Over a quarter of health subsidy cornered by the wealthiest 20%: PHFI

Low awareness combined with limited coverage means that the richest 20% get over a quarter of the health subsidy; only half of this goes to the poorest 20%

In 1946, the Bhore Committee report recommended that India adopt a three-tier health system to provide preventive and curative care. The main contention of the report was that India should ensure access to health care independent of socioeconomic conditions.

The Bhore report has since served as the foundation of India's health care reforms. Although the first National Health Policy was only formulated in 1983, its focus was primary health care for all by 2000. Even Ayushman Bharat, launched in 2018, tries to achieve the same objective, but it makes the private sector a player in providing universal healthcare.

However, data indicates that India is nowhere close to providing health care to a large proportion of the population. The last few decades of efforts have failed as most health subsidies are cornered by the rich.

A new paper by Public Health Foundation of India researchers highlights that over a quarter (26.7 per cent) of the health subsidy is cornered by the wealthiest 20 per cent (decile). In contrast, the poorest decile only gets a 13.1 per cent share.

 

Further analysis of PHFI data indicates that if one considers the wealthiest 40 per cent, the health subsidy share increases to 48 per cent. In contrast, the poorest 40 per cent can only secure 30.6 per cent of the health subsidy accruing to in-patient care.

The study compares data over two time periods of 2004 and 2018 based on NSS surveys.

While the proportion of the richest decile has reduced from 2004, even the poorest decile have witnessed a decline. Most of the subsidy is being cornered by a burgeoning middle class.

 

The situation is no different regarding outpatient care, where the wealthiest decile has a 30.2 per cent share of health subsidy, whereas only 17 per cent accrues to the poorest classes.

Besides, further analysis of the 2017-18 NSS survey shows that only 14 per cent of rural households and 19 per cent of urban households had some form of health expenditure coverage across India. The share of the poorest decile at 10.2 per cent was less than half the share of the richest decile (21.9 per cent). The extent of deprivation was greater in urban households, with only 9.8 per cent of people having health expenditure coverage amongst the poorest compared to 33 per cent for the richest.

 

Almost double the number of urban households availed of government-sponsored insurance schemes in rural areas; in urban centres, the lower middle and middle classes had a higher share.

The data pertains to a period before the implementation of Ayushman Bharat. But even the new scheme has not made much of a difference.

If 2.9 per cent of the population is hospitalised each year (as per NSS data), India accounts for 40 million hospitalisations. Since 2018, over 120 million hospitalisations would have taken place.

Until July 21, just over 161 million cards have been issued, and 19.5 million hospitalisations have occurred under the scheme.