Healthcare in India

​The dominance of the private sector as the provider of healthcare induces inflationary pressure on the household budget and potentially on the government health budget through the insurance route. Analysing 75th round NSS data, it is found that treatment costs in private commercial hospitals as well as in private charitable hospitals are manifold compared to public facilities.

The Maternity Benefit Act, 1961, a key legislation in India that enables women to transcend the public–private dichotomy and stake their claim for productive participation in the labour force, saw major amendments in 2017. Four aspects of the amendments—increased maternity leave, maternity leave for adoption and surrogacy, provision of crèche, and paternity leave—are juxtaposed with feminist and constitutional principles as well as ground-level realities and practices. An increase in maternity benefits in law with a neglect of paternity leave and benefits is a lopsided approach that further reinforces gendered division of labour and care work as the domain of women. The social responsibility of employers is emphasised, and a deeper engagement of the state with the policy of parental benefits is advocated.

Private hospitals are expected to play a key role in the implementation of government-sponsored health insurance schemes in India. Examining the availability and spread of private hospitals in the country and an analysis of their empanelment in government-sponsored health insurance schemes reveal that in low-income states of the country, empanelment of private hospitals by insurance companies is low and concentrated in a few pockets. This may indicate differences in entry conditions or low willingness of private hospitals to participate in these schemes, which has implications for the access to healthcare and insurance for the poor.

Using evidences from the Sample Registration System and the third and fourth rounds of the National Family Health Survey, this article shows that the fertility rate continues to be high in the Hindi heartland of the country, and that too among educated women. It also proposes some plausible hypotheses in this regard, which would require validation through further research.

How have wealth inequalities in child nutrition changed in the major states of India between the last two rounds of the National Family Health Survey? The temporal change in the likelihood of child stunting in the poorest quintile of households vis-à-vis the richer quintiles is examined. Alternative measures of wealth inequality in child nutrition, based on the ranking of the households’ wealth scores (namely the concentration index and the extended concentration index), are also used to see how the magnitudes have changed. The poorly performing states have not only retained the last ranks in terms of average stunting, but have also faltered in the reduction of stunting during the decade under study. In three of these states, the improvement in child stunting has disfavoured the poor by all measures. Comparing the concentration index and the extended concentration index for the two rounds, it is found that inequality in stunting has increased in all the states excluding Uttarakhand. This calls for immediate policy attention, since children from the poorest households in the backward states seem to suffer from the dual burden of the state effect and the class effect.