Mumbai: Only a fifth of patients in Maharashtra visit public hospitals for treatment, according to the recently released National Statistical Office (NSO) 80th round household consumption survey on health. The public-to-private divide is not as lopsided in any other Indian state, even though Maharashtra, one of the affluent states, has over 30 government medical and dental colleges.
According to the data, 77% of all hospitalisations in Maharashtra occur in the private sector, while only 18.6% take place in public hospitals. 'The 18.6% turnout is the lowest rate in the country,' said Dr Abhay Shukla of Jan Swasthya Abhiyan (JSA). 'It exposes Maharashtra's failed policy of healthcare privatisation.'
Public hospitalisations stand at 43% in Tamil Nadu, 45.3% in Rajasthan, 58.8% in West Bengal, and 64.7% in Goa, while the all-India average is 36.7%. Maharashtra also has high health inflation rates and high out-of-pocket expenses for patients. As per the latest NSO survey, the average cost of a private hospitalisation in rural Maharashtra is Rs 44,580, while urban hospitalisations cost Rs 67,831.
A comparison with the 2017-18 survey, where rural private hospitalisation costs were Rs 23,821 and urban costs were Rs 42,540, reveals high inflation. In rural areas, there has been an 87% rise in hospitalisation expenses. 'When we consider that cumulative inflation during the 2018-2025 period was approximately 43%, it becomes clear that private hospitalisation costs in Maharashtra have risen at nearly double the rate of general inflation. This indicates a major and unjustifiable hiking of costs by the unregulated, profit-driven private sector, linked with lack of regulation of their rates,' said Dr Shukla.
The government document also revealed that rural public hospitalisation in Maharashtra entails an average out-of-pocket spend of Rs 8,080 (up from Rs 5,606 in 2018), and urban public hospitalisation costs Rs 8,364 (up from Rs 7,189 in 2018). Most of the expenditure is on the private purchase of medicines and diagnostic tests, even though people are supposed to receive free healthcare at government facilities.
The NSO data also reveals that government health insurance schemes, such as the central government's Pradhan Mantri Jan Arogya Yojana (PMJAY) and the state's Mahatma Phule Yojana (MJPJAY), fail to provide adequate financial protection. On paper, everyone is covered for hospitalisations up to Rs 5 lakh. Yet, the NSO findings show that the average total hospitalisation spending in Maharashtra (across both public and private sectors, rural and urban regions) is Rs 44,778, and out of this, Rs 40,495 is still borne by the people from their own pockets. This means that 90% of hospitalisation costs in Maharashtra are paid for by the people themselves.
'Despite the traumatic lessons of the Covid-19 pandemic—where Maharashtra recorded the highest number of deaths in the country—the current state government seems to have learned nothing. Public health continues to be grossly neglected, while privatisation has been accelerated,' said Dr Shukla. The need of the hour is an expansion of public systems, combined with strict regulation of the private healthcare sector.
