OOP health expenses of Indians growing alarmingly

Even before the regional advisor of WHO, Dr. Kathleen A Holloway, sounded alarm on the ballooning out-of-pocket (OOP) health expenses of the average Indians and the direct relation of that fact with the progressive/catastrophic pauperization of the Indian population, the planning commission has apparently acknowledged the scenario (TOI, 2 NOV 2011). The commission has admitted that about 39 million Indians are pushed to poverty (below or close to the poverty line is a matter of debate as there is no consensus in this country yet about this ‘imaginary’ line). A LANCET article estimated that as many as 30% of rural population and 20% of their urban counterparts could not access medical care, during the year 2004, due to financial constraints.

Analysing NSS data on morbidity and health-related expenditure from 1980s till about 2005 it has been shown (Selvaraj and Karan, EPW, 3 October, 2009) how the public expenditure has progressively dwindled significantly over the years. It was estimated by the authors that more than 80% of Indians end up with private cancer treatment facilities and of them more than 90% meet the expenditure for such treatment OUT OF THEIR OWN POCKET. The TOI article mentioned above cites a statistics that about 47% and 31% of hospital admissions in rural and urban India, respectively, were financed by loans and sale of assets. These figures are roughly consistent with the WHO estimate of about 70% Indians having to meet their health expenditure from their own funds (by beg-borrow-sale route, stealing and other similar means may not entirely remain in the realm of movies in future). The trend in progressive reduction in government spending on purchasing drugs and other support to the public health care system is borne by cold statistics (TOI article as above).

By a detailed survey (conducted during 2006-2007) of the economic cost burden on ‘poor’ people (average monthly per capita household income of Rs 1835/-) suffering from a critical illness like cancer and having accessed significantly ‘cheaper’ treatment in a government funded medical facility adjunct to AIIMS, New Delhi, Mohanti and others (EPW, 22 October, 2011) have found that the overall OOP expenditure for a typical 5-7 week radiation therapy was between 330-450 % of their monthly family income. This was apart from the expenses on diagnosis and other complementary treatments like surgery or chemotherapy. It is important to note that about 60% of these expenses were on transport and food (possibly including those required by the supporting family members and relatives). But still 40% of the expenses which are purely medical are not borne by the government but by patients and the families. With the ideological lurching   towards reducing the government support to all kinds of public services these expenses can only grow with potential penury and destitution looming large.