Private Sector Dominates Healthcare
The role of private sector in India’s health care
has perhaps been underestimated so far. India has one of the highest
proportions of private health spending, comparable only to a few
countries in the world with a recent history of major internal unrest,
such as Cambodia and Myanmar.
Such is the lack of trust in the public health
system that not only do the wealthy 80 percent seek treatments in the
private sector, but a similar percentage of the poor also goes to
private practioners, even through the treatment may be low quality and
provided by untrained practioners.
The findings are part of a collaborative research undertaken by the
World Bank and institutions under the Union health and family welfare
ministry, which work towards binging about necessary health sector
reforms. Earlier studies had noted the role of private sector, but
this one completes the picture with statistics. The private sector,
the study says, accounts for :
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55 percent of all hospital admissions.
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40 percent of ante-natal and post-natal care.
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One-quarter of hospitalised Indians slip below
the poverty line because of hospital expenses alone.
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Hospitalised Indians spend more than half of
their annual expenditures on health care.
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More than 40 percent of those hospitalised
borrow money or sell assets to cover expenses.
Overall, the distribution of private services is
even more skewed towards the rich than the public sector. Indians
below poverty line are ten times more likely to be hospitalised in
Kerala than they are in Bihar, Punjab, Uttar Pradesh and Rajasthan.
Public health resources too are disproportionately distributed in
favour of higher-income groups. The poorest 20 percent of the
population receives only 10 percent of the benefits. As it is,
disparities across states and between groups are so striking that poor
show little benefits of reduction of mortality and morbidity; overall
the poorest 20 percent Indians have more than twice the rate of
mortality, malnutrition and fertility of the richest 20 percent.
Public health expert D Banerji says one of the
reasons for the continuing poor state of public health is low budgets.
And even when there is an external assistance worth several crores, it
is meant only for specific programmes and not for building
infrastructure.
Meanwhile, the World Bank has said it would support
projects that build health capacity and address issues of risk
protection for the poor as well as establish and strengthen new roles
for the public sector and engage the private sector.
One Lakh Fresh Cases of Kidney Failure Reported Every Year
Every year at least onenlakh fresh cases of kidney
failure are reported in India and the cumulative number of cases
amount to over 4.5 lakh in any given year. These are the observations
made by Dr S Sahariah, an eminent kidney transplant surgeon and the
man instrumental in the setting up of the renal transplantation unit
in Mahavir Hospital and Research Centre.
Dr Sahariah pointed out that more than two lakh kidney patients
were dying every year in the country due to lack of adequate kidney
donors and non-affordability of the treatment cost. Dr Sahariah, who
has performed over 1000 kidney transplants, with a success rate of
around 95 percent in Mahavir Hospital alone in a span of 20 years,
said every year at least four lakh patients needed either dialysis
treatment or kidney transplant for their survival.
"During the last two decades, over 15,000
kidney transplants has been done in various parts of the
country", he said. The senior surgeon said in the western
countries, nearly 90 percent of the kidney transplants were through
cadaver means (brain-stem death cases). In contrast, in India 99
percent of the transplants were from living donors. Though the law
allowed transplantation of cadaver organ in the country, the response
was very poor from cadaver patients due to lack of awareness of the
need for such noble donations among the public, he said.
Diabetic factor
Out of the one lakh fresh cases of kidney failures reported every
year, 20 to 30 percent of the cases were due to the complications from
diabetes. Eventually diabetes is among the top three diseases leading
to death. The surgeon said, "In the past, there was no early
treatment available for diabetic patients resulting in the death of
most of them. But now with the availability of improved drugs, they
live longer.
The patients now die due to its complications, and
not because of the metabolic disorder. With uncontrolled diabetes and
even without major symptoms, one is likely to suffer from kidney
ailment after a period of 10 to 12 years from the time of its
detection. The blood glucose level of more than 225 mgl for a long
period is a risk factor for kidney failure," he says.
The second important factor is high blood pressure.
"A person with untreated hypertension and even without any
symptoms is also prone to kidney damage", Dr Sahariah said.
Nephrites, congenial defects, kidney infection, etc. are the other
reasons for kidney damage.
Treatment cost
On an average of two dialysis a week, the treatment cost for a
renal failure patient amounts to Rs.8000 to Rs.10,000 a month, he
said. The cost for undergoing a kidney transplant ranged from Rs 1
lakh to Rs.3 lakh depending upon the possible complications and the
quality of drugs, the well known surgeon added.
Business of Health Injects New Life Into Sickly Economy
In terms of growth, healthcare is
the fastest-growing private consumption category. A 26 percent
compounded annual growth was seen in expenditure on medical and
healthcare services between the 1993-94 and 1999-2000 period.
Healthcare, at $2.8 trillion, is the world’s largest industry today.
The high growth rate suggests that the industry is headed in the same
direction in India.
The healthcare segment is by no
mean small – it’s close to a Rs.100,000 crore industry in India,
including the Rs.20,000 crore plus pharma segment. Although smaller
nursing homes account for a major chunk, standalone hospitals like
Indraprastha, Apollo, Escorts heart Centre, Bombay Hospital and
Hinduja Hospital generate revenues of over Rs.100 crore on a capacity
ranging between 200 and 600 beds.
In the Rs.20,000 crore plus pharmaceuticals
segment, which is relatively more organised, growth and strategies
will be driven by changes in pricing and patents policy. The industry
is likely to reach a size of Rs.29,370 crore with a growth of 14
percent.
[Ref: Economic Times, 29/11/01]
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