Health Spending

The Fortis case is no exception – these charts show how healthcare costs are soaring in India

Two-thirds of Indians now rely on private hospitals and the cost of hospitalisation has risen by 200% in 10 years.

Health Minister JP Nadda has asked Fortis Memorial Research Institute in Gurugram for a detailed report into the death of seven-year-old Adya Singh after her family alleged medical negligence and that the hospital had overcharged them. The child had been taken to the hospital with a severe case of dengue and had been treated for two weeks but died. The family spent almost Rs 16 lakh at the hospital during this time.

The girl’s father Jayant Singh told reporters that the family spent close to Rs 4 lakh on medicines, Rs 2.85 lakh on medical and surgical procedures, Rs 2.17 lakh on medical investigations including blood tests, Rs 29, 290 on other diagnostics and Rs 2.73 lakh on medical consumables including up to 2,700 gloves. They were billed for admission charges, room rent, doctor’s fees and equipment charges.

The family had medical insurance cover of only up to Rs 3 lakh and had to pay everything else out of pocket.

While enquiries may reveal whether Fortis hospital overcharged the Singh family, their tragic case also highlights the soaring costs of healthcare in India.

It has been said time and again that India’s investment in public health has been abysmally low. The government spends only 1.4% of gross domestic product on health. Even its target of bringing health expenditure up to 2.5% of GDP is far less than what most other countries spend on the health of their people. This feeble government spending has created a vacuum which is now filled by private health sector, which has grown in leaps and bounds, spending more than double of what the government does at 3.3% of GDP. This brings India’s total investment in health to 4.7% of GDP, still far short of the world average investment of 10% of GDP.

Low public health investment has resulted in high out-of-pocket expenditure for people availing of health services. Data from the National Sample Survey Office shows that not only are more Indians being hospitalised in recent years, almost two-thirds of all Indians seeking medical treatment go to private hospitals. The NSSO’s report on health in India based on a survey conducted between January and June 2014 shows that 79 people for every 1,000 were hospitalised. This is up from 54 people in 2014 and 33 people in 1995-’96.

As much as 68% of all hospitalisation cases in urban areas and 58% in rural areas now are at private hospitals.

This over-reliance on private hospitals allows hospitals to charge substantially more than government facilities. As public health activists often point out, healthcare is not like any other consumable where the consumer can hold out for better prices. When faced with the prospect of a sick or dying relative, a person will choose to expensive tests and procedures. Patients and families who are given choices between less and more expensive drugs, tests or procedures will choose the more expensive one, equating the higher price with better guarantee even though the more expensive drug, test or procedure may not be scientifically proven to be better.

According to the NSSO’s 2014 survey, the average cost of medical treatment for hospitalisation was Rs 18,268. This does not include non-medical costs incurred during hospitalisation. There were also large variations in the amounts spent at public and private hospitals.

The cost of hospitalisation in both rural and urban areas have risen by almost 200% between 2004 and 2014.

The NSSO’s analysis of non-hospitalised treatment procedures shows that costs at private hospitals are about twice as much as those in public hospitals, and generally higher in urban areas compared to rural areas. Most of this expenditure is on medicines.

Most of all this expenditure of out-of-pocket for people seeking treatment. Out-of-pocket expenditure is still more than 60% of all health expenditure, highlighting the failure of public investment in healthcare. Meanwhile more than 80% people across India do not have any kind of government or private health insurance to cover regular and emergency medical spending.

An analysis by Scroll.in in August this year shows that the healthcare is making money for private players as the government fails to step up investment. There has been massive private investment in large hospitals and chains of diagnostic centres, but with a sharp focus on profitability. Foreign direct investment has risen sharply since 2014.

All this investment and the dominance of the private sector in India’s healthcare has brought enormous earnings to the top healthcare companies. According to rating agency ICRA’s analysis of five big hospital chains – Apollo, Fortis, Narayana Hrudayalaya, Max India Limited and Healthcare Global Enterprises Limited – revenues of these entities alone touched Rs 12,990 crore in the year ended March 2017. This is an increase of about 80% over the course of a five-year period starting March 2012. Meanwhile, their profits grew by Rs 770 crore during the same period to touch Rs 1,890 crore by this March. This is an increase of 68.75%.

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People who fall through the gaps in road safety campaigns

Helmet and road safety campaigns might have been neglecting a sizeable chunk of the public at risk.

City police, across the country, have been running a long-drawn campaign on helmet safety. In a recent initiative by the Bengaluru Police, a cop dressed-up as ‘Lord Ganesha’ offered helmets and roses to two-wheeler riders. Earlier this year, a 12ft high and 9ft wide helmet was installed in Kota as a memorial to the victims of road accidents. As for the social media leg of the campaign, the Mumbai Police made a pop-culture reference to drive the message of road safety through their Twitter handle.

But, just for the sake of conversation, how much safety do helmets provide anyway?

Lack of physical protections put two-wheeler riders at high risk on the road. According to a recent report by the World Health Organisation (WHO), more than 1.25 million people die each year as a result of road traffic crashes. Nearly half of those dying on the world’s roads are ‘vulnerable road users’ – pedestrians, cyclists and motorcyclists. According to the Indian transport ministry, about 28 two-wheeler riders died daily on Indian roads in 2016 for not wearing helmets.

The WHO states that wearing a motorcycle helmet correctly can reduce the risk of death by almost 40% and the risk of severe injury by over 70%. The components of a helmet are designed to reduce impact of a force collision to the head. A rigid outer shell distributes the impact over a large surface area, while the soft lining absorbs the impact.

However, getting two-wheeler riders to wear protective headgear has always been an uphill battle, one that has intensified through the years owing to the lives lost due on the road. Communication tactics are generating awareness about the consequences of riding without a helmet and changing behaviour that the law couldn’t on its own. But amidst all the tag-lines, slogans and get-ups that reach out to the rider, the safety of the one on the passenger seat is being ignored.

Pillion rider safety has always been second in priority. While several state governments are making helmets for pillion riders mandatory, the lack of awareness about its importance runs deep. In Mumbai itself, only 1% of the 20 lakh pillion riders wear helmets. There seems to be this perception that while two-wheeler riders are safer wearing a helmet, their passengers don’t necessarily need one. Statistics prove otherwise. For instance, in Hyderabad, the Cyberabad traffic police reported that 1 of every 3 two-wheeler deaths was that of a pillion rider. DGP Chander, Goa, stressed that 71% of fatalities in road accidents in 2017 were of two-wheeler rider and pillion riders of which 66% deaths were due to head injury.

Despite the alarming statistics, pillion riders, who are as vulnerable as front riders to head-injuries, have never been the focus of helmet awareness and safety drives. To fill-up that communication gap, Reliance General Insurance has engineered a campaign, titled #FaceThePace, that focusses solely on pillion rider safety. The campaign film tells a relatable story of a father taking his son for cricket practice on a motorbike. It then uses cricket to bring our attention to a simple flaw in the way we think about pillion rider safety – using a helmet to play a sport makes sense, but somehow, protecting your head while riding on a two-wheeler isn’t considered.

This road safety initiative by Reliance General Insurance has taken the lead in addressing the helmet issue as a whole — pillion or front, helmets are crucial for two-wheeler riders. The film ensures that we realise how selective our worry about head injury is by comparing the statistics of children deaths due to road accidents to fatal accidents on a cricket ground. Message delivered. Watch the video to see how the story pans out.

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This article was produced by the Scroll marketing team on behalf of Reliance General Insurance and not by the Scroll editorial team.