In India, the rich and the upper class can take advantage of the best healthcare service through the private sector, while for nearly 600 million middle class, as well as the rural and urban poor, quality, affordable healthcare is beyond their reach.
Related Article:Certified polio-free in 2014, India remains watchful
Despite being the world’s youngest and fastest growing economy, India remains at the bottom of the United Nations Development Index. Healthcare inequities contribute greatly to India’s low standing. Irrespective of progress in improving access to healthcare, inequalities by socioeconomic status, geography and gender continue to persist.
Research by The Policy Times shows that this is compounded by out-of-pocket expenditures, with the rising financial burden of healthcare falling overwhelming on private households, which account for more than three-quarter of health spending in India. According to a study, ‘Health care and equity in India’, health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasingly pushing about 39 million Indians into poverty each year.
“Many of these health inequalities result from a broad set of social, economic and political conditions which influence the level and distribution of health within a population,” says the study. “Addressing these structural factors is important as some of these health inequalities may result from unjust distribution of primary social goods, power and resources.”
Redressing any inequalities in health can be considered a primary goal of public policies, with health systems having a specific and special role in achieving equity, with efficiency.
Jean Dreze, a development economist, said the problem in healthcare is worse because the privileged rely mainly on private medical facilities, so what happens in a public hospital is of little concern to them. Dreze explained that an enormous social distance separates the doctors who run public hospitals and their patients, especially in states like Uttar Pradesh. Giving the ‘Gorakhpur tragedy’ as an example, he said there is a general lack of attention being given in India to basic needs, especially those of poor or marginalized people.
“Illness itself also disempowers the patients. In all these ways, they are far removed from the levers of power and influence. So, the system gets away with an appalling lack of accountability.” The development economist said funding is not the only difficulty. “There are issues of management, corruption, accountability, ethics and so on. The main problem is healthcare is way down the political agenda.”
Dreze said the overarching responsibility for funding, planning and managing public health centres must remain with public authorities.