Context
- Definition: OOPE refers to direct payments made by households at the point of receiving healthcare services, excluding any insurance or government reimbursements.
- Issue: India’s out-of-pocket expenditure (OOPE) is the main mode of health financing → pushing families into poverty.
- NHA (National Health Accounts) reports show a decline in OOPE share (from 64% in 2013-14 → 39% in 2021-22).
- Criticism: The decline may be statistical, not real, due to survey limitations, under-reporting, and extrapolation.
- Why in news: Scholars compared NHA with CMIE, CES 2022-23, LASI, NIA data → found contradictions.
Relevance
- GS2: Health as a social justice issue, rights-based approach, federalism (Centre-State role in health).
- GS3: Human capital, poverty alleviation, economic burden of healthcare, inflation.
- GS1: Social inequalities in healthcare access.
Key Facts & Data
- NHA estimates: OOPE = 64% (2013-14) → 49% (2017-18) → 39% (2021-22).
- CES 2022-23: OOPE share in household consumption rose:
- Rural: 5.5% → 5.9%
- Urban: 6.9% → 7.1%
- LASI data: Higher hospitalisation by elderly than NSS suggests.
- CMIE-CPHS: Showed a V-shaped OOPE trend during COVID (steep rise + fall), absent in NHA.
- NIA estimates: Household spending on health in GDP shows steady increase, contradicting NHA’s decline.
Implications
(a) Polity & Governance
- Raises questions on data reliability for policymaking.
- Misleading statistics may allow governments to claim false progress in reducing healthcare burden.
(b) Economy
- Health-care inflation: Higher household budget share going to health.
- Increased borrowing/sale of assets for treatment → poverty trap.
(c) Society
- OOPE → catastrophic health expenditure.
- Women and children bear disproportionate burden (extra work, dropping out of school, reduced nutrition).
- Inequity: Poor often forgo care due to inability to pay.
(d) Pandemic Lessons
- NHA failed to capture COVID-19 distress → highlights gaps in real-time monitoring.
Critical Analysis
- Core Message of Article: The decline in OOPE shown by NHA is likely misleading, driven by flawed reliance on a single NSS round.
- Counter-arguments:
- Government schemes like PM-JAY, free drugs initiatives, Health & Wellness Centres may have actually reduced OOPE.
- But benefits may be uneven (urban vs rural, public vs private sector).
- Ethical & Political Dilemmas:
- Using selective statistics for political narratives undermines trust.
- Need balance between showcasing progress and acknowledging gaps.
Conclusion
- OOPE in India remains high and inequitable despite reported statistical declines, perpetuating poverty and health inequality.
- Strengthening public health schemes and improving real-time data collection are essential to protect vulnerable populations.
