Out-of-pocket expenditure biggest ills of Indian healthcare

Out-of-pocket expenditure on health continues to impact the finances of 62% Indians adversely, the Economic Survey has noted.

"In a developing country like India, incurring higher levels of out-of-pocket expenditure (OoPE) on health adversely impacts the poorer sections and widens inequalities," said the Survey tabled in Parliament on Monday.

Although OoPE declined approximately seven percentage points between 2004-05 and 2014-15, its share was still at 62% as per the National Health Accounts, 2014-15.

The Survey observations are in line with several research papers and international reports that red-flag extremely high out-of-pocket expenditure as one of the biggest ills of the Indian healthcare sector.

The World Bank, for instance, in a 2014 report shows almost 90% of private expenditure on health is out-of-pocket.

Nearly 10% of these expenses, according to the Survey, are spent on drugs and diagnostics.

As limited affordability and access to quality medical services contribute to delayed or inappropriate responses to disease control and patient management, the Survey advised the government to take steps to improve people's accessibility to drugs and diagnostics.

An analysis of prices of diagnostic tests across various cities in India not only reveals wide differences in average prices of diagnostic tests but also substantial prices of several tests.

This calls for a need to prioritise standardisation of rates by devising appropriate quality assurance framework and regulatory mechanism besides devising a way to accredit diagnostic laboratories across the country.

In 2016, malnutrition still remains the most important risk factor (14.6%) that results in disease burden in the country though the overall disease burden due to poor nutrition dropped substantially since 1990.

The contribution of air pollution to disease burden remained high in India between 1990 (11.1%) and 2016 (9.8%), with the levels of exposure among the highest in the world. It causes burden through a mix of non-communicable and infectious diseases, mainly cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections.

High anti-microbial resistance is another major health risk factor. It is of particular concern for India, where the burden of infectious diseases is high and health care spending is low. India carries one of the world's highest bacterial disease burden.

Unsafe water and sanitation are no longer a source of a major health worry, but a new health risk has emerged from poor diet. In 2016, the dietary risks, which include diets low in fruit, vegetables, and whole grains, but high in salt and fat, were India's third leading risk factor, followed closely by high blood pressure and high blood sugar.