GUWAHATI: According to the World Health Organisation (WHO), the current healthcare expenditure of India as a whole is only 3.01% of the GDP. This is a cause of concern, as the country is one of the fastest developing nations in the world. Assam, as one of the most populous states in the North Eastern Region of India, has a population of around 3 crore as per the Census data of 2011. With 86% of the population residing in rural areas and just 14.5% in urban areas, the state faces a challenge in allocating healthcare expenditure to reach both areas with the same standard of living, healthcare facilities and infrastructure.
In its budget for 2016-17, the Government of Assam allocated approximately Rs. 3,994 crore for health and family welfare schemes, which included new initiatives to improve the healthcare infrastructure in the state.
However, the National Family Health Survey IV shows that about 29.8% of children below the age of 5 years are underweight, 35.7% of children between the age group of 6-59 months are anaemic, and 25.7% of women have a body mass index (BMI) below normal. This highlights the need for further improvement in the healthcare sector
National Sample Survey (NSS) report of 2014 reveals that Assam has the highest cost of hospitalization in Urban India. The average expense of hospitalization in urban areas of Assam is Rs. 47,064, despite the fact that over 51% of the population utilizes public hospitals and 48.5% of the population uses private hospitals.
This indicates that the dependency on private hospitals by the urban population is adding to the healthcare bill extensively and bringing in more challenges in the reform building in the urban areas of Assam. In contrast, in rural India, Assam is among the states that have the lowest cost of hospitalization.
The average cost of hospitalization is Rs. 6,966 in rural Assam, where 89.2% of the population uses public hospitals. In addition to the financial challenges, the healthcare sector in Assam also faces a number of other challenges, including inadequate funding and resources, unequal distribution of resources, and a shortage of healthcare personnel. Assam, being a plural society both culturally, economically, and demographically makes it a mini “India” in the N.E. region and it reflects a miniature picture of the challenges faced in the country.
Healthcare sector and Health Expenditure in India:
Healthcare sector has become one of the largest sectors in India, both in term of revenue and employment. Moreover, various studies and survey suggest that there has been an increase in the expenditure on health by the Government of India, which is more evident by the recent report published by the National Health Accounts (NHA).
According to the NHA report the Government of India has increased the expenditure on health, making the decline to 48.8% in 2017-18 from 64.2% in 2013-14. Moreover, India's competitive advantage lies in its large pool of well-trained medical professionals. India is also cost competitive compared to its peers in Asia and western countries. Even the cost of surgery in India is about one-tenth of that in the United States or Western European States.
Moreover low cost medical services have resulted in a rise in the country’s medical tourism, attracting patients from across the world. It has also been reported that India has emerged as a hub for R&D activities for international players due to its relatively low cost of clinical research.
Average Medical Expenditure Incurred for Treatment of the North Eastern States:
Despite, the expenditure for treatment in public health care sector is less in the North-Eastern Region (NER). To be precise, in Urban Assam it is comparatively low than the Rural Assam. However, the statistics reveals that around 48.5% of the population use private health care in Urban Assam compared to public health care sectors (NSS, Report 2020).
Average medical expenditure incurred for treatment during stay at hospital in North-Eastern States:
Source: National Statistical Survey Office (NSS0) 75th Round Data
As previously discussed, the majority of the urban population relies on private healthcare services and is less dependent on public healthcare. This highlights a major failure of the expenditure in the urban areas, and raises concerns about the effectiveness of the current policies and initiatives aimed at improving healthcare in urban areas.
In recent years, various studies have been conducted to examine the healthcare expenditure in North Eastern Region (NER), India. These studies have revealed that, despite the higher expenses associated with private hospitals; a significant proportion of the population in Assam utilizes private healthcare services.
In particular, more than 50% of the population in Assam uses private healthcare services, in comparison to the 89.2% of the rural population who rely on public healthcare services. The data from various publications revealed that the highest percentage share of healthcare expenditure is dominated by medical and public health expenses. This is particularly relevant, as 80% of the population in Assam resides in rural areas. In light of these findings from various Government reports, it is important for the Government of Assam to consider the factors that might have led to the dependency of the population in urban areas on private healthcare services rather than public healthcare services.
(The author is a columnist & independent researcher in economics. All views and opinions expressed are the author’s own.)
