A reality check of the health sector

As India confronts the worst health crisis of a century, the gross inadequacies in its health system have been exposed. It is clear that a radical overhaul of the health sector must be an important element of the post-pandemic policy framework. Any such effort has to first recognise ground realities. The latest National Statistical Office (NSO) report on the consumption of health services in India can be an important
reference point.

The most important finding of the report is a bit counter-intuitive. It shows that both the share of Indians reporting themselves sick and getting hospitalised fell between 2014 and 2017-18. While this appears like good news, it is important to be cautious. Statistical and material reasons could have driven this change. The 2017-18 report is based on a full-year survey, unlike six-monthly surveys in the past two rounds. Seasonality can be a big factor in health outcomes. The year 2017-18 is also when the economy entered a deceleration phase. This was also the year when unemployment was at high levels. The poor in India tend to under-report illnesses. This is not surprising, as an overwhelming majority have to pay for health expenses from their own pockets. To be sure, the latest report does not account for coverage under Ayushman Bharat scheme which was launched in September 2018. But did worsening economic conditions force people to forego even necessary medical care? Hospitalisation can be expensive for most Indians. An average hospitalisation case cost Rs 16,676 and Rs 26,475 in rural and urban areas, respectively. The average monthly wage of a regular worker — the best employment category in India — was Rs 15,504.

Affordability is not the only red flag in the report. Infections are the biggest reason for ailments and hospitalisations in India. A lack of personal and perhaps clinical hygiene — hospitals spread infections as well — makes citizens even more vulnerable to pandemics such as the current one. Critics rightly underline the importance of allocating more resources to ramp up the country’s health sector. Resources are needed, but so is behavioural change, show the latest NSO findings. India has to take this into account while planning a revamp of the health policy.