Study finds public health spending has not resulted in significant pro-poor services in India
An analysis of equity between urban and rural health services using Benefit Incidence Analysis (BIA), a tool to estimate the equity of healthcare benefits accrued to individuals across socio-economic groups, has found that public spending has not resulted in significantly pro-poor services in India.
The paper titled 'Benefit Incidence of Public Health Expenditure in India: Urban–Rural Equity Matters for Universal Health Coverage' has been published in the Journal of Health Management, a Sage Journals publication.
A team of researchers led by faculty from the Indian Council of Medical Research (ICMR) and M.S. Ramaiah University of Applied Sciences, Bengaluru, used data from the 75th National Sample Survey (NSS) round done in 2017-2018 for the analysis. Disease burden, out-of-pocket expenses, and non-utilisation of public health services for outpatient and inpatient care were analysed. Concentration curves and indices were calculated for rural and urban areas.
'This article represents the most recent BIA completed in India and presents an analysis of the distribution of public spending in outpatient and inpatient care. The results help illustrate the extent of the effectiveness of resource allocation on public health by the government in meeting the needs of vulnerable populations,' said Denny John, professor - public health, faculty of life and allied health sciences at M.S. Ramaiah University of Applied Sciences.
Pro-poor inpatient care, pro-rich out-patient care
Dr. John, who is the corresponding author of the paper, told The Hindu that when both outpatient and inpatient care are considered together, public health spending approaches a more equitable distribution. However, for inpatient care, public health spending is more pro-poor, whereas for outpatient care, it is more pro-rich. In rural areas, public health spending on outpatient and inpatient care is more pro-poor compared to urban areas, where it tends to be more pro-rich, he explained.
In rural areas, the utilisation of public health facilities for both outpatient and inpatient care is concentrated among non-poor individuals but is more pro-poor for outpatient care.
'To fulfil the health needs of the urban and rural populations, public health funding must be appropriately allocated. This study sought to determine whether such practices were present in India. Results at the national level show a patchy distribution of equality in public spending between urban and rural people,' the doctor said.
Disparities in access to healthcare
The launch of Ayushman Bharat in 2018 marked India's start toward universal health coverage (UHC). However, various studies have shown that only 1.28% of India's GDP, or roughly ₹1.58 trillion, is allocated to public health spending, one of the lowest rates in the world. Besides, there are disparities in access to healthcare between urban and rural areas, and a lack of accountability.
'This research yields a number of important conclusions. Overall, at the national level, the non-poor are the main users of public health facilities for both inpatient and outpatient care. Our examination of public spending reveals that we are getting close to achieving equality. Spending on public health is getting closer to parity when outpatient and inpatient treatment are taken into account jointly. However, public health spending is more pro-poor for inpatient care, but more pro-rich for outpatient care. Outpatient and inpatient public health spending in rural areas benefits the poor, whereas in urban areas, it tends to benefit the wealthy,' Dr. John said.
