Between 2014 & 2018, Average per hospitalization expenditure in Private hospitals increased by 23%
Sai Krishna Muthyanolla
September 23, 2020
The 75th round of NSS report on Health indicates that the average per hospitalization expenditure in private hospitals increased by 23% between 2014 & 2018. During the same period, the per hospitalization expenditure in public health care facilities decreased.
Recently, the Ministry of Statistics and Programme Implementation (MOSPI) has released the results of its 75 round of National Sample Survey (NSS).  The survey was conducted during July’2017 – June’2018.  One of the reports published by MOSPI as part of this survey is Health in India report.  The earlier survey on health was conducted as part of the 71 round of NSS for the period January-June’2014. This health report, as part of National Sample Survey on Household Social Consumption helps in gathering basic information related to health sector like – morbidity, profile of the ailments, their treatments, role of government & private facilities in providing healthcare, medical expenditure, maternity, childbirth etc.
In this story we look into the survey findings regarding the trends in expenditure on health in India.
Average expenditure on treatment per hospitalization in a private hospital has increased by 23%
The average expenditure incurred for treatment per hospitalization in a private hospital during the 365-day period of 75 round of survey was Rs. 31,845. Meanwhile, the average expenditure for the same during the earlier round of health survey i.e. during 71 round of NSS (Jan-Jun’ 2014) was Rs. 25,850 which means this has increased by 23%.
The expenditure in case of hospitalization includes – bed charges, doctor’s fee, cost of medication, diagnostic tests, etc. These figures for expenses of hospitalization are excluding the expenses incurred for hospitalization for purpose of childbirth.
There is a large variation between the expenditure in private hospital in Urban areas and Rural areas. As per the survey results, the average medical expenditure incurred in an Urban private hospital for each hospitalization was Rs. 38,822 as per the 75 round of survey, whereas in the earlier survey it was Rs. 28,165 i.e. an increase of nearly 38% . Although, not in the same proportion as urban hospitals, even expenditure incurred in rural private hospitals has also increased significantly. In the latest survey, the average expenditure of hospitalization in a rural private hospital was Rs. 27,347 and  has increased by around 25% compared to 71 round of survey.
Unlike in the private hospitals, the expenditure incurred in a government hospital has reduced during the current survey period compared to previous round of survey. This is the case for government hospitals in both rural and urban areas.
Average Expenditure per hospitalization is higher for Males compared to Females
As per the survey results, Indian households spend more on the hospitalization in case of males when compared to females.  This trend is constant across both Rural and Urban locations as well as the type of hospitals.
In Rural healthcare facilities, the expenditure incurred on average for hospitalization of a male is Rs.19,428 whereas in case of females it is Rs.13,762.  The same holds good even in an Urban setting, wherein the hospitalization expenditure incurred on male is Rs. 29,518 while in the case of females it is Rs. 23,235.
The difference between the expenditure incurred for hospitalization of males and females is starker in cases of Private Hospitals. The average expenditure in incurred for females per hospitalization in rural areas is Rs. 22,292 while for males it is 35% higher with Rs.31,262 per hospitalization. This difference in case of Urban Hospitals is comparatively lesser. Although the average expenditure incurred for males per hospitalization is highest in Urban private hospitals with Rs. 43,088, it is only 25% higher compared expenditure incurred for females.
However, in case of Hospitals that were run by Charitable trusts or NGOs in the Urban areas, the difference between hospitalization costs of males and females is much higher with the expenditure incurred by males being 50% higher.
Expenditure per hospitalization is least for Rural Females from SC community.
Categorized by social group, the survey results show that SC community has the least expenditure on hospitalization compared to other social groups.  On an average, the expenditure incurred by SCs in rural area is Rs. 11,315 per hospitalization which is only 55% of the expenditure of those belonging to ‘Others’ in rural areas i.e. Rs. 20,664.
The expenditure per hospitalization for ‘STs’ and ‘OBCs’ in rural areas is Rs. 14,857 and 16,114 respectively. The ratio holds good even in the case of Urban healthcare facilities, where the expenses are comparatively higher. The per hospitalization expenditure for ‘SCs’ is Rs. 18380, while in case of other social groups it is – Rs.19,492, Rs. 21,778 and Rs. 34,355 respectively for STs, OBCs and Others respectively.
As observed earlier, variations exist in terms of gender as well as the area, with the expenditure per hospitalization being less for females from rural areas. The difference is more evident in case of rural women belonging to SC community where the cost per hospitalization is least with only Rs. 8,802.
86% of the rural population not covered under any health expenditure support program
As per the survey results, a vast majority of the population do not have any type of Health expenditure support. In rural areas, the survey estimates that 85.9% of the households do not have any formalized health expenditure support. In urban areas, it is slightly better with 80.9% of the population not having any sort of support.
The government sponsored insurance schemes benefitted 12.9% of the rural households to meet their health-related expenditure, while 8.9% of the urban households is estimated to have been benefitted from government sponsored schemes.
With a large portion of rural households engaged in agriculture and un-organized sector, only a minute portion i.e. 0.6% and 0.3% have health expenditure support from their employers. The is better in the case of urban population where 3.3% get the support for being employed in government and PSU sector, while 2.9% of the households reported private employer-based health support. 3.8% of the Urban population have arranged health support by opting to insure with Insurance companies on their own, while this is very low in rural areas with only 0.2% of the population making such arrangements on their own.
Better Public health infrastructure is the need of the hour
The survey results indicate the widespread disparities in the expenditure for hospitalization and health based on gender, social group, locality, type of facility (private/public) etc. There could be other factors like type of illness etc. influencing expenditure, but the disparity is evident.
Survey data also shows that nearly 80% of rural households and 84% of the urban ones meet their health-related expenditure through personal income and savings. Another 17% & 13% of rural and urban households respectively meet the expenditure through borrowings and help from friend and relatives. Such expenditure puts the marginal and low-income communities at a disadvantage and gets them into a debt trap as they lack the necessary resources.
The situation is not even across the country. States like Andhra Pradesh (76%), Telangana (70%), Chhattisgarh (66%) etc. have higher coverage of rural households under government insurance schemes and also have a good proportion of urban households covered as well. While the Ayushman Bharat scheme, modelled on the lines of Aarogyasri in Andhra Pradesh & Telangana, now provides insurance coverage to 10 crore households across the country, this is limited to tertiary treatment. A good chunk of the health expenditure by households could be for illnesses not covered by such schemes.  The only way out is better public health facilities since the expenditure is least in public facilities, as the survey points out.
Better public health facilities like in the case of United Kingdom and the Nordic Countries are the need of the hour.
Featured Image: Average per hospitalization expenditure