16% of Indians pushed into poverty by rising health costs

from One World South Asia

According to a World Health Organisation survey, many Indian families, whose inability to access or afford water, sanitation and nutritious food has made them more prone to ill-health, have been pushed below the poverty line by the rising cost of healthcare

More than 40% of low-income families in India have to borrow money from outside the family to meet their healthcare costs, says a World Health Organisation (WHO) study on the impact of rising health costs. The study found that 16% of families were pushed below the poverty line by this phenomenon.

The ‘World Health Survey’, conducted by the Indian Institute of Population Sciences (IIPS) on behalf of the WHO in six Indian states, also found that 12% of such families had to sell their assets to cover the medical expenses of family members.

The survey interviewed 10,000 families in the lower income group in Maharashtra, Karnataka, Himachal Pradesh, West Bengal, Tamil Nadu and Uttar Pradesh between 2002 and 2005. The results were declared in late-2006.

A whopping 43.3% of those interviewed said they could not foot the cost of their medical bills and had to borrow money to meet expenses.

Additionally, the survey noted, clean drinking water, basic sanitation, proper nutrition and pollution-free fuel, still unavailable to a majority of the poor in India, made lower income groups more vulnerable to disease and health hazards, eventually leading to higher health expenditure. For instance, nearly 84% of such families cannot afford vegetables and fruit due to the spiralling cost of food.

According to the WHO, when a household is forced to reduce its basic expenses over a certain period of time to cope with the medical expenses of one or more of its members, it is called ‘catastrophic healthcare spending’. In India, over 12% of the poor fall in this category.

While the average expenditure on health of a middle-class Indian family is Rs 116.7 a month, the figure rises to Rs 202 for the poor -- which is half their monthly income.

Surprisingly, the biggest chunk of expenses is for medicines, which the poor should get free from government hospitals. “Many times, the medicines are either not available or not offered to the poor, with increasing privatisation in government hospitals,” says a public health expert in Mumbai.

With no insurance, the poor are left with no choice but to spend out of their own pockets. “A serious policy intervention is required to develop insurance as an important source of health financing,” says P N Mari Bhat, director, IIPS, and one of the investigators in the survey.

The privatisation bug has also infected many health schemes like free check-ups and treatment for the poor at government hospitals, free medicines and free beds. “The policy framework never focused on improving the overall health conditions before withdrawing welfare schemes owing to privatisation,” claims Arun Bal of the Association for Consumers’ Action on Safety and Health (ACASH) in Mumbai.

“The state governments are not interested in creating healthy and hygienic living conditions in the cities and villages. Due to this, the poor fall ill and are forced to spend more,” he concludes.