The Hindu Business Line : 'Rich reap more than poor from healthcare sops'

IT'S not the poor who are benefiting from Government subsidies in healthcare, but the rich indicated the World Bank report on Health Policy Research in South Asia.

The findings indicate that there are large inequalities in health outcomes and in Government subsidies to the sector. "The richest 20 per cent capture about 31 per cent of the subsidies meant for the poor while the 20 per cent of the poorest could use only 10 per cent of the services. The subsidies are primarily made as the poor could not afford health care services," said the report, which is a compilation of the research work done in the region.

The report also said that the health subsidies are not particularly well targeted to the poor in India, especially the poor who live in the rural areas and in the poorer States. "States in the South of India, such as Kerala and Tamil Nadu, do so considerably well in this regard than their poorer counterparts in the north, such as Bihar and Uttar Pradesh," it added.

According to Mr Abdo Yazbeck, Lead Health Economist at the World Bank International, India was among the top five countries that offered poor health services in public sector. Other four countries being the conflicted ones could not offer quality services, he said. Also, the allocation of subsidies across different quintiles is driven by the size and distribution of subsidies to hospital-based care. Interestingly, programmes associated with maternal and child health that are linked to schemes sponsored by the Central Government appear to be targeted much better, from a distribution perspective, than purely curative one.

It was also found that providing insurance cover to the poor is a challenge.

"The catch is that meeting the insurance objectives of the poorer sections of society appears to involve a trade-off in providing insurance for the poor, the public sector is also handing over large amounts of public subsidies to the rich, especially those who live in rural areas," it added.

Richer individuals also consume more healthcare. "It is obvious that increasing household income and developing infrastructure that increases access to hospital care would help to improve the allocation of subsidies," said the report.

The report also stressed on the lack of proper regulator in the healthcare sector. It suggested that poorer States could have poor-quality regulatory systems that, in turn, may promote low quality of care.

Hence, there may be a case for developing additional Government facilities and for improving the regulatory regime that oversees the provision of healthcare, the report said.