Lok Sabha Question No. 1607 (UNSTARRED), answered on 2023-07-28
Subject: Healthcare Outcomes due to Socio-economic Inequalities
Ministry: HEALTH AND FAMILY WELFARE
Asked by: V. Kalanidhi

## GOVERNMENT OFINDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILYWELFARE

## LOK SABHA UNSTARRED QUESTION NO. 1607 TO BE ANSWERED ON 28 TH JULY, 2023

## HEALTHCARE OUTCOMES DUE TO SOCIO-ECONOMIC INEQUALITIES

## 1607. DR. KALANIDHI VEERASWAMY:

Will the Minister of HEALTHANDFAMILYWELFARE be pleased to state:

(a) whether the Government has taken note of the report that points out growing socioeconomic inequalities in India are disproportionately affecting health outcomes of marginalized groups;

(b) if so, details thereof along with the reasons for the lack of accessibility to the services for the marginalized groups;

(c) the number of health care seekers based on the social and economic categories, districtwise;

(d) whether there is a recent study which has estimated the total out-of-pocket expenditures on healthcare services segmented across social groups; and

(e) if so, details thereof for last four years, State/UT-wise?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

## (PROF. S.P. SINGH BAGHEL)

(a) to (e) : The National Health Policy 2017 envisages to provide universal access to good quality health care services through increasing access, increasing affordability by lowering the cost of healthcare delivery and equity. The goal of the policy is to attain the highest possible level of health and wellbeing for all at all ages through a preventive and promotive health care orientation in all developmental policies and universal access to good quality health care services without anyone having to face financial hardship as a consequence. The Policy is centered on the key principles of Equity, Affordability, Universality, Patient Centered & Quality of care, accountability, Inclusive partnerships, Pluralism and Decentralization. One of the key policy principles is Universality i.e. prevention of exclusions on social, economic or on grounds of current health status.

The Government has launched four mission mode projects, namely PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), Ayushman Bharat Health & Wellness Centres (ABHWCs), Pradhan Mantri Jan Arogya Yojana (PMJAY) and Ayushman Bharat Digital Mission (ABDM). Other notable initiatives are National Health Mission (NHM), setting up of new AIIMS, upgrading of Government medical colleges under the Pradhan Mantri Swasthya

Suraksha Yojna (PMSSY), support to States/UTs for setting up of new medical colleges as well as for increasing UG and PG medical seats, provision of free drugs and free diagnostic facilities at Primary Health Centres (PHC)/ Community Health Centres (CHC) and district hospital level, substantial increase in availability of government ambulances etc.

Under NHM, many important steps have been taken towards universal health coverage by supporting the State Government in providing accessible & affordable healthcare to people. Financial and technical support are provided to States/UTs to provide accessible, affordable and quality healthcare, especially to the poor and vulnerable sections of the population, in both urban and rural areas. The NHM provides support for improvement in health infrastructure, availability of adequate human resources etc to improve availability and accessibility to quality health care especially for the underserved and marginalized groups in rural areas. Major initiatives for which States are supported include Janani Shishu Suraksha Karyakram (JSSK), Rashtriya Bal Swasthya Karyakram (RBSK), Rashtriya Kishor Swasthya Karyakram (RKSK), PM National Dialysis Programme and implementation of National Quality Assurance Framework.

PM-ABHIM was launched as a mission to develop the capacities of primary, secondary and tertiary health care systems, strengthen existing national institutions and create new institutions to cater to detection and cure of new and emerging diseases. PM-ABHIM has an outlay of Rs 64,180 crore.

Under Ayushman Bharat Health & Wellness Centres (HWCs), Comprehensive Primary Healthcare by strengthening Sub Health Centres (SHCs) and Primary Health Centres (PHCs) are facilitated. The HWCs provide preventive, promotive, rehabilitative and curative care for an expanded range of services encompassing Reproductive and Child care services, Communicable diseases, Non-communicable diseases and all health issues. Around 1,60,479 HWCs are functional.

Ayushman Bharat Pradhan Mantri - Jan Arogya Yojana (AB PM-JAY) is the largest publicly funded health assurance scheme in the world which aims to provide health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to 12 crore families. Further, many States/UTs implementing AB PM-JAY have expanded the beneficiary base under the scheme to approximately 15.5 crore families, at their own cost. District-wise details of beneficiaries verified under the scheme are available uner:

https://acrobat.adobe.com/link/track?uri=urn:aaid:scds:US:87420415-52cd-3491-9dc7-226fbd805150

Ayushman Bharat Digital Mission (ABDM) has been launched with aim to develop the backbone necessary to support the integrated digital health infrastructure of the country.

The quality generic medicines are made available at affordable prices to all under Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) in collaboration with the State Governments. Affordable Medicines and Reliable Implants for Treatment (AMRIT) Pharmacy stores have been set up in some hospitals/institutions.

As per National Health Account (NHA) estimates 2019-20, there is decling trend in Out of

Pocket Expenditure (OOPE) as percentage of Total Health Expenditure (THE). During 201314 to 2019-20, OOPE as a percentage of THE has declined from 64.2% to 47.1%. During the same period, Government Health Expenditure (GHE) as a percentage of THE has increased from 28.6% to 41.4%. As per National Health Account (NHA) estimates, Statewise OOPE as percentage of THE of the States are as under:

(In percentage)

|   S.No | State             | 2016-17   |   2017-18 |   2018-19 |   2019-20 |
|--------|-------------------|-----------|-----------|-----------|-----------|
|      1 | Assam             | 53.8      |      35.9 |      36.7 |      34.9 |
|      2 | Andhra Pradesh    | 72.2      |      67   |      63.2 |      63.6 |
|      3 | Bihar             | 77.6      |      58.2 |      53.5 |      54.3 |
|      4 | Chhattisgarh      | 55.9      |      38.8 |      38.3 |      36.7 |
|      5 | Gujarat           | 48.1      |      43.9 |      40.7 |      40.8 |
|      6 | Haryana           | 56.6      |      50.4 |      47.2 |      45.5 |
|      7 | Jammu and Kashmir | 58.5      |      42.8 |      44.9 |      46.6 |
|      8 | Jharkhand         | 66.0      |      68   |      63.9 |      64.7 |
|      9 | Karnataka         | 49.2      |      34.2 |      33.3 |      31.8 |
|     10 | Kerala            | 67.0      |      68.7 |      68.6 |      67.9 |
|     11 | Madhya Pradesh    | 68.9      |      56.3 |      55.7 |      53   |
|     12 | Maharashtra       | 56.7      |      49.1 |      48.4 |      44.1 |
|     13 | Odisha            | 68.9      |      55.9 |      53.2 |      53.4 |
|     14 | Punjab            | 77.3      |      69.4 |      65.5 |      64.7 |
|     15 | Rajasthan         | 56.7      |      49.6 |      44.9 |      47.4 |
|     16 | Tamilnadu         | 62.1      |      45.9 |      44.3 |      44.2 |
|     17 | Uttar Pradesh     | 74.8      |      72.6 |      71.3 |      71.8 |
|     18 | Uttarakhand       | 62.1      |      41.7 |      35.5 |      35.8 |
|     19 | West Bengal       | 74.1      |      69.8 |      68.7 |      67.1 |
|     20 | Telangana         | -         |      49.7 |      48   |      41.6 |
|     21 | Himachal Pradesh  | 46.4      |      49.2 |      45.8 |      46   |

Source: National Health Accounts Estimates for India

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