insurance expenditure is Rs 22,013 crore (4.1 per cent of the total health expenditure).
The break-up of ailments treated on medical advice by healthcare service providers, showed that the share of public hospitals was 32.5 per cent for rural India and 26.2 per cent for urban India. The all-India average share of public hospitals was 30 per cent. Regional disparity in ailments treated on medical advice by healthcare service providers also exists all over India. In major states such as Andhra Pradesh, Karnataka, Telangana and Haryana, private hospitals were preferred to public hospitals. In terms of access to public health services states such as Himachal Pradesh stood third in rural (66.3 per cent) area and first in urban (73.4 per cent) area, while Odisha stood fifth (55.2 per cent) in rural and 2nd in urban areas (62.3 per cent).
Percentage breakup of hospitalisation expenses varied hugely between government and private hospitals across rural reaches in major states. The percentage share of expenses on medicine in public hospitals was highest for Delhi (69.5 per cent) followed by Odisha (68.3 per cent) and the lowest share (26.5 per cent) was seen for Tamil Nadu followed by Punjab (35.6 per cent). While packages and diagnostic test components are 21.6 per cent and 3.6 per cent respectively for Delhi and 18.5 per cent and 2.2 per cent for Odisha. Further, percentage share of these components are 32.1 per cent and 1.8 per cent for Tamil Nadu and 26.6 per cent and 15.8 per cent for Punjab.
This analysis suggests that regardless of the national and state health policies, individual health expenditure in private hospital is much higher, and expenditure in public hospital lower. Given these issues, the government’s role in providing affordable healthcare has implications for social welfare.
The survey advocates public-private partnership in health interventions. If allocation of public funds for such policies is not executed better, in terms of quality as well as quantity, it will have implications on health status. People who have borne heavy burden of availing private medical care will end up concentrating socio-economically disadvantaged people of the society.
Anirudha Barik and Balakrushna Padhi work as Economists at Centre of Excellence in Fiscal Policy, and Taxation (CEFT), Xavier University, Bhubaneswar. They are research scholars of Jawaharlal Nehru University. Views are personal.