Govt pays just a fifth of Indians' health bill

With government-funded health facilities stretched to the limit "" only 42 per cent of children below two years were vaccinated in 1999 ""private spending on health has grown by leaps and bounds.

During 1983-99, this grew from Rs 5.37 per capita per month to Rs 33.1. For the poorest 40 per cent of the population, the hike was steeper from Rs 1.66 to Rs 11.71.

This data has been collated from the National Sample Survey by economist Surjit Bhalla for a research project for the Planning Commission.

In 1983, 4.37 per cent of the per capita monthly expenditure was incurred on health. This went up to 5.72 per cent in 1999. This makes India's per capita private spend on health one of the highest in the world.

Against a total public spend of 0.9 per cent of the gross domestic product (GDP) in the health sector, private individuals spend 4 per cent of the GDP on health. In the UK, private spending on health is just 1.4 per cent, while public spending is 5.9 per cent of the GDP.

This is virtually a reversal from the 1980s, when private health expenditure grew at a little over 2 per cent and total consumption expenditure grew around 4 per cent. In the 1990s, however, private health expenditure grew 7.5 per cent per annum, against a 4.6 per cent hike in private final consumption expenditure.

Unlike in the case of education, where groups like SC/STs and Muslims have caught up with Hindus over the decade, expenditure patterns on health have remained by and large constant.

In 1983, Muslims spent Rs 4.86 per capita per month on health, against Rs 5.82 for Hindus. In 1999, health expenditure by Muslims went up to Rs 30.64, but it remained constant at around 84 per cent for Hindus.

Similarly, health expenditure by SC/STs rose from Rs 3.96 to Rs 23.97 during this period, but remained at around a third lower than that for Hindus. The results hold true for almost all income classes.

Details on performance in terms of certain physical parameters are mixed, depending on the source used. According to the latest United Nations Development Programme (UNDP) Human Development Report, just 43 per cent of births in India are attended to by skilled health personnel.

The government's National Human Development Report, 2001, however, puts the number of births attended to by health professionals at 73.3 per cent. This publication also shows that the number of births in medical institutions is up from 25 per cent in 1992 to 65 per cent in 1999.

On the whole, however, India's health performance is poor. Even basic health parameters like infant mortality, below-five mortality rate or population with access to essential drugs are lower than that for countries like China. This explains the sharp surge in private health expenditure.