More than 40 crore Indians are caught in a healthcare gap: panel, Pg II

Key Highlights:

• A Parliamentary Standing Committee on Health and Family Welfare has identified a healthcare gap affecting over 40 crore Indians, who are too well-off for government subsidies but cannot afford rising private care costs.
• The committee's report, 'Affordability and Accessibility of Healthcare Facilities in Public and Private Sector,' highlights that over 60% of inpatient and 70% of outpatient care is delivered by the private sector.
• Public health expenditure in India stands at 1.43% of GDP, significantly below the National Health Policy, 2017 target of 2.5%.
• Out-of-pocket spending on childbirth is over 16 times higher in private facilities (₹37,630) compared to public facilities (₹2,299).
• The committee recommended strengthening public healthcare infrastructure and nationwide implementation of the Clinical Establishments Act.

Detailed Insights:

• The "missing middle" faces a structural fault line in the healthcare system, leading to a slow erosion of household income due to medical expenses.
• Medicines account for nearly 30% of the current health expenditure, exacerbated by the rising burden of non-communicable diseases.
• Government schemes like Ayushman Bharat–PM-JAY primarily protect vulnerable households, often excluding the "missing middle" from fully subsidised coverage.
• Private insurance often comes with limitations such as premiums, exclusions, waiting periods, and co-payments, making it insufficient to close the healthcare gap.
• The committee advocated for mandatory quality standards and greater price transparency in private healthcare facilities.
• Concerns were raised about retail pharmacy practices, including excessive trade margins and non-prescription antibiotic sales, with calls for stronger audits and enforcement.
• The National Health Policy, 2017, aimed to increase public health spending to 2.5% of GDP by 2025, focusing on universal health coverage and preventive care.
• The Clinical Establishments Act, 2010, seeks to register and regulate healthcare facilities, ensuring minimum standards and promoting patient safety and transparent pricing.

Key Concepts Involved:

• Missing Middle: A demographic segment that is not poor enough to qualify for government welfare schemes but not wealthy enough to afford private services.
• Out-of-Pocket Expenditure (OOPE): Direct payments made by individuals to healthcare providers at the time of service use, without third-party reimbursement.
• National Health Policy, 2017: A policy framework by the Government of India aiming for universal access to quality healthcare services and increased public health spending.
• Clinical Establishments Act, 2010: A central legislation mandating registration and setting minimum standards for healthcare facilities across India to ensure quality and accountability.