The price of healthcare

In a country riddled with malnutrition, toxic levels of pollution, lopsided sex ration, intimidating amounts of out-of-pocket spending of healthcare which is not available to most of those who need it most, the nation is obviously not in the best of its health. The National Health Profile is an annual stocktaking exercise on the health of the health sector and is significant for giving an insight into what loopholes exist and what could be done to address irregularities. To begin with, it is indeed important that the health of the health sector be assessed as it is the very means to materialise the plans and schemes of the government in this direction. With Ayushman Bharat, Universal Health Coverage became the star feature but as the assessment of the National Health Profile (NHP) go, figures are rather sobering. Between 2009-10 and 2018-19, India's public health spend as a percentage of GDP had gone up by just 0.16 percentage points from 1.12 per cent to 1.28 per cent of GDP, and remains distant from the target of 2.5 per cent GDP on health expenditure. And now, with much less disposable income with the common man and spiralling costs of treatment, there is an inequity in access to health care services. India spends only 1.28 per cent of its GDP in public expenditure on health. Per capita public expenditure on health in nominal terms has increased from Rs 621 in 2009-10 to Rs 1,657 in 2017-18. Further, compared to the average total medical spending per childbirth in a public hospital, Rs 1,587 is in a rural area and Rs 2,117 is in an urban area. With the amount of money drained only at child birth, it is only predictable that a financial crunch is a significant cause of malnutrition and proper postpartum care. The health survey conducted by NSSO reveals that the average medical expenditure incurred during hospital stay during January 2013-June 2014 was Rs 14,935 for rural and Rs 24,436 in urban India. With the major concern of financing public health, Prime Minister Narendra Modi had announced in 2018 that "We are committed to increasing India's health spending to 2.5 per cent of GDP by 2025, reaching to more than $100 billion. This will mean an actual increase of 345 per cent over the current share, in just eight years." A lofty target indeed, the path towards this has, however, been full of stumbling blocks.

Taking note of the wide disparities in the health expenditure of states, the NHP points out that the Northeastern states had the highest and the Empowered Action Group (EAG) states and Assam had the lowest average per capita public expenditure on health in 2015-16. EAG states are the eight socio-economically backward states of Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand, and Uttar Pradesh. Among the big states, (now erstwhile) Jammu and Kashmir leads with a 2.46 per cent GSDP (Gross State Domestic Product) expenditure on healthcare—closest nearest to the ideal spend. In the Northeast, the leading states in healthcare expenditure were Mizoram with 4.20 per cent GSDP spend and Arunachal Pradesh with 3.29 per cent. The states such as Tamil Nadu and Kerala known to perform better on healthcare parameters have fared poorly on the health finance index as Tamil Nadu spent 0.74 per cent of its GSDP and Kerala 0.93 per cent of its GSDP on healthcare. With India's ambition of Universal Health Coverage, a comparison with countries that are on this path will shed more light on the condition of India. In 2016, India's Domestic general government health expenditure stood at $16 per capita—lower than Norway (at $6,366), Canada (at $3,274), Japan (at $3,538), Republic of Korea (at $1,209), and Brunei Darussalam (at $599). Of the 23 countries including India that the Central Bureau of Health Intelligence chose for that comparison, the highest per capita spender is the United States at $8078; this is when the American system is said to be neither ideal nor economical. Moreover, within India, there has been a notable shift in the disease profile towards non-communicable diseases. Deaths from non-communicable diseases include suicide—mental health being a pervasive concern getting much less attention due to it. The disease burden due to communicable, maternal, neonatal, and nutritional diseases has dropped from 61 per cent to 33 per cent between 1990 and 2016. In the same period, disease burden from non-communicable diseases increased from 30 per cent to 55 per cent. Pollution, malnourishment, and lack of resources to bear the heavy out-of-pocket expenses are some of the reasons for this changing trend. Despite the significant growth of medical education infrastructure has over the past few years, the enrolment of students for higher education in this line remains a concern awaiting addressing. With the three-fold objective of equity in access to health services, quality of health services being good enough to improve the health of those receiving them, and people to be protected against financial-risk, it is necessary that the cost of health care services do not land people at the brink of financial harm. It comes out very clear that with financial constraints of the common people being a significant factor in the context of falling public health and pertinent concerns, the onus lies on the government to address the situation and prevent it from escalating into a socioeconomic crisis.