New Delhi: A poll has found that over half of people it surveyed in India primarily paid for their or their family members’ hospitalisation costs out-of-pocket, while a little over a quarter availed government schemes to cover costs.
According to the poll, which was conducted by the Artha Global policy organisation’s Centre for Rapid Insights (CRI) and published in the Hindustan Times, those respondents who did not own a vehicle were more likely than those who did to pay for hospitalisation costs out-of-pocket.
Out-of-pocket healthcare expenditure is spending that people incur on their own for accessing healthcare services.
CRI said it polled 6,755 respondents across 421 Lok Sabha constituencies.
When asked what primary mode of payment respondents had used the last time they or someone in their household was admitted to hospital, 53% said out-of-pocket expenditure was their primary mode of payment, the poll’s results said.
They added that 29% of respondents said their primary mode of payment involved a government scheme, while 10% and 9% said they relied on private and employer insurance, respectively.
Sixty percent of respondents who did not own a vehicle said they primarily paid for this expenditure out-of-pocket. But this figure was 48% for respondents who owned a two-wheeler and 40% for those who owned a four-wheeler.
Those with two and four-wheelers were more likely to avail private or employer insurance to cover this cost, while similar proportions across all three categories (between 24% and 31%) availed government schemes to do so.
“The relatively universal nature of government schemes combined with market inefficiencies generate a regressive structure in which the target population (the poor who are most in need) are precisely those who are the least protected,” CRI director Neelanjan Sircar wrote in the Hindustan Times.
Some inefficiencies in the context of health insurance schemes like Ayushman Bharat are that they do not incentivise investment in preventive healthcare, and that low coverage amounts or delays in disbursals could mean that healthcare providers are not incentivised to provide high-quality services, Sircar pointed out.
Another limitation of Ayushman Bharat is that its coverage is restricted to in-patient department services. In other words, it does not provide assistance for those seeking out-patient department services (those that do not require overnight admission to hospital), even as the latter comprise between 40% and 80% of healthcare services.
These “market inefficiencies” have “pernicious effects in obliging citizens to pay health expenses out of pocket, and are only likely to be mitigated if citizens have access to another source (private or employer) of insurance,” Sircar also said in the article.
The poll’s findings came even as the government has increased its expenditure as a share of the country’s total health expenditure.
Ayushman Bharat, which is a Union government scheme, providers Rs 5 lakh cover per eligible family per year in empanelled hospitals.
As of 2019-2020, a majority of India’s current health expenditure was contributed out-of-pocket at 52%, as against by the state and Union government’s at 35%, the National Health Accounts Estimates said.
While out-of-pocket expenditure as a share of total health expenditure in India has declined over the years, this figure was still higher in India than in other large economies and in its pre-expansion BRICS partner countries in 2021, IndiaSpend reported citing WHO figures.
A NITI Aayog report from the same year said 7% of India’s population – about ten crore people – were pushed into poverty every year due to the amount of money they spent on healthcare.
