Despite funding increases promised by the National Health Policy 2017, current spending levels have stagnated. Does this stagnation, coupled with a continued increase in the overall amount spent on healthcare, indicate the government’s role in India’s health is becoming ever more distant?
Government keeping their hands out of healthcare?The latest data from National Health Accounts (NHA) show that current levels of public health expenditure are around 1.2 percent of GDP. This amount does, however, vary considerably on a state by state basis. The National Health Policy pledges a shift towards increasing health spending to 2.5 percent of GDP.
States such as Jammu and Kashmir have a comparatively high level of government spending, currently at 1.7 percent. Others fall far shorter, with Haryana spending around 0.8 percent.
Worth noting is that in all states, private healthcare spending — that being the difference between public health expenditure and the total health expenditure of the state — exceeds that of public spending, often by a considerable margin.
In the examples of Jammu and Kashmir, despite the higher than average public expenditure of 1.7 percent, overall expenditure was 4.2, leaving a further 2.5 to private expenditure. The implication of this is that the majority of Indian health expenditure is out-of-pocket by the patient.
Out-of-pocket expenditure, unaided by health insurance?
Though public healthcare expenditure continues to stagnate, hope may be on the horizon for India’s patients in the form of Modicare. Known as the world’s largest government healthcare scheme, the project aims to bring health insurance to India’s poorest 500 million.
To what extent such a scheme will provide relief, however, is debatable. This is of concern given the lack of healthcare infrastructure dogging India’s public health system. For many, even those with health insurance, medical facilities in the area do not provide the necessary services. For others, insurance schemes may not cover even prescription costs, making chronic conditions an expensive situation for the patient.
Recent evidence suggests that, despite increased prevalence of health insurance, out-of-pocket expenditure continues to rise. Data from 2014 suggested around 65.6 percent of healthcare expenditure was out-of-pocket. More recent reports suggest a figure closer to eighty percent.
Investment into infrastructure may be more beneficial to poorer Indians than insurance. A lack of access to services would imply that, even with insurance, many Indians will still not receive the necessary levels of care.
Currently, many services are provided free at public facilities. However, government-run hospitals are typically focused within urban areas and so many individuals will be forced to seek treatment in private clinics simply due to lack of access.
Current estimates put eighty percent of outpatient care and sixty percent of inpatient care in the hands of the private sector. It is believed that out-of-pocket expenditure for services by private hospitals places 55 million Indians into poverty each year.
The urban-rural divide
Access to healthcare is extremely uneven, with accessibility biased in favour of those living in India’s urban centres.
This is despite the fact that urban areas house around a third of the population, or around 442 million people. Despite this, urban areas hold 74 percent of the doctors. This leaves close to a billion people left with only 26 percent of the overall number of doctors.
This coincides with data published by The Lancet, noting that India loses around 1.6 million deaths each year to sub-par healthcare. This figure is twice the established number of people who died due to lack of access to healthcare, which is estimated to be around 838,000 people. This indicates that, in a considerable number of cases, the healthcare that is provided is of such low quality that it becomes ineffective, or even dangerous. This may in part be due to the significant lack of medical staff.
Issues may be faced when taking into account the rapid expansion of India’s population. As more and more individuals are born, government spending levels must meet the infrastructure needs. Failure to do so could lead to many simply falling through the gaps.
The private sector dominates the rural Indian healthcare market and so many medical outlets that are available for people in rural areas are often out of their price range. To an extent, greater levels of health insurance coverage may aid with this. However, a person living in a rural area will never be able to obtain the free services provided in public facilities without considerable improvements to infrastructure.