In order to better target the underprivileged in rural and urban areas and achieve UHC in India, policymakers should use these statistics to increase the amount of detail in their work and monitor levels and equity patterns in government health spending, he added.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Time of India
38 minutes ago
- Time of India
'No Indian Should Be Out of Network — Digitally or Medically, as India Advances from Digital Dependence to Digital Dominance': Union Minister Dr Chandra Shekhar
New Delhi: Reflecting on India's rapid transformation in both digital connectivity and healthcare access, Union Minister Dr. Pemmasani Chandra Sekhar declared that the country has moved from 'digital dependence to digital dominance' over the past decade — with sweeping gains in affordable mobile internet, world-leading 5G rollout, and the scaling up of Ayushman Bharat , now the world's largest public health insurance programme. 'No Indian should ever be out of network — digitally or medically,' the minister said, calling for industry and public partnerships to bridge the last-mile gaps in rural healthcare and digital inclusion . Speaking at the inaugural edition of ETHealthworld FutureMed X - The Smart Patient Care Summit, Dr. Chandra Sekhar, who has worked extensively across both telecom and healthcare sectors, emphasised how connectivity and care are becoming twin pillars of India's progress. Turning to healthcare, the minister highlighted that the Ayushman Bharat scheme has become the world's largest public health insurance programme, having provided more than nine crore cashless treatments worth ₹1.25 lakh crore. He noted that out-of-pocket healthcare expenses in India have fallen significantly, from 62 per cent to 39.4 per cent, easing financial pressure on millions of households, particularly in rural areas. Over 1.5 lakh Ayushman Bharat Health and Wellness Centres have been established to bring quality primary care closer to communities. India's healthcare workforce has also expanded considerably, with over one lakh doctors graduating annually and postgraduate medical seats increasing by 127 per cent. The country now has about 13 lakh allopathic doctors and nearly 19 lakh total practitioners across systems of medicine, moving closer to WHO standards for doctor-patient ratios. However, a key challenge remains: most doctors are concentrated in urban areas, even though 60 per cent of Indians live in rural regions. India's digital healthcare infrastructure continues to grow rapidly, with 36 crore teleconsultations conducted to date, peaking at half a million consultations per day. The Ayushman Bharat Digital Mission has integrated 55 crore health records, while the Tele-MANAS helpline now offers round-the-clock mental health support in multiple languages. An experimental COVID-era immunisation tracking app has evolved into a nationwide vaccination tracker. According to the minister, more than 95 per cent of India is now covered by 4G, with only 30,000 remote villages, largely in forests or hilly terrains, yet to be connected to 3G or 4G networks. These gaps are actively being addressed. India's mobile network today serves nearly 1.2 billion subscribers and offers the world's lowest data rates. The country also achieved the fastest 5G rollout in the world, with more than 250 million Indians already using 5G services. More than 80 per cent of the population can access 5G, provided they have compatible devices. The Union minister noted that India has also connected 2.14 lakh villages with high-speed optical fibre, with more than seven lakh kilometre of fibre already laid. However, ongoing highway and industrial works have caused frequent cable cuts. A new Rs 1.3 lakh crore project will connect another 40,000 gram panchayats, maintain and repair existing fibre, and enable 1.5 crore rural households to access affordable high-speed internet without upfront costs. To cover ultra-remote terrains, satellite communication services like Starlink have been licensed. 'This connectivity is not just about faster data; it is about faster development across sectors like education, governance, and most importantly, healthcare,' Dr. Chandra Sekhar said. Dr. Chandra Sekhar called on innovators and entrepreneurs to help tackle remaining gaps in healthcare delivery. He emphasised opportunities to expand telemedicine services in rural India, supported by networks of trained nurses and mobile medical units. He also encouraged the use of drone technology to deliver medicines and emergency supplies to underserved regions. Improving electronic prescriptions, enhancing interoperability of health records, and addressing counterfeit drug risks were also identified as key priorities. The minister said India could learn from international experiences — for instance, fragmented EMR systems in the US led to inefficiencies, while India has the opportunity to build more integrated, user-friendly systems from the start. The country's late-mover advantage could help avoid legacy mistakes and drive global best practices. He also stressed the need to strengthen preventive care, expand home-based services such as occupational therapy and hospice care, and promote workforce planning that reflects regional needs. He pointed out that mental health services — including school-based counselling — need more investment, alongside case coordination to help patients navigate India's complex healthcare system. Dr. Sekhar also suggested that India develop opportunities for mobile preventive care units (for dental, mammograms, vaccinations, screenings), create real-time medical language translation tools, and promote community health worker networks to deliver care and education in local languages. 'India should be a living laboratory for the world,' he concluded. 'Every Indian deserves global-standard healthcare — and no Indian should ever be out of network, digitally or medically.'
