eHEALTH Bureau The out-of-pocket healthcare spending by Indians continues to push them further into poverty with the public spending on health is almost negligible, according to the India Health Report 2010.Studies have documented that households in India spend a disproportionate share of their consumption expenditure on health, with the contribution from government being almost negligible. Public spending on health is very low, stagnant at about 1% of GDP, putting India among the bottom 20% of countries and far below what is needed to provide basic healthcare to the population, the recently published study said.India needs to make significant improvements in its public health scenario. Addressing this challenge, India Health Report 2010 provides a direction for India’s health sector. It examines the status of health in India by bringing together data and information from government documents, health economics and policy literature, and a host of other sources. It critically examines the performance of various components of the sector. Providing a holistic understanding of the health scenario, the report describes the achievements of health policy – and the factors that have facilitated them – as also the hurdles that have come in the way of good health for all. Quoting the available statistics, the study said the households spend an average of 7% of their total expenditure on medicine and healthcare. “This all-India figure, however, hides variations across economic status as poor households spend a greater share of their household expenditure on health and healthcare, often with a debilitating impact of sinking into deeper poverty. Private health spending accounts for more than 80% of all health spending in India and one of the highest proportions of private spending anywhere in the world,” the study done by Indicus Analytics said.Until the mid-1980s public hospitals played a significant role in providing healthcare, and tended to be much cheaper than private healthcare. Since then, however, the private healthcare sector has become the dominant player, especially in case of out-patient care. Per capita costs have almost doubled in the last decade, across both in-patient and out-patient care. In rural areas, per capita out-patient cost increased from INR11 to INR20, while urban areas showed an increase from INR14 to INR28, the report said.Even the per out-patient expense, that is, the cost of one visit to the facility, has increased by about INR30 over the last nine years. Similar trends are visible in the case of in-patient care. Further, both rural and urban residents spend significantly more money on seeking private in-patient treatment than on that provided in government healthcare facilities, the study said.Consider the fact that expenditure has increased by roughly 6% annually in case of out-patient, while for in-patient care the increase is steeper-at about 10% annually over the nine-year period between 1995-96 and 2004. Further, the divide between the rich and poor has increased considerably as accessing healthcare is becoming more and more taxing on the poor. In 2004, the rural poor were paying about 25% more than what they did in 1995-96 for the same in-patient treatment; the increase was only about 3% for the rural rich. A similar pattern is visible in urban areas as well. However, out-patient expenditures for both rural and urban areas do not show such expenditure trends, it said.The average expenditure incurred for one case of hospitalisation is about INR7,182 with government hospitals stand at about INR3,454 while private facilities cost almost double, at INR8,828. Even the poorest 20% in rural areas spend about INR4,291 on one hospitalisation case, the study said.

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