A study conducted in five randomly selected district hospitals in Haryana and Punjab has found that the investment in public facilities for provision of curative care was just Rs139 per patient, thus indicating that the Government needs to do more than what it is doing if it desires to achieve Universal Health Care (UHC) delivery.
Experts say that an expenditure of Rs1,713 per capita per year is needed to meet UHC targets as promised under the UN Sustainable Development Goals. It is estimated that 3 per cent of India's population slips below poverty line each year because of health-related expenses.
The researchers of the study, which has appeared in the latest edition of the Indian Journal of Medical Council (IJMR) of the Union Health Ministry, noted that overall annual cost of delivering secondary-level health care services in the district hospitals surveyed was Rs11,44,13,282. Human resources accounted for 53 per cent of the overall cost, while drugs, consumables and building, and grants accounted for 14 and 10 per cent, respectively.
The five district hospitals covered were in Panchkula, Jhajjar and Rohtak districts in Haryana and Sangrur and Ropar districts in Punjab. "While the annual outpatient attendance ranged from 169,314 in Ropar to 526,508 in Panchkula, the number of inpatient hospitalizations varied from 12,391 in Ropar to 31,799 in Panchkula. The bed-occupancy rate reported ranged between 59 per cent in Rohtak and 116 per cent in Sangrur," said the researchers.
"Our study findings point to an imperative need to improve hospital efficiency.
Two factors appear important in explaining inefficiencies. First, majority of the supply-side health system spending occurs on account of paying salaries. Moreover, little is left to meet other recurrent resource needs which are required for service delivery, for example, drugs and diagnostics," they said.
As a result, there is a need to reorient health system spending by ensuring a minimum threshold spending on drugs, said the researchers citing previous studies conducted in Tamil Nadu and Bihar which suggested that improving access to medicines in public sector facilities improved the patient attendance in public sector facilities significantly.
The study 'Cost of delivering secondary-level health care services through public sector district hospitals in India' called for increase in investment in public facilities for provision of curative care if India envisages achieving UHC.
The researchers included Shankar Prinja, Deepak Balasubramanian, Gursimer Jeet, Pankaj Bahuguna , Manmeet Kaur and Rajesh Kumar from School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh and Ramesh Verma fromPt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak. Dinesh Kumar from Dr. Rajendra Prasad Government Medical College, Kangra was also part of the study.
However, the researchers recommended the government to undertake a study with a bigger and more representative sample from multiple States in the country to generalize the findings given wide variations in health care delivery infrastructure in various parts of the country.