E-Paper
Cost of delivery in Karnataka govt hospitals shoots up: NFHS
Data from the National Family Health Survey 5 (2019-20) shows that the average out-of-pocket expenditure per delivery in a public health facility in Karnataka on average has risen only by 2
Data from the National Family Health Survey 5 (2019-20) shows that the average out-of-pocket expenditure per delivery in a public health facility in Karnataka on average has risen only by 2.69% from ₹4,824 to ₹4,924.
But a closer look into district-wise data shows that the rise is much more significant in the most backward regions of the southern state where regional imbalance has led to lower expenditure into healthcare infrastructure, adding to costs of delivery.
For instance, in the mineral-rich region of Ballari, average out-of-pocket costs for delivery have gone up from ₹4,413 in 2014-15 to ₹12,348 or an increase of nearly 180%.
In Haveri, the home district of Karnataka chief minister Basavaraj Bommai, the average out-of-pocket costs for delivery at a public hospital has risen from ₹2,866 to ₹11,573, and has shown an increase of 303% in just six years. In comparison, Bengaluru has seen its costs plunge from ₹9,333 in 2015-16 to ₹3,633, registering a degrowth in costs by over 150%.
The continued focus on Bengaluru, the state’s biggest contributor to the exchequer and home to almost a quarter of its over 70 million population, it has added to the growing regional imbalance that even a special status of the constitution has not been able to fix in the Kalyana-Karnataka region.
Public health experts said the trend was “a matter of concern” if people had to spend an average of ₹5,000 (state average but higher in some districts) in public health facilities.
“This shows that public facilities that should ideally be giving fully subsidised care, especially for things such as delivery, people are spending around ₹5,000 and there needs to be some further studies on where these expenses are being incurred,” Dr Adithya Pradyumna, faculty member, Azim Premji University told Hindustan Times.
The regional imbalance continues to rear its head despite the state taking steady strides in attracting foreign direct investments and large corporations to set up their business in the state.
However, this has been mainly in Bengaluru and surrounding regions that have influenced successive governments, irrespective of party or ideology, to fixate on “developing” the city and turning a blind eye to other backward regions.
The stray scheme, project or sector-specific parks in some of these backward districts, it appears has done little to change the on-ground realities of such districts.
Experts say the cost of healthcare shoots up when their travel quotient is factored. And this is prevalent in backward districts where people are forced to go to the district or taluka headquarters for any treatment due to the shortage of hospitals or staff.
“Our coverage needs to improve in terms of the AB_ARK (Ayushman Bharat- Arogya Karnataka) card distribution. Our health minister has taken it upon himself to ensure that AB-ARK cards are distributed across (the state),” D Randeep, Karnataka’s commissioner for health and family welfare told Hindustan Times.
He said that the number of cards distributed are around 1.4 crore but there is scope to take this to 4 crore. He said that there needs to be a sustained drive like distribution of ration cards as well as raise awareness.
On the rising cost of delivery in public healthcare facilities, he said that the sampling data needs to be looked into for this.
“The whole thing of referrals outside (the hospital) that needs to kind of stop. Be it for medicines outside, diagnostics.. Within the system there is adequate access be it in district hospitals and medical colleges. Almost every diagnostic facility is available. Most of the high-end drugs are also available,” he said.
While costs are up, the push by the Prime Minister Narendra Modi-led Bharatiya Janata Party (BJP) government in the Centre for health insurance schemes like Ayushman Bharat has had a negative impact, data shows.
The key indicator on households with any usual member covered under a health insurance/financing scheme (%) remains stagnant in the state at 28.1 but data from districts show that it is the most backward regions that continue to see a decline in people covered under health insurance.
Just 13 districts out of the 30 surveyed in the report, show an increase in healthcare coverage. In Haveri, which falls under the Kittur-Karnataka region (earlier known as Mumbai-Karnataka), the fall in health insurance coverage is down 15.6% from 44.4 in 2015-16 to 28.8 in 2019.
The state and city of Benglauru, are known globally as home to India’s silicon, technology and startup revolution, but the growing number of urban poor is hidden in plain sight as migrants from regions that are backward come into the city in the hope to get better education, healthcare and opportunities that are denied to them in their respective villages or towns.
The Covid-19 pandemic-induced lockdowns exposed the fault lines of India’s urban centres where the poor had survived much of the time indoors without income largely due to the help of generosity of individuals and organisations rather than the government.
A November report by Azim Premji University (AZU) shows that due to rapid and unplanned urbanisation, the need for a better coordinated and governed health care system is crucial at this point.
“Our evidence from Bengaluru shows that 30% of even the poorest quintile seek delivery care from private sources. Since there is a 10-fold difference in cost between public and private facilities, this significantly adds to their financial burden,” according to the report.
“There seems to have been some focus on Ayushman Bharat and other sorts of insurance schemes but for whatever reason the proportion of households that are covered with insurance seems to have remained stagnant,” Dr Pradyumna said.
