Health Care System in India: Policies of Exclusion Working Against the Poor

India ‘s growth story as displayed through popular ideas of large scale urbanization and big ticket reforms tend to overlook certain fine, crucial details like indicators which point towards tendencies working as traps for the poor and the voiceless.

While “growth” is charted out for everybody in macro-economic terms, development is yet to be inclusive for all. A great example of this paradox lies in the state of the healthcare system in India (and more generally its sector as a whole), which deserves due attention in addressing the plight of the poor and the vicious cycle which they recurrently fall prey to.

The hospital industry in India

India has of late earned a reputation for being a much preferred destination for medical tourism for people from all over the world. One of the main reasons for this is the affordability of quality healthcare in the country as compared to similar services elsewhere in Asia and Europe.

Interestingly though it has been noted through studies and surveys conducted that for a significant proportion of the Indian population, the case is quite the opposite. About 63 million people suffer from poverty because of catastrophically high health care costs (in relation to their income).

The rising costs of healthcare

Most Indians find trained and quality medical attention an expensive affair in the country which hurts the lowest income group the most. Cost of treatment has been noted to have risen at a double digit pace, overtaking average inflation in both rural and over the span of a decade as per a cross national survey on health conducted by
the National Sample Survey Organization in the first half of 2014.

Not all Indians are born equal

Further, the cost of treatment has been noted to vary across the Indian states. In few states like Delhi, Punjab, Maharashtra which are on the higher cost of treatment side, it has been noted that most of the quality health care services are provided by private providers and with quality healthcare, there is also a consequent generation of health awareness leading to more reporting of cases of illness.

Due to the lack of quality services in public health facilities in these states, the demand in private facilities go up thus further pushing treatment costs up. This affects the poor people of the state as they have to spend a greater proportion of their income to afford standard services thus often causing them to compromise on their health and bear the risk of being pushed into the category of financially vulnerable families in the country.

For states where cost of treatment is relatively low like Jharkhand and Odisha, it is noted that services there are provided by public facilities rather than private ones. However, due to lack of investment in public health facilities in India, the quality of health care at these public health centers are often deplorable.

The need for pro-poor health policy in India

The lack in adequate number of health care professionals in proportion to the number of patients, access to quality drugs and health infrastructure in the public health sector in turn leads to less awareness amongst the low income groups about preventive health measures and curative measures.

Accessibility of quality care is an expensive ordeal, which often requires India's massive rural population to travel long distances to nearby towns for treatment. This in turns also
keeps many from reporting illnesses thus causing infections and communicable diseases to claim lives and valuable human potential.

What about public healthcare services?

The logical next question which arises at this point is about the scope and reach of any form of employer provided or state-funded insurance that can address the expenditure side of the story and cushion the lower income groups from the impoverishing blow of out of pocket expenditure for health care.

On paper, there are a number of social security schemes such as Rashtriya Swasthya Bima Yojana, Employment State Insurance scheme, Central Government Health Scheme etc, but studies reveal that 86% of rural patients and 82% of urban patients are not covered under any of these schemes.

The high cost of hospitalization and treatment thus disproportionately affects the people who have no social security coverage. This in turn leads to families, compromising on food (quality and quantity) and other preventive health measures, such as vaccines, which are not promoted effectively anyway by the public sector.

For low income groups, falling sick acts as “double jeopardy” most of the time. They not only end up losing their income during the days that they are ill but for treatment and medical emergency, they also have to spend their limited savings if any. Between 8-9% of households across rural and urban areas have reported the need to take loans to meet their medical expenses.

The cost of poor health

Economic costs

Poor health in India is expensive, not only for the poor people but also for the government. The lack of a proper healthcare system in India causes health problems from early life such as stunting and also increases the risk of throughout life and thus directly affect work potential and economic growth.

Less work potential in turn affects income generation thus limiting social and economic mobility of certain families in the long run. On the part of the government, there is loss of potential workforce and a real chance to increase production.

Social costs

Ill health for the poor also leads to social fragmentation, reinforces exclusion of vulnerable communities and frustrates all attempts for sustainable development. The conditions in urban areas can be taken up in this context as an example.

Urban areas at present serve as engines of economic growth and development and they will continue to serve in the same capacity for years to come. Poor health in the urban context leading to financial shocks for middle and low income groups act as a major driver for inequalities in economic security.

Urban areas, in a time of rapid changes and reforms already tend to be less accommodating of the weak and marginalized. Coupled with a rush to attract investment and capital from the rest of the world, one witnesses a steady rise in the standard of living in these areas which further pushes resources out of the affordable zone for the health deprived poor.

The result of this is ghettoization of the poor without access to basic amenities or services of standard quality. The trap is thus set yet again, keeping generations bound in health care woes translated into economic woes and substandard lives.

REFERENCES

• Healthcare spend pushing households below poverty line, Financial Express
• Minimizing out of pocket expenditures for India's poor, Devex
• India's missing patients, LiveMint