In 2018, on an average, a person in the rural India spent about Rs 16,676, and his urban counterpart spent Rs 26,475 on medical expenditure for hospitalisation, predictably most of it in private hospitals. Ninety-five per cent of people trusted the allopathic medicines to get well, while the percentage of people using alternative medicines was minuscule. The cost of treatment has increased in the last five years—in 2014 a person, on average, spent around Rs 2,000 less on hospitalisation.
These are the findings of the latest survey on household social consumption related to health, conducted by the National Statistical Office during the period from July 2017 to June 2018, as a part of 75th round of National Sample Survey (NSS). The previous consumption survey was conducted in 2013-14.
These government surveys are important as they offer a peek into the changing consumption levels in the country, and how the citizenry was changing. The report, Health in India, released this week, is based on information collected from 1,13,823 households (64,552 in rural areas and 49,271 in urban areas), covering 5,55,115 persons (3,25,883 in rural areas and 2,29,232 in urban areas).
What has changed between the last survey in 2014, and the latest survey is the number of TB cases, which halved in five years. According to the report, the proportion of persons suffering from tuberculosis saw a drastic decline—38 per 1,00,000 persons from 76 per 1,00,000 persons. It also recorded a decline in estimated number of cases of anaemia—from 8,80,700 cases to 5,96,200 cases.
“Average out-of-pocket medical expenditure per hospitalisation case (excluding childbirth) was about Rs 15,937 in rural India, and Rs 22,031 in urban India. In government/public hospitals, on an average Rs 4,072 in rural and Rs 4,408 in urban areas, and in private hospitals about Rs 26,157 in rural and Rs 32,047 in urban areas were spent,” the report said.
Given the affordable healthcare in the government hospitals, in terms of the 'in-patient hospitalisation' (excluding childbirth), about 42 per cent (46 per cent in rural areas, 35 per cent in urban areas) of population availed treatment in public hospitals, 55 per cent (52 per cent in rural areas, 61 per cent in urban areas) of population availed treatment in private hospitals and 2.7 per cent (2.4 per cent in rural areas, 3.3 per cent in urban areas) of population availed treatment in charitable trust/NGO-run hospitals.
As the survey was conducted before the launch of Ayushman Bharat scheme, it found that only 14 per cent of the rural population and 19 per cent of the urban population had health expenditure coverage.
The survey noted that in rural India, percentage people receiving free medicines, and facilities like X-ray, ECG’, and other diagnostic tests have gone up by over two per cent, when compared to the findings in the previous survey.
For funding their hospital finances, the rural and urban households mostly dipped into their personal savings (around 80 per cent) and on borrowings (13 per cent). Dependence of the urban households on their ‘income/savings’ was more (84 per cent) for financing expenditure on hospitalisation, than on ‘borrowings’ (about 9 per cent).
The survey also recorded childbirth and maternity care services and found that among women in the age-group 15-49 years, about 7.4 per cent in rural areas and 5.3 per cent in urban areas were reported as pregnant during the 365 days preceding the date of survey. “In rural areas, about 90 per cent childbirths were institutional (in government and private hospitals) and in urban areas it was about 96 per cent. Among institutional childbirths, in rural areas, about 69 per cent cases were in government hospitals and about 21 per cent in private hospitals and, in urban areas, about 48 per cent cases each were in government hospitals and private hospitals.”
In terms of expenditure on pre-natal and post-natal care, among women in the age-group 15-49 years, about 97 per cent of women took pre-natal care and about 88 per cent took post-natal care. “On an average, about Rs 2,786 (Rs 2,271 in rural areas and Rs 4,405 in urban areas) was spent on pre-natal care and about Rs 1,306 (Rs1,137 in rural areas and Rs 1,832 in urban areas) was spent on post-natal care.”
The survey found out that surgery was done in about 28 per cent of hospital childbirths in India (in rural India about 24 per cent, and in urban India about 41 per cent). In government hospitals only about 17 per cent of childbirths were surgery cases (in rural India about 14 per cent and in urban India about 26 per cent) and, in private hospitals about 55 per cent of childbirths required surgery (in rural India about 54 per cent and in urban India about 56 per cent).
Average expenditure per hospital childbirth was recorded at about Rs 2,404 in rural India and Rs 3,106 in urban India at government hospitals, and about Rs 20,788 in rural and Rs 29,105 in urban were spent for childbirth at private hospitals. “For a normal delivery: average expenditure per childbirth in a government hospital was about Rs. 2,084 in rural India and Rs 2,459 in urban India and average,” the report said.
In rural India, about 97 per cent of both boys and girls had received any vaccination and in urban India, about 98 per cent of boys and 97 per cent of girls had received vaccination.
About 59 per cent of boys and 60 per cent of girls at all-India level had been fully immunised (received all 8 prescribed vaccinations). About 58 per cent (57 per cent boys and 60 per cent girls) children in rural India and about 62 per cent (62 per cent boys and 61 per cent girls) children in urban India had been fully immunised, the survey said.