Time of India
6 hours ago
- Time of India
Unregistered hosp sealed after Ayushman scheme fraud in Kashi
Varanasi: Taking swift action in response to a case of alleged fraud under Ayushman Bharat scheme, UP Finance and Parliamentary Affairs Minister Suresh Khanna , who is also the in-charge minister for Varanasi district, on Saturday ordered the immediate closure of an unregistered hospital and the lodging of an FIR against its operator. The minister was in the city to lead International Yoga Day events on Saturday, when he reached the Prime Minister's parliamentary constituency office in Jawahar Nagar for a public hearing. The action came after Surendra Banwasi, a local resident, filed a complaint during the public hearing. He alleged that Asha Hospital, located in Nayepur area under Baragaon police station limits, had claimed reimbursement for his father's treatment under the Ayushman Bharat scheme while also charging him money for the same services. The hospital later refunded the amount taken from Banwasi. Responding immediately, the minister directed the Chief Medical Officer and local authorities to probe the matter and take decisive action. CMO Dr Sandeep Choudhary said that a medical officer, Dr Sher Muhammad, was appointed to investigate. Upon verification, it was found that the hospital was functioning without valid this revelation, Dr Muhammad, accompanied by the Baragaon police, reached the hospital and ensured its closure with immediate effect. "The in-charge minister took the complaint seriously and instructed for strict action without delay. The hospital was found unregistered and action was taken on the same day," said Dr Choudhary.
The Hindu
6 hours ago
- The Hindu
Study finds public health spending has not resulted in significant pro-poor services in India
An analysis of equity between urban and rural health services using Benefit Incidence Analysis (BIA), a tool to estimate the equity of healthcare benefits accrued to individuals across socio-economic groups, has found that public spending has not resulted in significantly pro-poor services in India. The paper titled 'Benefit Incidence of Public Health Expenditure in India: Urban–Rural Equity Matters for Universal Health Coverage' has been published in the Journal of Health Management, a Sage Journals publication. A team of researchers led by faculty from the Indian Council of Medical Research (ICMR) and M.S. Ramaiah University of Applied Sciences, Bengaluru, used data from the 75th National Sample Survey (NSS) round done in 2017-2018 for the analysis. Disease burden, out-of-pocket expenses, and non-utilisation of public health services for outpatient and inpatient care were analysed. Concentration curves and indices were calculated for rural and urban areas. 'This article represents the most recent BIA completed in India and presents an analysis of the distribution of public spending in outpatient and inpatient care. The results help illustrate the extent of the effectiveness of resource allocation on public health by the government in meeting the needs of vulnerable populations,' said Denny John, professor - public health, faculty of life and allied health sciences at M.S. Ramaiah University of Applied Sciences. Pro-poor inpatient care, pro-rich out-patient care Dr. John, who is the corresponding author of the paper, told The Hindu that when both outpatient and inpatient care are considered together, public health spending approaches a more equitable distribution. However, for inpatient care, public health spending is more pro-poor, whereas for outpatient care, it is more pro-rich. In rural areas, public health spending on outpatient and inpatient care is more pro-poor compared to urban areas, where it tends to be more pro-rich, he explained. In rural areas, the utilisation of public health facilities for both outpatient and inpatient care is concentrated among non-poor individuals but is more pro-poor for outpatient care. 'To fulfil the health needs of the urban and rural populations, public health funding must be appropriately allocated. This study sought to determine whether such practices were present in India. Results at the national level show a patchy distribution of equality in public spending between urban and rural people,' the doctor said. Disparities in access to healthcare The launch of Ayushman Bharat in 2018 marked India's start toward universal health coverage (UHC). However, various studies have shown that only 1.28% of India's GDP, or roughly ₹1.58 trillion, is allocated to public health spending, one of the lowest rates in the world. Besides, there are disparities in access to healthcare between urban and rural areas, and a lack of accountability. 'This research yields a number of important conclusions. Overall, at the national level, the non-poor are the main users of public health facilities for both inpatient and outpatient care. Our examination of public spending reveals that we are getting close to achieving equality. Spending on public health is getting closer to parity when outpatient and inpatient treatment are taken into account jointly. However, public health spending is more pro-poor for inpatient care, but more pro-rich for outpatient care. Outpatient and inpatient public health spending in rural areas benefits the poor, whereas in urban areas, it tends to benefit the wealthy,' Dr. John said. In order to better target the underprivileged in rural and urban areas and achieve UHC in India, policymakers should use these statistics to increase the amount of detail in their work and monitor levels and equity patterns in government health spending, he added.
