Government must pay for healthcare at point of use: WHO expert

India looks to reduce out-of-pocket expenditure on health in 12th Plan

By Sonal Matharu
Published: Tuesday 28 February 2012

Ahead of the 12th Five Year Plan, which aims to focus on health, the Union ministry of health and family welfare called a one-day national consultation to deliberate social determinants of health. The outcome would influence health policies for the next Plan period, beginning April.

According to the World Health Organization (WHO), social determinants like poor economic status, lower social status, unemployment, under-nutrition, unhealthy environment and poor access to health system contribute significantly to premature deaths and diseases, particularly among vulnerable groups such as women, children and minority groups.

Inaugurating the consultation along with Union health minister Ghulam Nabi Azad, minister of state for health S Gandhiselvan said, “Although there have been substantial advances in life expectancy and disease prevention, the healthcare systems provide little protection against financial risk, and most importantly there is widespread inequity in the health status of the population. The poor have much higher levels of mortality, malnutrition and fertility than the rich.” Azad said the goal of the 12th Plan period will be to reduce out-of-pocket expenditure of the poor to improve their access to better healthcare.

The consultation was also attended by Michael Marmot, epidemiologist and public health expert with University College  London, who chairs the Commission on Social Determinants of Health of WHO.

Talking to Down To Earth, Marmot said to improve the social determinants of health, the government must pay for the healthcare somehow at the point of use. “Access to healthcare gets limited if the poor have to pay for it. If people have to pay at the point of use for healthcare, either it is a disincentive to use it when needed or it makes poverty worse because people have no alternative but to pay out-of-pocket,” he said.

Another important social determinant that can lead to better healthcare is women’s literacy. Women with more education have children less likely to die in the first year of life and are less likely to suffer from malnutrition, he said. Literate women are also less likely to be subject to domestic violence and have control over reproduction.

India should follow a bottom to top approach and learn from communities that have taken initiatives to improve healthcare, Marmot said, adding that India should form general principles to address the social determinants of health, but that each community should implement those according to their needs. “The peculiar thing about India is its enormity and heterogeneity. This means it is going to be very hard to have one central solution for better healthcare that is going to cover this vast subcontinent.” However, with the country’s growing economy, Marmot is hopeful that India can meet its increasing demand for healthcare.


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