Free healthcare is a myth

Consider this. A staggering 66.8 per cent of the total health expenditure in the State is borne by patients themselves with the State government playing a relatively minor role when it comes to taking care of the health of its citizens.

On an average, rural households shell out Rs 7,918 per admission for treatment in private hospitals. Even in government hospitals, patients have to pay an average of Rs 2,610 per admission. The latter being user fee and cost of medicines that need to be purchased from private pharmacies.

These statistics have prompted a high-level study panel set up by the Karnataka Knowledge Commission (KKC) to recommend that the government immediately increase the overall budgetary allocation to the health sector from the present five to at least seven per cent.

It has further recommended that user fees at tertiary level government hospitals (speciality hospitals with surgical facilities), especially autonomous ones, be scrapped with immediate effect.

The six-member study group, headed by community health expert H Sudarshan, who is also the secretary of the Karuna Trust, has cautioned that high ‘Out-Of-Pocket’ (OOP) expenditure by individual households on healthcare had the danger of pushing families into “debt and poverty”.

In Karnataka, individual households bear the major burden of financing healthcare (66.8 percent). On the other hand, government (local, state and Central) expenditure only accounts for 28 per cent of the total health expenditure.

The group, besides studying the status of delivery of health service in the State, has drawn on statistics from State Health Accounts 2004-05 and the 60th round of the National Sample Survey Office (NSSO) to arrive at its recommendations.

The report notes that there has been a decreasing commitment of the State to spend on healthcare. Statistics speak. At the turn of the millennium, the State government allocated more than five per cent of the total budget for healthcare. A decade later, the allocation has reduced to 3.8 per cent. The plan allocations have reduced from 8.1 per cent in 2001-02 to 4.9 per cent in 2009-10.

The panel has suggested that increased budgetary allocation should be channelised to enhance supply of medicines to government hospitals. The study group has recommended allocation of taxes from sale of tobacco products for healthcare.

The report states that with the introduction of the Yashaswini insurance scheme by the government, the proportion of patients who are accessing surgical services, especially among the low and middle income groups will increase. But the impact will be small, as surgical treatments are only a minuscule portion of all hospitalisation. With the introduction of Rashtriya Swasthya Bima Yojana (RSBY) in five districts, one can expect an increase in access to hospital care among below poverty line (BPL) families.

The panel has recommended that the State government set up a nodal agency comprising government officials, academicians and insurance company representatives to develop a policy on health insurance in the State.

Besides, the panel has suggested that the government should expand the existing RSBY scheme to all districts with an ultimate goal to provide universal access to healthcare for all.