Analysis of Health Expenditure of India

In order to address the persistence of inequities in health and access to health services in India, we identify four key areas that require urgent attention and actions. Most of the equity enhancing programmes are centrally sponsored, time bound and vertical interventions. They are sponsored and implemented by separate ministries with little coordination let alone synergies between programmes. There has been a tendency for these newer initiatives to target the socially marginalised and those below poverty line. Our analysis of burden of expenditure shows that while the poorest are worst affected, the burden is substantial even for the middle quintiles. This holds true for outpatient and inpatient care in rural and urban areas. This raises concerns regarding targeted approaches that focus only on poorest, but argues for universal access to health services.

Given the number of programmes that are focusing on the poor and socially marginalised, the need arises for enhanced public investments and greater synergies at different levels of implementation within and across ministries.

Comprehensive regulation of the public and private sectors is required in provisioning, medical technology and pharmaceuticals. This is critical for controlling costs and improving quality and accountability. Provider behaviour, an essential component of quality and accountability, requires innovative approaches that permit a greater voice in monitoring performance to beneficial communities and their representatives. For the private sector, accountability can be assured by a combination of legislation, involvement of professional organisations, consumer rights groups and public action. The way forward in the public sector could be the implementation of the Indian Public Health Standards and a combination of incentives and disincentives to induce greater sensitivity and accountability of providers at the panchayat or the municipality level.

New and innovative systems of monitoring performance and evaluating progress towards equitable health outcomes need to be introduced. It would be worthwhile, for instance, to adopt the idea of institutionalising a health equity gauge that helps to track inequities, similar to that initiated in South Africa and adopted by a few middle- and low-income countries at the central and state levels. Another innovative initiative is seen in the case of Health Councils in Brazil that have institutionalised health issues as a primary policy concern both at the local and national levels as a citizen's right. The present government can build further on the steps they have started, and address inequalities in availability, utilisation and affordability with greater seriousness, as well as a courtship of democratic voices and the rules of deliberative democracy.

Health security in India needs to become an urgent national and political priority. Rapid improvements in health are needed not only to accelerate and sustain India's economic growth; they are also fundamental to India gaining recognition as a distinguished middle-income country with improved standards of living and reduced levels of human deprivation. Focusing on health equity will be critical to enhancing human capabilities and advancing the progress of Indian society over the next decade.