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Two-thirds of healthcare spending in India is out of pocket, or done by the common man, according to a study by the Institute for Health Metrics and Evaluation, University of Washington. At 65.6 per cent, the study places India sixth among 25 countries where out-of-pocket personal spending on healthcare in 2014 was 50 per cent or higher. Sudan leads the list at 76.6 per cent, followed by Yemen, Azerbaijan, Nigeria and Cameroon ahead of India.
Spending on healthcare by nations is expected to increase significantly over the next two decades, but the rates of increase and sources of spending will differ widely, according to the analysis, “Future and potential spending on health, 2015-2040,” published in The Lancet Wednesday.
Countries with 50 per or more out-of-pocket health spending make up one of three lists compiled in the state. Another list compares countries with 10 per cent or lower personal spending on healthcare, headed by Seychelles (2.4%) and followed by Kiribati, Solomon Islands, Cuba, Botswana and the Netherlands (5.3%). The third list is of 15 countries whose governments financed 80 per cent or more of total health spending in 2014; this one is headed by Cuba (95.5%), followed by Brunei, Seychelles, Oman, the Netherlands and Samoa, and includes Japan, the UK and New Zealand among the 15.
Another simultaneous study examines health spending trends globally between 1995 and 2014. The work was conducted by a health financing collaborative network, a group of nearly 250 economists and researchers in more than 60 counties.
“India is known to have one of the highest out-of-pocket expenditures on health globally,” says Dr Anita Kar , Director of School of Health Sciences at Pune University and one of the contributors to studies on the global burden of disease. She cites the growth of private healthcare, saying the government had roped in private practitioners initially to assist in the task of addressing high morbidity and mortality after Independence and given them special incentives to ensure health services would be available till the time the government was capable of offering health facilities for the population. However, she says, the private sector proliferated in terms of hospitals as witnessed by lack of uniform costs across the country. Development of public-private collaborations, where public responsibility is being slowly shifted to the private sector, is exposing people to the risk of out-of-pocket expenditure, Kar says.
“Development assistance for health is no longer an expanding cushion for low-income countries’ health budgets,” says Dr Christopher Murray, IHME director. “Following a decade of impressive worldwide expansion, that growth in funding has stagnated.”
In India, the development assistance for health for a population of 1.3 billion is a total of $650 million out of which the majority is provided for child and newborn care ($230 million) and maternal health ($110 million).
If current trends continue, overall expenditures will increase from $9.2 trillion in 2014 to $24.5 trillion in 2040, conclude the researchers.”Our study shows that health spending is likely to increase rapidly in high-income countries, while low-income countries, where it is needed the most, are expected to see relatively slow growth,” says Dr Joseph Dieleman, assistant professor at IHME and the primary author of the study.
Dr Murray notes that from 2000 to 2010, development spending on health grew at 11.4 per cent annually, but since 2010, it has risen only 1.8 per cent per year. Funding for HIV/AIDS, for many years the largest health focus area, has begun to decline.