Health Policy Issues and Health Programmes in ... - Amazon S3

Household Health Care Costs in Indiachronic illness. Similarly, Kulkarni and Chitanand (1994) find that, in Maharashtra, the treatmentcost for a major illness is 12-15 times greater than the cost for a minor illness.Several other studies present interesting findings about the cost of treatment. Studies byKrishnan (1994) find that (1) the cost of treatment is higher in states where the public healthinfrastructure is least developed; (2) poor patients pay more for health care and bear the higherburden of treatment (See section on Policy Issues); (3) hospitalization increases the intensity ofpoverty for poor families; (4) treatment in private hospitals, either as an in-patient or an outpatient,is expensive and out of reach of the poor; and (5) the burden of treatment is the highestfor women, due to the inaccessibility of affordable services.Another study by Gumber and Berman (1997) finds that (1) the in patient treatment tends to bequite expensive and burdensome; (2) for both in patient and out patient care, the burden tendsto be higher in rural areas as most rural patients have to travel to the health care facilitieslocated in urban areas; (3) in cases of no insurance coverage and longer duration of treatment,the financial burden of treatment on households was much higher if the patient was treated in apublic sector institution; (4) there exist inter-state differentials in the burden of treatment whichwere more pronounced for in-patient treatment; and (5) the burden of treatment is inverselyproportional to monthly per capita expenditure.Table 1. Per Capita Annual Health ExpenditureStudy Scope of Study Per Capita HealthExpenditure, Annual(in rupees)National Service System42nd Round, 1992 National 248Duggal and Amin, 1989 Jalgaon 182George, 1997 Madhya Pradesh 299Kulkarni and Chitanand, 1994 Maharashtra 415A few studies attempted to estimate the percapita annual health expenditure (NSSO,1992; Duggal and Amin, 1989 [Jalgaon];George, 1997 [Madhya Pradesh]; and Kulkarniand Chitanand, 1994 [Maharashtra]). Asshown in Table 1, estimates range from Rs182 to Rs 415 per capita.Only the Madhya Pradesh and Jalgaonstudies have directly estimated the share ofhousehold health expenditure of the total income/expenditure. Other studies calculate thisshare indirectly. The proportion ranges between 5% and 15% in the Bombay (Yesudian, 1990)and National Council for Applied Economic Research (NCAER) (Sundar, 1992) surveys,respectively. The National Sample Survey (NSS) 1992 reports that the share of health expenditureof total income is 5.7%. None of these studies have provided estimates of the total annualamount spent on RCH services.142Only two studies (Sujata Rao et al., 1997; Duggal and Amin, 1989), collected information regardingthe source of money that was used by the household to pay out-of-pocket costs. The study bySujata Rao et al. (1997) in Hyderabad reports that about 50% of the families with at least onemember with a health problem financed their health care payments with loans or distress sale oftheir assets. The median amount of loan was Rs 4000–5000, for which monthly interest between3%-5% was paid. According to Duggal and Amin (1989), 1.3% of all episodes of illness were