Increasing Out-Of-Pocket Health Care Expenditure in India-Due to Supply or Demand?

Abstract

Introduction:After a gap of ten years the information regarding morbidity and health expenditure in Indian states were collected in detail National Sample Survey Organization (NSSO) and were published on June 30th, 2015. During this decade the country and health system has undergone major changes including introduction of public funded health insurance schemes (PFHI). This paper was done with the objectives to study the OOP health expenditure and factors affecting it and to understand the impact PFHI on OOP in India. Method: Study done by reviewing, analysing the availing data from NSSO survey conducted during 2014 and 2004 and for assessing the impact of PFHI schemes on OOP other published studies on evaluation of PFHI schemes were included. Results: Proportion of Ailing Persons (PAP) was 104 per 1000 with 13 points increase during the last ten years. The utilization of public services for outpatient (O P) care like subcenters, primary health enter , Community health centres were 25% and inpatient (IP) care was 40%. OP expenditure has increased > 100% and IP care expenditure almost 300% increased during last ten years. More than 80% of the expenditure are met by out of pocket (OOP).Rural households primarily depended on their 'household income / savings' (68%) and on 'borrowings' (25%), the urban households relied much more on their 'income / saving' (75%) for financing expenditure on hospitalizations, and on '(18%) borrowings. Even from the upper quintile, both rural and urban areas have borrowed money to meet the hospital expenditure which was 23%and 14% respectively. Only 12% urban and 13% rural population received any protection coverage through any of the PFHI like " Rashtriya Swasthya Bhima yojana " (RSBY). Conclusion: The morbidities cost per illness episode were inevitably increased in the last decade in India. The increase in life expectancy, demographic change of more aged population coupled with chronic disease will increase the morbidity and health expenditure in the future. Unless overt reliance on unregulated private sector are systematically corrected by alternative health financing mechanisms and strengthening public health system " right for health " will be a distant dream for common citizens.