Poor being pushed out of public healthcare: Study

‘Apathy and private practice by doctors driving them away’

Written by Express News Service | Mumbai | Published:July 30, 2013 1:24 am

A large chunk of Mumbai’s poor and lower-income category citizens is spending a good portion of income on healthcare by opting for relatively more expensive facilities at private or charitable clinics/hospitals over public services,according to the findings of a white paper on health published by Praja,a non-government organisation (NGO).

The NGO’s data on the “state of health of Mumbai” reveals that 58 per cent of those belonging to socio-economic classification or SEC C,65 per cent from SEC D and 46 per cent from SEC E have preferred private services over government dispensaries/hospitals. The data is striking as a similar percentage from the upper strata of the society — the SEC A and SEC B — too turn to private services in Mumbai.

Only about a third of the city’s population relies only on government-based healthcare facilities. Across socio-economic strata,a mere 31 per cent of the population depends on government dispensaries and hospitals,62 per cent goes to only private or charitable clinics and hospitals,while seven per cent uses both private and government health services.

Dr Amit Jadhav from Bombay Hospital said quality suffers as doctors are allowed to practice in public hospitals and privately,too. “Very few provide adequate healthcare services in public centres,thereby forcing their patients to end up in their (private) clinics. Even patients have more faith in private hospitals and clinics in comparison to public ones,” he said.

Padma Deosthali from the Centre for Enquiry Into Health and Allied Themes (CEHAT),a research centre working on health advocacy,said public primary healthcare is almost non-existent,forcing those from lower-middle and middle class to opt for private services. “The ward-level health posts and maternity homes of the municipal corporation in Mumbai are in a bad state. At the secondary and tertiary level of healthcare,people have to deal with the apathetic attitude of government hospitals where referrals are slow and user fee is still being charged. So,instead of saying that the economically weak sections are opting for private healthcare,the truth is that they are being pushed out to these,” she said.

Dr Gustad Daver,medical director at Hurkisondas Nurrotumdas Hospital & Research Centre,however,said if 31 per cent is availing government healthcare services,it is still a “fairly large” number. “For diseases such as dengue,malaria and diabetes,people generally consult their neighbourhood private clinic; if it is a complicated surgery or an ailment like cancer,people seek multiple opinions,” he said.

Dependency on non-government healthcare facilities is the highest for ailments like cancer and diabetes with 78 per cent cancer and 71 per cent diabetes patients choosing private or charitable hospitals. Further,56 per cent of those suffering from malaria turn to private facilities,while 52 per cent with dengue opt for the same.

While the number of malaria cases has sharply declined in Mumbai,that of dengue has shot up. Dependency on government hospitals for malaria and dengue is 36 per cent and 31 percent respectively,higher than diabetes and cancer,in which 23 per cent and 13 per cent respectively seem to have faith in government services.

According to Dr Shubhangi Parkar,head of academics at KEM hospital,economically backward sections are apprehensive about getting treated in public healthcare centres due to the massive number of patients coming in daily. “I have seen cases where poor people go to private doctors for consultations because public hospitals are crowded. But they end up in public hospitals for treatment. They get diagnosed by private doctors,but since they cannot afford the private fees,they opt for treatment in public centres,” she said.

The study reveals that households spending over six per cent of their annual income on hospital or medical costs are maximum or 59 per cent in the lowest socio-economic strata or SEC E,followed by 56 per cent from SEC C,SEC D (54 per cent),SEC B (54 per cent) and SEC A (53 per cent). The figures are similar when we compare households spending over 11 per cent of their total annual income on medical or hospital costs — 17 per cent for SEC E,18 per cent for SEC A,B and C and 15 per cent for SEC D. On an average,the lowest socio-economic strata spends 7.6 per cent of total income on healthcare,more than the most affluent that spends 7.1 per cent.

Additional municipal commissioner Manisha Mhaiskar,however,said civic hospitals cater to lower income groups and poor people usually prefer coming to public hospitals for treatment.

mumbai.newsline@expressindia.com

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