Remember ME - You Me and Dementia

Thursday, March 5, 2009

Costly healthcare pushes people into poverty: VHAI report

The recently released report of the Independent Commission on Development and Health in India (ICDHI), ‘Governance of the Health Sector in India: Has the State abdicated its role?’, analyses the current mess in the public health system and suggests ways in which to deal with it. It focuses mainly on governance and funding of public healthcare in the country.

It is common knowledge that public health facilities in India are overburdened, underfunded and face a shortage of skilled personnel and equipment. This report by the Voluntary Health Association of India, New Delhi (2008), authored by former Union health secretary Javed Chowdhury and other ICDHI members, makes a number of important points and suggestions for improvement. The ICDHI was set up in 1995 and comprises distinguished persons from the health and development sectors. It assesses the development and health situation of the country through policy research and analysis, surveys, focus group discussions, public hearings, etc, and works with concerned ministries as well as NGOs.

The report points out huge regional imbalances in both the process and outcome indicators for health. While the average health status for the country as a whole is poor, and per capita spending on health also low by international standards, there are sharp differences across the states.

Kerala, Maharashtra, Himachal Pradesh and Tamil Nadu that account for 18.8% of the country’s population have health indicators similar to those in more developed middle-income countries such as Venezuela, Argentina and Saudi Arabia. At the other end of the spectrum are the BIMARU-plus states (Bihar, Jharkhand, Madhya Pradesh, Rajasthan, Uttar Pradesh, Orissa and Assam) that comprise nearly 42% of the population and whose indicators are close to those in sub-Saharan Africa and other low-income countries such as Sudan, Nigeria and Myanmar.

States with poor health outcomes also spend less on public health -- a mere 7.5% of total health expenditure, or Rs 84 per capita, in Uttar Pradesh.

Shortage of doctors is also a problem. The availability of graduate allopathic doctors in the country as a whole is only 0.6 per thousand population. They are concentrated in the south and in more developed states (Punjab has more than five times the availability of Uttar Pradesh). They are also present in larger numbers in urban areas over rural areas.

Medical colleges too are unevenly spread: the four southern states have 63% of the colleges and 67% of the seats. The states with the biggest shortfalls in medical personnel are predictably the BIMARU states along with Jharkhand, Chhattisgarh, the northeastern states, Orissa and Haryana.

Quality of service provided is also poor. The statutory councils for doctors, nurses, dentists and others are almost dysfunctional. So people are forced to turn to private health services, and, in the poorer states, impoverished people are made to pay because government provision is unavailable or inadequate. Thus, in the poorest states, illnesses involving hospitalisation are more likely to deplete poor families’ finances. The report cites National Sample Survey Organisation (NSSO) data to show that in Bihar and Uttar Pradesh, more than one-third of those who were hospitalised fell into poverty on account of medical expenditure.

The cost of private healthcare, which the poor are forced to resort to, has also gone up in recent times. According to the National Sample Survey Organisation, urban hospitalisation costs increased by 126% between 1995-96 and 2003-04, while rural hospitalisation costs increased by 78%. The ICDHI report notes that one-fifth of the population that is just above the poverty line will automatically slip into poverty if they face even one serious health crisis.

The increase in the cost of therapeutic drugs has been particularly steep. On average, some 75% of health expenditure is on drugs, rising to 90% in Orissa and almost the same in Rajasthan, Bihar, Himachal Pradesh and Uttar Pradesh. In no state was the ratio less than 61%, indicating clearly that the health system is “over-medicalised”.

The new patent regime, lack of adequate regulation of Indian drug manufacturers, and a lax drug policy that allows non-essential, irrational and even hazardous drugs to proliferate are some of the reasons for the high price of drugs.

The report makes the following recommendations:

* More public expenditure and more allocation of funds to the same.
* More and different types of regulation.
* New approaches to training and initiatives to change the current tendencies to over-medicalise and to depend excessively on curative rather than preventive healthcare.


Forget yourself for others, and others will never forget you.

No comments: