The private sector dominates the healthcare system in Maharashtra with nearly three-fourths of the state’s residents preferring private hospitals over government ones.
The 75th round of the National Sample Survey on household consumption related to health, released in July, stated that 73.7 per cent of all those who were hospitalised in the state for treatment, excluding for childbirth, had been treated in private hospitals.
By comparison, the national average for those who sought treatment in private hospitals is 55.3 per cent.
In Maharashtra, 22.2 per cent people availed treatment in public hospitals as against the national average of 42 per cent while 4.1 per cent availed treatment in charitable hospitals as against the national average of 2.7 per cent.
The 75th round, the latest survey conducted by the National Sample Survey Office (NSSO), was held from July 2017 to June 2018 – three years before the Covid-19 pandemic, which has seen both the Centre and state governments ramp up existing public health infrastructure, while the private health sector had to be persuaded by the states to participate in the anti-Covid efforts.
The survey, conducted periodically, is done to assess expenditure on health-related activities as well as access to private and public health facilities. It had a representative sample of 5.5 lakh people in both rural and urban areas.
“The growth of the public healthcare system has been restricted due to the state’s policies. A very limited range of services are available in public hospitals and no serious heed has been paid in augmenting the facilities over the years. This has led to a spillover in private hospitals, which have grown as people do not have any option left,” said T Sundaraman, former dean of School of Health System Studies at Tata Institute of Social Sciences.
Over the years, the void left by the fund-starved public health care system has been filled by private hospitals and corporatised hospital chains.
In the 2020-21 state Budget, Maharashtra had allocated 4.3 per cent of its expenditure for health, which is lower than the average allocation for health by states. Maharashtra’s allocation to health has remained nearly constant at 4 per cent since 2016-17. However, the Covid-19 pandemic may bring some changes in the way India thinks about its healthcare infrastructure, officials said.
In an interview to The Indian Express last month, state Health Secretary Pradeep Vyas said there was an all around realisation of the poor investment in public health systems over the years. “Everybody, in policy making and in the finance department, have realised that now… maybe we will get more funds in the budget for health now,” he added.
The study stated that the average medical expenditure per hospitalisation case in Maharashtra, excluding those for childbirth, is Rs 19,383 for rural areas as compared to the national average of Rs 16,676. For urban areas, it is Rs 36,612 as against the national average of Rs 26,475.
The average medical expenditure in private hospitals in rural areas is almost four times that in government hospitals. As per the survey, patients spend Rs 5,606 per hospitalisation in government hospitals as against Rs 23,821 in private units. The difference in cost rises to over seven times in urban centres where the average spend in government hospitals is Rs 7,189 as against Rs 42,540 in private hospitals.
As per the survey, nearly 97.6 per cent of those needing hospitalisation in rural areas are not covered under any health expenditure support scheme while the figure for the same in for urban areas is 85.6 per cent. This means that a large number of people fund their treatment through either their savings or household incomes. Some have to borrow money.
As per the survey, 8.8 per cent of patients in rural areas of Maharashtra, who were hospitalised, had to borrow money compared to the national average of 13.4 per cent. In urban areas, 3.8 per cent were forced to borrow money as against the national average of 8.5 per cent.
“We have seen the role played by public hospitals during the pandemic. Wherever facilities are available, people have not shied away from approaching public hospitals. There is a need for wider investment in public hospitals to create a robust health care system,” Sundaraman said.
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