Eleventh Five Year Plan

68 Eleventh Five Year Plan3.1.36 Public spending on health in India is amongstthe lowest in the world (about 1% of GDP), whereasits proportion of private spending on health is one ofthe highest. Households in India spend about 5–6%of their consumption expenditure on health (NSSO).The cost of services in the private sector makes itunaffordable for the poor and the underprivileged.HEALTH CARE UTILIZATION3.1.37 Despite a steady increase in public health careinfrastructure, utilization of public health facilities bypopulation for outpatient and inpatient care has notimproved. The NSSO (1986–2004) data clearly showa major decline in utilization of the public healthfacilities for inpatient care and a corresponding increasein utilization of the same from private healthcare providers in both rural and urban areas (Figures3.1.10 and 3.1.11). With the exception of a few States,there has been very low utilization for outpatient careas well (Figure 3.1.12). Despite higher costs in the privatesector, this shift shows the people’s growing lackof trust in the public system. Critical shortage of healthpersonnel, inadequate incentives, poor working conditions,lack of transparency in posting of doctors inrural areas, absenteeism, long wait, inconvenient clinichours, poor outreach, time of service, insensitivity tolocal needs, inadequate planning, management, andmonitoring of service/facilities appear to be the mainreasons for low utilization.COST OF TREATMENT BY HOUSEHOLDS3.1.38 According to NSSO (60th Round), the averageexpenditure for hospitalized treatment from a publichospital was less than half that of private hospitalin rural areas and about one-third in urban areas(Figure 3.1.12). There are also inter-State variations.The cost per hospitalization in government hospitalwas lowest in Tamil Nadu (Rs 637 in rural areas andRs 1666 in the urban areas) and highest in ruralHaryana (Rs 11665) and urban Bihar (Rs 30822).The cost of hospitalization in private hospitals washighest in Himachal Pradesh (Rs 14652 in ruralareas and Rs 23447 in urban areas) and lowest in ruralKerala (Rs 4565) and urban Chhattisgarh (Rs 4359),respectively.3.1.39 As per NSSO 60th Round, during 2004, 24%of the episodes of ailments among the poor wereuntreated in rural areas and 22% in urban areas. Lackof finances was cited as a reason by 28% of personswith untreated episodes in rural areas and 20% inurban areas. It is also notable that 12% cited lack ofmedical facility as the cause of not receiving treatmentin rural areas.Review of Tenth Plan Schemes3.1.40 The Tenth Five Year Plan (2002–2007) indicatedthe dismal picture of the health services infrastructureand emphasized the need to invest more on buildinggood primary-level care and referral services.The plan emphasized on restructuring and developingthe health infrastructure, especially at the primarylevel. The plan highlighted the importance of therole of decentralization but did not state how thiswould be achieved. Programme-driven health carewas in focus. Verticality and technical solutions were70605040302010059.756.2 58.340.343.8 41.71986–87 (42nd) 1995–96 (52nd) 2004 (60th)70605040302010060.356.961.839.743.138.21986–87 (42nd) 1995–96 (52nd) 2004 (60th)GovernmentPrivateGovernmentPrivateSource: NSSO 60th Round (2004).Source: NSSO 60th Round (2004).FIGURE 3.1.10: Percentage of Cases of Hospitalized Treatmentby Type of Hospital in Rural AreasFIGURE 3.1.11: Percentage of Cases of Hospitalized Treatmentby Type of Hospital in Urban Areas