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Post at: Aug 19 2021

Oxfam’s Inequality Report 2021: India’s Unequal Healthcare Story

Recent Context

  • Oxfam India has recently released a report on India titled ‘Inequality Report 2021: India’s Unequal Healthcare Story’.  Report presents a grim reality of India’s healthcare system’s unequal treatment of its rich and the poor.

Premises of Report

  • Although  India is one of the fastest growing economies in the world, it is also one of  the most unequal  country. Rich are getting richer at a much faster pace while the poor are still struggling to earn a Minimum wage and access quality education  and healthcare  services, which continue to suffer from chronic under- investment.
  • India invest only 1.25% of its GDP in health sector.
  • Report provides a comprehensive analysis of the inequality present in the Indian Health care system.
  • The findings are primarily based on secondary analysis from rounds 3 and 4 of the National Family Health Survey and various rounds of the National Sample Survey.

Findings of Report
Performance of Various groups in population: 

  • The general category performs better than SCs and STs; Hindus perform better than Muslims; the rich perform better than the poor; men are better off than women; and the urban population is better off than the rural population on various health indicators.

Rural and Urban divide: 

  • One rupee in every Rs 6 spent on hospitalisation came through borrowing; while urban households depended on savings, rural households depended on loans. This divide was further highlighted during covid pandemic when there was acute shortage of medical supplies in rural sector.

Female literacy Rates:

  • People with lower literacy are more likely to use emergency services and be hospitalized instead of using preventive services such as diagnostic tests and taking medications.
  • While women’s literacy has improved across social groups over the years, SC and ST women lag behind the general category by 18.6% and 27.9%, respectively. Female literacy rate among Muslims is lower than all religious groups.
  • There exists a gap of 55.1 percent between the top and bottom 20 percent of the population in 2015-16.

Health Expenditure: 

  • The expenditure incurred by the general category was 2.2 times higher than STs, 1.7 times higher than SCs and 1.5 times higher than Other Backward Classes (OBCs) in 2017-18, which is roughly the same as the corresponding figures in 2004. Average expenditure among Hindus is higher than Muslims, it is lower than Christian and Sikh households.

India’s Low Spending on Public Healthcare Has 

  • left the poor and marginalised with two difficult options: suboptimal and weak public healthcare or expensive private healthcare. In fact, the out-of-pocket health expenditure of 64.2 percent in India is higher than the world average of 18.2%.

State Performance difference: 

  • States that have for the past few years been reducing inequalities, such as inequalities to access to health between the general category and SC and ST populations, have less confirmed cases of Covid – such as Telangana, Himachal Pradesh and Rajasthan. 
  • States that have had higher GDP expenditure on health, such as Assam, Bihar and Goa, have higher recovery rates of Covid cases.

Sanitation and Water access: 

  • Poor Sanitation and polluted water are major sources of health related death in world. In India Access to improved water has increased by 2.3 percent reaching 89.9 percent; access to improved sanitation has increased by 19.3 percent reaching 48.4 percent. Access to improved sources of water is almost equal for all groups except STs who are approximately 10 percent behind the rest. For sanitation 65.7 percent households have access to improved, non-shared sanitation facilities in the general category while SC households are 28.5 percent behind them and ST are 39.8 percent behind them.

Life Expectancy: 

  • Life expectancy based on wealth is 65.1 years for the bottom 20% of the households, while it is 72.7 years for the top 20%.

Critical problems in Indian Health care

  • Indian government’s spending on public healthcare ranks among the lowest in the world. In the place of a well-funded health service, it has promoted an increasingly powerful commercial health sector. 
  • This has led to  growth in private healthcare sector that has only increased the existing inequalities leaving the poor and the marginalised with no viable healthcare provisions.
  • Although experts acknowledge that primary care is the cornerstone of achieving equitable delivery and access to quality healthcare by all yet public sector has prioritized secondary and tertiary care over primary care. 
  • While focus has been put on achieving Universal Healthcare in India; successive governments have selectively focused on the insurance model which is even with best intention is quite limiting model.
  • The central and state governments have rolled out several insurance schemes. Unfortunately, they cover in-patient care only though most of the expenditure made on health is incurred due to illnesses that do not require hospitalization and other out-patient costs such as doctor visits, diagnostic tests and medicines.
  • Financially poor people demonstrate low health seeking behaviour because of the high cost of health services in the country.

Way Forward and Recommendations

  • The right to health should be enacted as a fundamental right. It will make obligatory for the government to ensure equal access to timely, acceptable, and affordable healthcare of appropriate quality and address the underlying determinants of health to close the gap in health outcomes between the rich and poor.
  • Spending of healthcare must be increased to 2.5% of the GDP.
  • Regions with higher concentration of marginalised population should be identified and public health facilities should be established, equipped and made fully functional as per the Indian Public Health Standards (IPHS). 
  • Insurance covers should be widened to Out patients care as most of the expenditure is incurred there only. 
  • Private health sector must be regulated by the government so that they do not charge exorbitant amount of money.

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