Take any measure and juggle the figures, change the basis of comparison—no matter what you do, it would come out that India has one of the most privatised healthcare systems in the world. Pakistan is a constant companion in this club, along with countries like Burundi, Ivory Coast, Laos and Congo.
   If you take public expenditure on health as a percentage of GDP, in India it is a mere 0.9%, among the lowest in the world and ahead of only four countries—Burundi, Myanmar, Pakistan, Guinea and Laos.
   If you take the share of the government in total health expenditure, India figures at the bottom of the pile, with government spending accounting for just 25% of the total health spend in the country. The only other countries with lower public health expenditure are Burundi (8%), Pakistan (16%), Laos (19%), Congo (19%), Cameroon (21%) and Ivory Coast (24%). The share of government in health spending varies from 76% in Europe to 34% in Southeast Asia.
   India’s spending plummets below the lowest even in this range.
   If you were to consider the share of health expenditure in total government expenditure, India again has among the lowest proportions in the world a mere 3.4%. Only Pakistan (1.3%) and Burundi (2.3%) allocate a lower portion of total expenditure on health.
   In India, private spending on health is 4.2% of GDP. More than 70% of all health expenditure in India is paid for by people from their own pockets and this expenditure has been rising, especially for the poorest with privatisation of healthcare increasing.
   According to a Planning Commission paper of May 2009, several studies conducted in villages showed that healthcare expense was responsible for over half of all the cases of decline into poverty. It is estimated that in 2004-05, an additional 39 million people were pushed into poverty due to out-ofpocket payments.

Drugs eat up 80% spending of people


   Astudy has revealed that India has one of the most privatised healthcare systems in the world, along with Pakistan, Burundi, Ivory Coast, Laos and Congo.
   N S S O data for 2004-05 shows that of the total medical expenditure per capita, medicines alone accounted for 74% of the expenses in rural areas and 67% in urban areas. If we were to consider only non-institutional medical care, which constitutes the bulk of health expenses, drugs constitute over 80% of peoples expenditure, indicating the huge impact rising drug prices have on health expenditure. However, while most countries around the world, including the capitalist democracies, have drug price control measures of some kind or the other, India is under pressure to remove whatever meagre control it has over drug pricing.
   Increasing privatisation over the past few years has led to cost escalation in healthcare that has pushed more and more people into poverty. Though the National Rural Health Mission (NRHM) is making a difference, it has a long way to go before it shows any results. Moreover, it is only for the rural areas and mostly for primary health. Secondary- and tertiary-level care continues to be expensive, says Dr Selvaraj Sakthivel of the Public Health Foundation of India.