Last week I was at a private hospital in Kolkata when I came across the family of a patient who was admitted in the Critical Care Unit (CCU). The breakdown of the current bill for the patient, which the family shared with me, showed the CCUcharge alone at around Rs 8,000 ($129) per day. Of course, this is just a small part of the bill, and only the first day's. In a country where the per capita monthly income is less than Rs 7,000 ($112), these are exorbitant prices for even middle-class households like the one I met, let alone the poor.
So why wouldn't they opt for treatment at a government hospital where prices are subsidised? Because - the family told me - they wanted the best facilities and doctors, which they believe were simply missing in state-run health facilities. The family has had to dip into its savings. It is not unusual in India where out of pocket payments (OPP) or direct cash outlays by individuals/families for healthcare account for more than 70 per cent of total health-related spending. To put things in perspective, consider that the concomitant figure in the US is below 12 per cent.
There are three aspects to the problem at hand: (a) the poor state of government hospitals (broadly lacklustre state participation in the health sector as a whole); (b) the choice citizens make in favour of private healthcare; and finally (c) poverty and health inequality. It is well known that poor Indians who dip into their family savings to pay for privately-provided healthcare often plunge back into the below-poverty-line (BPL) zone as critical illnesses potentially wipe out a lifetime of savings. Remember that even a 0.5 per cent increase in poverty would mean an addition of 6 million BPL households in India.
The three aspects highlighted above are distinct but connected to each other, with each feeding into the other.
The first disturbing reality is that there is a near absence of either a comprehensive/universal state-sponsored insurance programme or a publicly-funded health system in India. The piecemeal health schemes that exist are reportedly marred by ineffective implementation, poor health infrastructure to back up, and even corruption. With the turn of the millennium, India opened up health insurance to private players, but the latter play a marginal role in the health insurance market. Existing public health insurance programmes (by way of employee/ employer contribution) put together cover not more than a quarter of the total population. Importantly, these schemes exclude 51 per cent of Indians who are self-employed (auto-drivers, housemaids, farm labourers and what have you).
The Rashtriya Swasthya Bima Yojana does cover BPL households and its implementation by states has had tangible effects on curbing private expenditure. However, a lot of the dispensaries and hospitals in India's overall public health network lack doctors, beds, medicines and surgical and other infrastructure. Clearly, more state funds need to be channelled to the sector.
Government health expenditure as a percentage of GDP in the US is higher than seven per cent and ranges between six and eight per cent in EU countries. At 1.4 per cent of total GDP, India's state expenditure compares lowly against even other developing countries, leave aside the OECD. India's bed-to-patient and doctor-to-patient ratios (basic parameters) are way below global averages and even below the WHO's minimum ratio stipulations. This situation is fundamentally owed to government hospitals, particularly in remote parts of the country.
On the other hand, across India today, the very word 'private' evokes efficiency. And this perception has penetrated the psyche of ordinary Indians - poor, affluent and those in between. Irrespective of income situation and the impact on domestic finances of making such a choice, a large majority of Indians (an estimated 75-80 per cent) prefer to avail private healthcare facilities for minor and major illnesses. However, unless the situation with public healthcare provision improves substantially from where it is today, we can't even begin to consider reflecting upon the issue of citizen's affinity for the private sector as being a 'problem'. It is safe to assume that people will respond with their feet if government facilities are adequately shored up and brought in line with the advanced diagnostic and treatment facilities of our times.
The Social Progress Index, which ranks countries based on developmental outcomes, ranked India as low as 95th and 97th in the 'Health and Wellness' and 'Nutrition and Basic Medical Care' sections respectively. In the more popular Human Development Index (HDI) India ranked a miserable 135ththis year. Indeed, we don't need global indices to tell us how serious the health policy problem in India is. The situation merits a range of measures: increasing state spending in the sector and beefing up government health infrastructure is a good place to start. A focus on basic hygiene andsanitation meanwhile can aid in prevention. On the cure side, broad-basing and streamlining existing insurance schemes under one umbrella will ensure better delivery and implementation.
So why wouldn't they opt for treatment at a government hospital where prices are subsidised? Because - the family told me - they wanted the best facilities and doctors, which they believe were simply missing in state-run health facilities. The family has had to dip into its savings. It is not unusual in India where out of pocket payments (OPP) or direct cash outlays by individuals/families for healthcare account for more than 70 per cent of total health-related spending. To put things in perspective, consider that the concomitant figure in the US is below 12 per cent.
There are three aspects to the problem at hand: (a) the poor state of government hospitals (broadly lacklustre state participation in the health sector as a whole); (b) the choice citizens make in favour of private healthcare; and finally (c) poverty and health inequality. It is well known that poor Indians who dip into their family savings to pay for privately-provided healthcare often plunge back into the below-poverty-line (BPL) zone as critical illnesses potentially wipe out a lifetime of savings. Remember that even a 0.5 per cent increase in poverty would mean an addition of 6 million BPL households in India.
The three aspects highlighted above are distinct but connected to each other, with each feeding into the other.
The first disturbing reality is that there is a near absence of either a comprehensive/universal state-sponsored insurance programme or a publicly-funded health system in India. The piecemeal health schemes that exist are reportedly marred by ineffective implementation, poor health infrastructure to back up, and even corruption. With the turn of the millennium, India opened up health insurance to private players, but the latter play a marginal role in the health insurance market. Existing public health insurance programmes (by way of employee/ employer contribution) put together cover not more than a quarter of the total population. Importantly, these schemes exclude 51 per cent of Indians who are self-employed (auto-drivers, housemaids, farm labourers and what have you).
The Rashtriya Swasthya Bima Yojana does cover BPL households and its implementation by states has had tangible effects on curbing private expenditure. However, a lot of the dispensaries and hospitals in India's overall public health network lack doctors, beds, medicines and surgical and other infrastructure. Clearly, more state funds need to be channelled to the sector.
Government health expenditure as a percentage of GDP in the US is higher than seven per cent and ranges between six and eight per cent in EU countries. At 1.4 per cent of total GDP, India's state expenditure compares lowly against even other developing countries, leave aside the OECD. India's bed-to-patient and doctor-to-patient ratios (basic parameters) are way below global averages and even below the WHO's minimum ratio stipulations. This situation is fundamentally owed to government hospitals, particularly in remote parts of the country.
On the other hand, across India today, the very word 'private' evokes efficiency. And this perception has penetrated the psyche of ordinary Indians - poor, affluent and those in between. Irrespective of income situation and the impact on domestic finances of making such a choice, a large majority of Indians (an estimated 75-80 per cent) prefer to avail private healthcare facilities for minor and major illnesses. However, unless the situation with public healthcare provision improves substantially from where it is today, we can't even begin to consider reflecting upon the issue of citizen's affinity for the private sector as being a 'problem'. It is safe to assume that people will respond with their feet if government facilities are adequately shored up and brought in line with the advanced diagnostic and treatment facilities of our times.
The Social Progress Index, which ranks countries based on developmental outcomes, ranked India as low as 95th and 97th in the 'Health and Wellness' and 'Nutrition and Basic Medical Care' sections respectively. In the more popular Human Development Index (HDI) India ranked a miserable 135ththis year. Indeed, we don't need global indices to tell us how serious the health policy problem in India is. The situation merits a range of measures: increasing state spending in the sector and beefing up government health infrastructure is a good place to start. A focus on basic hygiene andsanitation meanwhile can aid in prevention. On the cure side, broad-basing and streamlining existing insurance schemes under one umbrella will ensure better delivery and implementation.
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