The National Sample Surveys Organisation (NSSO) is a governmental entity functioning for over six decades now, collecting all-India sample data primarily pertaining to the social sector. In its recent survey on ‘Social Consumption: Health in its 71st round, Report 574’ released on April 20, 2016 the NSSO came up with interesting results on health in India. The nation-wide rapid survey was conducted during May-June 2015 in order to generate basic quantitative information on India’s health sector.
While analysing two interesting data sets of the NSSO data, fascinating results emerged. One data set measures the household-wise ailments reported in various age groups, and the other maps state-wise hospitalisation cases in rural and urban areas.
As is commonly understood, an older person suffers from a large number of chronic and intermittent or short-duration ailments (Fig. 1). The data conforms to that hypothesis and clearly shows the majority of ailments are experienced in the 60 and above age groups as the all India figures indicate (276 in of rural areas and 362 in urban areas) .
State-wise classification the data (Fig. 2) revealed that Kerala (310 in rural areas and 306 in urban areas) mapped the highest total number of ailments in both urban and rural areas, followed by Goa and West Bengal (160 in rural areas and 194 in urban areas; 161 in rural areas and 179 in urban areas respectively) in the 15 days reporting period. The north-east mapped the least number of ailments (Manipur: 26 in rural areas and 4 in urban areas; Mizoram: 26 in rural areas and 31 urban areas; Nagaland: 31 rural areas and 19 urban areas) for the same period which would make it the choicest destination for health conscious people.
NSSO also reports that the chronic ailments are more frequent than short-duration ailments in urban areas of the country in both males and females. For the rural area it is the other way round. The figures 3 (a and b) indicate that, both for rural and urban areas, age patterns for short-duration ailments differ markedly from those for chronic ailments. For both rural and urban areas, ages specific patterns for short duration ailments show a distinct U-shape, while those for chronic ailments a positively-sloped pattern. Younger children are less likely to suffer chronic ailments, while older persons are liable to experience a higher number of chronic ailments.
When the state wise data for hospitalisation record over 365 days is considered, an interesting pattern emerges (4 a and b). Juxtaposed against the state wise per capita income for 2014-15 by Ministry of Statistics & Programme Implementation, the data reveals that states with higher per capita income opt for private hospitals as opposed to the poorer states that opt for public hospitals, due to perhaps paucity of resources. As NSSO survey shows, more than 70 per cent (72 in rural and 79 per cent in urban) of ailments were treated in the private sector (consisting of private doctors, nursing homes, private hospitals, charitable institutions, etc.).
The Report also shows that the rural population spent, on an average, INR 5636 for a hospitalised treatment in a public sector hospital and INR 21726 for that in a private sector hospital while the urban population spent on an average INR 7670 for treatment in public hospitals and INR 32375 in private hospitals. In the light of the dismal services extended by public health sector in India, it is perhaps not surprising that richer states, where purchasing power is higher, are turning away from public hospitals. This may place the services extended by public hospitals in a downward spiral whereby they will neither improve their services to meet global requirements, nor will the public repose faith in them and ensure a larger user base, effectively shutting down public enterprises in the long run. However, the over arching fact that still holds true for India as of now, is that a huge number of people are still dependant on the public health systems.
The trend towards opting for private hospitals holds true for both urban and rural India although it is perceptible that the services of a private hospital is accessed in larger numbers in the urban areas. The only anomaly that shows up against the state-wise per capita discourse is in states like Delhi and Goa where public hospital seems to be the preferred mode of treatment. It may be due to the fact that these regions are highly urbanised, city-states, and may have been able to overhaul its public health services to a level that makes it sought after by the general populace.
The NSSO 71st data set is exhaustive and thus needs further probing to arrive at results that can uncover finer regional variations.