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REDUCING THE POOR’S HEALTH BURDEN

Relevance:

• GS 1 – Poverty and developmental issues
• GS 2 – Issues relating to poverty and hunger.

Why in the news?

• The Household Consumption Expenditure Survey (HCES 2022-23) shows a significant reduction in poverty rates since 2011-12.
• Beyond poverty, the focus should be on the vulnerability of households to adverse shocks, particularly those in the bottom 50% of the population.
• A household’s ability to cope with adverse shocks is crucial for overall well-being and is a key measure of welfare.
• Quantifying a household’s vulnerability to shocks remains a challenging task.

Household Vulnerability as a challenge

• Increase in Hospitalisation Expenditure: The proportion of households in the bottom 50% incurring hospitalisation expenses increased from 17% in 2011-12 to 22% in 2022-23. For rural households, this figure rose from 18% to 23%, and for urban households, it increased from 16% to 20%.
• Improved Healthcare Accessibility: This increase reflects a significant improvement in access to healthcare for the poorest 50% of the population across both rural and urban areas of India.
• Health Expenditure Ratio Analysis: For the bottom 50% of households, health expenditure without hospitalisation increased slightly from 3.3% of monthly household expenditure in 2011-12 to 3.6% in 2022-23.
• In contrast, households that experienced hospitalisation saw a notable decline in the share of health expenditure as a ratio of their monthly household expenditure, decreasing from 10.8% to 9.4% over the same period.
• Economic Burden: Health shocks not only restrict individual freedom but also impose a heavy economic burden on families as essential resources are redirected from other needs to cover medical costs.

Rural-Urban Differences in Health Expenditure Ratios

These findings indicate that healthcare involving hospitalisation expenses is becoming more affordable for the poorest 50% of the Indian population, especially in rural areas.

• Rural Areas:
  • For the bottom 50%, the ratio of health expenditure without hospitalisation increased slightly from 3.4% to 3.6% over 11 years.
  • For households that experienced hospitalisation, the ratio significantly declined from 11.15% to 9.14% during the same period.
• Urban Areas:
  • The ratio of health expenditure for households without hospitalisation increased marginally from 3.2% to 3.6%.
  • For those that experienced hospitalisation, the ratio decreased from 10.3% to 9.9%.

Impact on Consumption Status Due to Hospitalisation

• The aim is to demonstrate that households with high medical spending due to hospitalisation may not have sufficient resources for other essential items.
• Vulnerability and Consumption Status:
  • Among the poorest 50%, 40% of households that experienced hospitalisation in 2011-12 faced a decline in consumption status.
  • By 2022-23, despite the rise in hospitalisation incidence, only 33% of these households experienced a decrease in consumption status.
• Reduction in Odds of Decline:
  • These results indicate a 23% reduction in the odds of households facing a decline in consumption status due to hospitalisation.
  • This effect is more pronounced in rural areas, where 44% of the bottom 50% of households that incurred hospitalisation expenses faced a decline in consumption status in 2011-12, reducing to 36% by 2022-23—a 29% reduction in odds.
  • For poor urban households, the odds of facing a decline in consumption status due to hospitalisation fell by 14% over the 11 years.

Healthcare Accessibility and Affordability

• Increased Accessibility and Affordability: Over the past decade, healthcare has become more accessible and affordable for the bottom 50% of the Indian population.
• Decline in Vulnerability: There has been a significant decline in the odds of households facing a loss in overall consumption status due to the financial burden of hospitalisation, a key indicator of reduced vulnerability.
• Rural Households and Vulnerable Groups: The positive trends are more pronounced among rural households. Households with young children and elderly members show particularly strong improvements.
• Public Health Policy Impact: These trends are closely linked to public health initiatives in India, especially the Ayushman Bharat Yojana, which aims to alleviate the financial burden of hospitalisation for the poor.

Way Forward

• Enhance Public Health Initiatives: Strengthen and expand programs like the Ayushman Bharat Yojana to ensure broader coverage and accessibility for low-income households.
• Focus on Rural Healthcare: Increase investment in rural healthcare infrastructure to further improve access and affordability for the poorest segments, addressing the specific needs of rural populations.
• Strengthen Health Insurance Coverage: Promote health insurance schemes tailored for low-income families to reduce out-of-pocket expenses and financial risks associated with hospitalization.
• Monitor Health Expenditure Trends: Regularly assess health expenditure ratios and hospitalization rates to identify trends and areas needing intervention, ensuring timely responses to emerging challenges.
• Support Vulnerable Groups: Implement targeted support for households with young children and elderly members, who may face higher health risks and financial burdens due to medical expenses.
• Promote Preventive Healthcare: Encourage preventive healthcare measures and regular health check-ups to reduce the incidence of severe health issues that lead to hospitalization.
• Facilitate Access to Essential Medicines: Ensure the availability and affordability of essential medicines and treatments, particularly in underserved areas, to reduce overall health expenditure.
• Encourage Community Health Programs: Foster community-based health programs that provide localized support and resources, enhancing overall health outcomes and reducing vulnerability.
• Evaluate Policy Impact: Continuously evaluate the effectiveness of health policies and programs, making data-driven adjustments to improve their impact on poverty reduction and health accessibility.

Alternative articles

https://universalinstitutions.com/analysis-of-public-health-spending-in-india/

https://universalinstitutions.com/a-system-that-heals/

Source: https://indianexpress.com/article/opinion/columns/ayushman-bharat-india-poor-9501487/

Mains question

Discuss the impact of public health policies on healthcare accessibility and affordability. Access the household vulnerability in rural and urban India over the past decade.” (250 words)