The Indian Economy by Matthew McCartney;

Author:Matthew McCartney;
Language: eng
Format: epub, pdf
Publisher: Book Network Int'l Limited trading as NBN International (NBNi)
Published: 2019-06-15T00:00:00+00:00

HEALTH

There are huge variations in the availability of healthcare in contemporary India (Baru et al. 2010). For example, life expectancy in Kerala in 2001–05 was 74 years and in Uttar Pradesh, 62 years; infant mortality 13 and 69 per 1,000 live births; population per government hospital bed 1,299 and 20,041; and proportion of children aged 12–23 months fully immunized 75 per cent and 23 per cent (ibid.: 51). The all-India immunisation coverage of 43.5 per cent in 2005–06 hid considerable variation across socio-economic groups. Immunisation among the top 20 per cent of households by income was 71 per cent, or almost three times that among the lowest 20 per cent of households. Among STs the immunisation rate had increased from 26 per cent in 1998–9 to only 31 per cent in 2005–06 which showed no decline in inter-caste gaps (ibid.).

There are various factors responsible for these high levels of health inequalities. The government has traditionally invested very little in public health, leaving much of it up to the free market. Between 2004 and 2006 for example per capita health expenditure was around $35, of which only $6.50 was accounted for by the government (ibid.). The private sector has gained a dominant presence in medical education and training, medical technology and diagnostics, the manufacture and sale of pharmaceuticals, hospital construction and the provision of medical services (Selvaraj & Karan 2009). Even though public health facilities are supposed to be free (as with education) many people choose to pay private providers. There are widespread perceptions of poor quality, high absentee rates, long waiting times, and lack of courtesy among public-sector providers (Das & Hammer 2007). The public-sector share of total outpatient care declined from 26 per cent in 1987–8 to 20 per cent in 2004 and in hospitalization the decline was from 60 per cent to 40 per cent over the same years.

A consequence of the growing dominance of the private sector has been that the share of household out-of-pocket expenditures (OOPs) is very high and rising. OOP include direct payments for consultations, diagnostic testing, medicines, and transportation. It is estimated that 80 per cent of total health expenditure and 97 per cent of private expenditure (indicating the lack of insurance) are borne through OOPs. This imposes huge financial burdens on households. In 2004–06 the average direct health expenditure on outpatient care per treated person in rural areas was nearly 20 per cent of total annual household consumption expenditure and around 30 per cent for the poorest groups (Baru et al. 2010). These results indicate that a large majority of the economically vulnerable population, and even a sizeable section of the middle class, are susceptible to catastrophic health spending especially if an earning member of the household is afflicted with serious hospitalization. There are widespread reports of corruption in public health services in terms of bribes demanded for admission and treatment in public institutions, in the recruitment, promotion and transfer of personnel, admission to medical/paramedical education, procurement of drugs and technology. In

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