Health Ministry termed expert’s evaluation of OOPE expenditure as ‘misleading and inaccurate’

Indraneel Chakrabarty: Ministry of Health and Family Welfare has responded sharply to the recent evaluation by health economists claiming inaccuracies in National Health Accounts (NHA), especially over their analysis on out-of-pocket (OOPE) expenditure and termed it ‘misleading and incorrect.’

In a recent TOI report, Dr. Mukhopadhyay, health economist and professor at the school of government and public policy, OP Jindal Global, University evaluated that the data indicated a deep state of hardship and claimed that people are withdrawing from accessing healthcare as they are scared of healthcare costs. ‘This is difficult to believe because one can postpone hospitalization but cannot avoid it altogether,’ he wrote in Times of India. Meanwhile, Professor T.R. Dilip, associate professor at the International Institute for Population Sciences, Mumbai, asked for a ‘closer’ look at the OOPE estimates. 

Responding to the expert’s analysis, the Ministry of Health has shared that these estimates are crucial as they are not only a reflection of the existing Indian healthcare system but also aides the government in monitoring progress in different health financing indicators.

According to the government, National Service Scheme (NSS) claims an increase in government facilities utilization among those who took medical advice in the last 15 days by almost 5%. “The increase seen in the case of hospitalization is about 4% in rural sectors and 3% in urban sectors. For cases of childbirth, the government facilities’ share has witnessed a 13% increase in rural areas and 6% in urban areas. Additionally, a decline of over 20% in average medical expenditure in government facilities for hospitalization has been observed. For institutional delivery, rural belts have shown a decline of 16%, whereas urban areas reflected a 9% decline,” read the Ministry of Health and Family Welfare release. 

With seasonality playing a critical role, the 2017-18 survey was undoubtedly more robust Vs the 6-month 2014 survey. What is truly arbitrary is that while the same experts had unequivocally backed the 2014 data, is their assessment of the 2017-18 survey as “doubtful.”   

Furthermore, they observe this decline is driven by an increase in the use of public facilities for outpatient and in-patient services between the two NSS rounds. They also find that not only has the utilization of public facilities increased, but there has also been a decline in average OOPE in public facilities.

The share of people seeking outpatient care has increased by almost 5% among those who have undergone treatment based on medical advice between NSS’ 71st and 75th rounds. The increase indicates the shift towards outpatient services from in-patient services, where outpatient care is being substituted for in-patient care by the people. 

The ongoing criticism of NHA 2018-19 is a typical prima-facie example of ignoring sound reasoning and facts and leaving the mantle of justification to others. The Indian government’s current health expenditure has constantly increased between 2013-14 and 2017-18. As a share of GDP, there has been an increase of over 10% during the same period.