HT SPECIAL - Medical bills make poor poorer

WHO report says 16 per cent Indians have sunk below poverty line to meet
health costs According to the WHO report, lack of drinking water, sanitation
and pollution-free fuel, still unavailable to a majority of the poor in
India, made them vulnerable to health hazards and eventually led to higher
health expenditure

Aditya Ghosh

POVERTY IN India has a new cause - rising medical bills. According to a
survey conducted by the World Health Organisation (WHO), many Indian
families have been pushed below the poverty line due to heavy medical
expenses, all because they could not afford basic hygiene, nutrients and
sanitation.

The study - World Health Survey - was conducted by the Indian Institute of
Population Sciences (IIPS) on behalf of WHO in six states, Maharashtra,
Karnataka, Himachal Pradesh, West Bengal, Tamil Nadu and Uttar Pradesh. The
survey was conducted on about 10,000 families from the lower income group in
the period 2002-05, and results were declared in October 2006.

The survey reveals that over 16 per cent of the study population were pushed
below poverty line, while 12 per cent had to even sell their assets to meet
health expenses. A whopping 43.3 per cent had to borrow from outside the
family to cover the costs.

Lack of drinking water, sanitation and pollution-free fuel, still
unavailable to a majority of the poor in India, made them vulnerable to
health hazards and eventually leading to higher health expenditure.
Nearly 84 per cent cannot afford vegetables and fruits due to their rising
costs, making them vulnerable to diseases.

According to WHO, a household that is forced to reduce its basic expenses
over a certain period of time, to cope up with its medical bills of one or
more of its members, it is termed 'Catastrophic healthcare spending'. In
India, over 12 per cent of the poor fall in this category.

While the average expenditure on health of a single middle class Indian
family Rs 116.7 a month, the spending rises to Rs 202 for the poor - which
is half their monthly income.

Surprisingly, the biggest chunk of the expenses is attributed to medicines,
which the poor should get free from government hospitals. "Many a time, the
medicines are either not available or not offered to the poor with
increasing privatisation in the government hospitals," said a public health
expert in Mumbai.

With no insurance, the poor have been left with no choice but to spend from
their pockets.

"A serious policy intervention is required to develop insurance as an
important source of health financing," said P.N. Mari Bhat, director, IIPS,
and one of the investigators of the survey.

Also adding to the poor's woes is the bug of privatisation that has bitten
into many a health schemes like free treatment for poor in hospitals, free
medicines, free beds in public hospitals, free check-ups.

"The policy framework never focused on improving the overall health
conditions before withdrawing welfare schemes owing to privatisation,"
claims Arun Bal of Association for Consumers' Action on Safety and Health
(ACASH) of Mumbai.

"The state governments are not interested in creating healthy and hygienic
living conditions in the cities and villages. Due to this, the poor fall ill
and are forced to spend more," he said.

aditya.ghosh@hindustantimes.com To meet health expenses. 16% were forced
into poverty 12% forced into catastrophic spending 43.3% were forced to
borrow 12% were forced to sell assets Possible causes of disease 95% have no
sanitation 28.2% have no drinking water 84% cannot afford fruits, vegetables
98.6% have no access to clean fuel Monthly expenses 116.7 A middle class
family Rs 202 A poor family Rs Rs 212 A poor family in Maharashtra


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